What “Will” Happen With Health Reform

With the Senate scheduled to start debating (and likely amending) health reform legislation this coming week, speculation is rampant about what will happen with health reform.  Since the title of this blog is “health policy and communications,” I want to focus on the use of language in discussing health issues, studies, proposals and legislation – specifically the word “will.”

The word “will” is very strong and it implies a high degree of certainty about predicting future events, such as “The Sun will come up tomorrow morning.”   And while I have no problem with predicting the future – as my friends know, I have a great reputation for predicting the future, particularly about sporting events like fake punts and winning 8 straight games to win a World Series – but using the word “will” to describe the implications of scientific studies, or legislation and policy proposals, can be misleading.

Specifically, the word “will” is often used loosely as a stand in for the phrases, “is projected to be” or “is estimated to be.” For example, in a recent press release for a study about diabetes in the US it was reported that, “The diabetes population in the United States will almost double over the next 25 years…” Interestingly, the next part of that sentence states, “and annual medical spending on the disease is projected to hit $336 billion, up from $113 billion today…”  So apparently future costs can only be projected, but future cases of diabetes can be predicted with much greater certainty. [emphasis added]

Assumptions v. Future Reality
The reason to be concerned about the use of this type of language is because although the methodology for any study or projection may be valid and reasonable, its conclusions are only as good as its assumptions. And as ever researcher and policy person knows, many, many, many things can occur that cause reality to differ from what is projected based upon those assumptions – particularly over the course of 25 years. Think about it, how accurate do you think the predictions about 2009 were in 1984?

Media Contributes to Impression of Inevitability with Language
The media also tends to propagate some misleading impressions.  For example, the phraseology about the implications of the diabetes study was copied by multiple new sources – such as Time Magazine – and even expanded upon by the Chicago Tribune to imply that costs will also dramatically increase, “…diabetes cases will nearly double in the U.S. in the next 25 years and the cost of treating the disease will almost triple…” and CNN, “The number of Americans with diabetes will nearly double in the next 25 years, and the costs of treating them will triple…”[emphasis added]

What Will Happen With Legislation
It is also common so see the word “will” used when referring to legislation.  Many politicians and pundits use it in asserting that various bills and provisions “will do” something specific, such as expanding coverage, controlling costs, etc… when actually they are referring to projections or estimates – often from the Congressional Budget Office which is generally very careful about describing their work as projections or estimates.

The reason politicians, pundits, and others use the word “will” is because it is very effective in rallying support for (or against) specific bills or proposals, since it increases the impact on the listener (or reader), makes them feel more concerned about the issue, and increases the likelihood that they will  take some desired action.  Thus politicians and PR people use the word “will” rather than “projected” or “estimated.”  So the next time you hear a speech or news report about legislation that states the bill “will” do something in terms of changing the number of people with some benefit, or it “will” cost or save so much, substitute the phrase, “is projected to” for “will” in your mind, and see how much less impact and traction the message has – and you’ll see why the word is used.

The only drawback for politicians of making such statements, is that 5-10 years later when the actual results are different than what was projected or estimated, there can be rhetorical battles about why someone “promised” that the legislation “would” do something, yet the actual results were different.  (A great example of this was the provisions in the Balanced Budget Act of 1997 that were intended to expand options for Medicare HMO plans, but it actually reduced the options for such plans.)

Next Up: Implementing Health Reform – What Will Happen

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