CULTURE BEAT: It's Not Funny, Honey -- Health Reform Meets the Comedy Club

If you're a politician, you know you've hit the big time if a late night talk show host makes fun of you. Ditto for an issue -- it's big time if it makes the leap from  think tank "Issue Brief" to a riff in a stand-up comedy routine.  At the D.C. Improv the other night, it was pretty clear that the state of the American health care system has hit the big time. Jake Johannsen had the packed house doubled-over or nodding vigorously to a series of truisms about our broken system. It was only after I left that I remembered that it's not really funny.

Jake, who has been on Letterman and the other major late night shows, is Seinfeld-esque in that he manages to talk about all the mundane realities of life in a way that makes your sides hurt from laughing. When we saw him, he was on a "How The Man Sticks It To The Little Guy" run when he used  health insurance as an example. First, he mentioned how lucky most of us feel if we can buy insurance through our employers (unspoken subtext: because if we get health insurance at work, we don't have to worry about being denied coverage because of preexisting conditions). But then we don't feel so lucky if we get sick and, even with coverage, get a pretty big bill. At least then, Jake joked, we could complain about how our boss was "sticking it to us." But some of us have to purchase our own insurance directly, so, he deadpanned: "I end up sticking it to myself! That doesn't seem right." (If he were a wonk instead of a comedian, he'd explain that many of us are underinsured, or facing a bigger share of costs even with insurance.)

Then, in surprisingly fluent health insurance-speak, Jake went off about how he could barely keep up when his insurance broker was trying to explain his policy choices:

• an HMO
• an HMO with a POS
• a PPO
• variances between the deductible, premiums, co-pays, co-insurance and out-of-pocket maximums

Jake asked "but which one is best" and the broker replied "it depends on the individual." And Jake, being a comedian, said: "Let's say, hypothetically, that the individual is me." The broker responded: "You have to make your own decision about what's best for you." At which point, Jake made a funny face that meant "You've got to be kidding" and the audience responded with gales of laughter. (Tragicomedy gets them every time.)

Unfortunately, we are not living a comedy routine. As things currently stand, no one (not even those of  us who work on health policy for a living!) can make truly informed decisions about which health care policy is best for us. It is difficult to determine whether paying more up-front or taking the risk of paying more later or having more or less provider choice is the way to go. This kind of confusion is not funny, which is why transparency and consumer-friendly decision support tools (real ones, that real people can understand) must be part of any health reform.

I woke up the next morning with my sides still hurting, but very glad that I could come to work and try to offer solutions to the problems Jake joked about. We have to offer more Americans coverage, make sure that millions aren't still uninsured, and reduce health care costs so that we can afford the coverage. If we don't get well down this path in 2009, you can bet I won't be laughing. Not sure if Jake will be either.