It’s happening across many parts of the federal government, in many sectors. Officials of the National Park Service have been reprimanded for tweeting about climate change. Scientists at the Centers for Disease Control (CDC) have been warned away from seven specific words in their budget documents, including “fetus,” “evidence-based,” and “transgender.”
It is happening in healthcare as well. In previously secret proceedings, revealed here for the first time, representatives of organizations and companies across healthcare are in negotiations with a cross-agency team at Health and Human Services to restructure the language we use around medicine and healthcare.
This is being done for the good of the industry, its regulators and payers, and ultimately of course of the American people. And the industry. In fact, this will impact the industry in multiple ways, not the least of which is clarifying and easing the labors of those of us in the pundit and panjandrum crowd.
A HHS employee delivers a list of “potentially objectionable” and/or “problematic” words to a cabinet meeting in December as part of the administration’s comprehensive new “word strategy.”
Honesty in labeling and punditry
After all, those of us who are dedicated to fixing healthcare first have to talk about it properly. We have to be sensible, straightforward, and honest in our discussions.
Take, for instance, “overtreatment,” which can now be re-labelled “medical exuberance.” “Unnecessary” tests and procedures will be called “recreational,” while the tenth MRI for the same problem will be referred to as “just dialing in the range.”
We can quit talking about the over $1 trillion per year we spend on these recreational tests and procedures as “waste,” and refer instead to healthcare as “America’s vital job creation engine.” People like jobs. The new healthcare slogan writes itself: “We turn medical exuberance into jobs.”
“Epidemics,” in which particularly popular disease states “go viral,” can be re-framed as “population-based marketing trends.”
We can trade the pejorative term “upcoding” for “opcoding,” as in “opportunity.” And “fee-for-service,” which is getting such a bad rap these days from the panjandrum crowd, can now be called “streamlined menu-based payment,” kind of like a Chinese restaurant. Instead of “one from Column A, and two each from Columns B and C,” we can just say, “This whole column. All the columns. And the desserts on the next page.”
“Overcharging” vs “Value Enhancement”
It has become blatantly obvious that slapping the label “overcharging” on the common and useful business practice of charging ten times as much as the shop down the road for, say, a new knee or a remodeled heart is a downright Orwellian twisting of language for political ends. The more reasonable and neutral replacement term is “value enhancement.”
This is eminently logical. The economist’s definition of the value of anything is “what an informed buyer will pay for it.” If you (or some payer on your behalf) paid $115,000 for a new knee while some other poor loser only got to pay $17,500 for the same implant, the same institution, the same surgical and rehab teams, clearly you have a lot more value packed into that titanium baby. And you were informed about it, at least after the fact, when the six-foot-long bill in six-point dot matrix type finally showed up in the mail.
Your $115,000 new knee is clearly something to brag about. Does anyone order a new Mercedes to be delivered without the three-pointed star in a circle on the hood? I don’t think so. The liver transplant doc who lasered his initials on the livers he put in? Forget that, you’ll want the doc’s logo tattooed right on the outside of the knee, just like those folks who leave the “Armani” or “Zegna” tag on the sleeves of their suits and keep checking the time so that you can see their Rolex. Maybe the surgeons can re-engineer one of the skin flaps you keep growing into a cute little all-natural price tag that will wave around merrily as you get back to dancing around the racquetball courts.
“Organic” vs. “primitive” medicine
As different styles of medicine emerge, we will have to think carefully about how we label them. Remember when the first hospitals to open departments of “Nuclear Medicine” were met by angry crowds of citizens bearing pitchforks and petitions—when the practice in fact had nothing to do with nuclear reactors or nuclear weapons?
What should we call diagnostics and therapies derived from big data troves and embedded sensors put through AI wringers and deep-learning algorithms popped through CRISPR machines to deliver personalized RNA medicine? We will call that style “real” medicine or “organic” medicine.
In contrast, medicine derived from intense personal consultation with a physical human doctor who actually knows you, your lifestyle, and your stage in life, and actually touches your body and subjects it to thoughtful testing, will be called “primitive” medicine.
And life expectancy? What about the fact that for every 10 million people who drop insurance because it would cost them more than the roof over their head, we get 10,000 extra premature deaths? We can just call that “market-adjusted longevity.” People choose what they choose, and they are free to. This is America!
Even calling them “premature” deaths is overly argumentative and political. If people want to die earlier than some government actuary thinks they should, why should we give their deaths a pejorative label? Rather than “premature deaths,” we’ll call them “opt out deaths.” Ten thousand, 20,000, 40,000 “opt out deaths” (OODs) per year actually represent the ultimate consumer choice. The new metric will be KO/A, that is kilo-OODs/annum. As in, “This bill will result in a quite nominal 35 KO/A, a number the committee feels comfortable with when we consider the net present value of the ROI to the GDP resulting from consumers exercising their ultimate free choice to permanently de-access the market.”
There are of course multiple well-meaning groups working tirelessly to eliminate this precious consumer choice. We have to acknowledge that. But calling the schemes they propose “universal” or “single payer” or even “Medicare for all” is blatantly contentious. We will prefer a more neutral, descriptive term such as “forced march” healthcare.
Acronym Control (AC)
It is widely agreed that acronyms must be brought under control. This inter-agency effort will be coordinated by a new office within the CMS of HHS called the ACA Agency for Control of Acronyms (ACA), known more simply as (HHS(CMS(ACA2))). Programs and agencies that lose their own acronyms will have to fall back on the generic OWA (Other Weird Arrangements).
The communication of quantum financing
Many of the seemingly intractable problems at the core of healthcare are really problems of communication. For instance, over the past few decades, America’s hospitals and clinics have bravely pioneered the use of quantum financing. But they have not sufficiently explained this to their patients, their patients’ families, and the executors of their patients’ estates. We as an industry have to get straight with the public and clearly lay out the theory and the facts of, for instance, Schrodinger’s networks, in which the surgeon that you hired to rebuild your sterno-thoracic cavity is definitely both in your network and out of network at the same time. He or she will not collapse into one state or the other until the moment you rip open the bill they send you afterwards.
Similarly, we will see a big leap in price transparency when we understand the application of Heisenberg’s Uncertainty Principle, which has long existed as an undergirding axiom of hospital finance. For example, you might be able to discover just which items you might be charged for in a given procedure, within a reasonably narrow curve of probability. You might be able to discover exactly how much each item cost at some indeterminate point in the past. You may well be able to discover what an operation like yours cost somebody else last year, or this year in some other state. But if you were to somehow discover exactly what your operation will cost you in this institution this year, your knowing that would collapse space-time as we know it and annihilate at least the institution or possibly even the entire healthcare sector.
We can anticipate ever greater clarity as the science proceeds. The biggest, deepest cosmological conundrum has long been: How can the universe exist at all? If matter and anti-matter arise randomly and in equal amounts as theory suggests, and they continually combine and annihilate one another, why is there so much more matter than anti-matter in the universe, enough to build planets and stars and forceps and Senators?
When cosmologists and physicists resolve this core problem, I think we will find the answer to the analogous problem in healthcare: Why, with all the discounts and special prices and risk-sharing and all this maniacal curve-bending going on, does healthcare continue to cost more every year, gobbling up more and more of the economy? And the corollary question: At what point does healthcare get so large and eats up so much of the resources available to it that it begins to eat its own tail and soon disappears completely with a barely audible “pop”?
These are serious questions.
After all, the whole healthcare system is derived from evidence-based economic science “in consideration with community standards and wishes” as the CDC directive helpfully suggests.
Which begs the question: Which community? Whose fine standards and wishes are being considered and weighed with the available evidence? A close examination of the design of the vast agglomerated healthcare sector suggests that it’s the warm and charming community of shareholders, bondholders, entrepreneurs, and executives. And of course us, the pundits, podium poohbahs, and grand panjandrums, who will not be out of work for a long long time. Whether we like it or not.
Joe Flower has 40 years of experience in the healthcare world and has emerged as a thought leader on the deep forces changing the system in the United States and around the world.