A rose by any other name
Thursday, 10/1/2009 - 4:03 pm by Anat Shenker-Osorio | 12 Comments
How words shape the way we think…and set our course for the future.
The change was barely noticeable. And as irritating as the hold music that followed: “please stay on the line, we’re with another customer right now…” With that, transformed from patient to consumer, it became acceptable to think of health care as an industry and health as a product. There. All done, you didn’t even feel that, did you?
Flash of insight (not mine): words mean things. When we fundamentally alter how we talk about an issue, we eventually alter how we perceive it. What we assume should be done and insist is illogical. When we became consumers instead of patients or people, we conceded that health, like any product, is subject to the rules of the market. Consumer tells us you get what you pay for and those who can’t pay don’t get.
This is what makes it possible for us to accept and even expect that health care provisions can be for-profit. That you can actually extract money, beyond covering costs, in healing the sick.
But this flies in the face not only of decency but logic. Health insurance, the mechanism by which fortunate Americans pay for most care, is risk-pooling. By design, most of us throw more into the pot than we to draw out. What’s left over goes for those who use lots of health care or can’t pay to play.
Risk pooling doesn’t function according to market mechanisms. With health insurance we aren’t buying a set amount of a good, like time with a doctor, x-rays or drugs. We’re buying the opportunity for us and others to access these things when they’re needed.
In addition, defaulting to language about customers and consumption severely limits what it makes sense to put in the category “things that affect our health.” It reduces health to the identifiable transactions we have with providers: the prick of a needle or the provision of a pill. But public health experts, and — let’s face it — common sense tell us that everything affects our health — what we eat, if we exercise, how much love and luck are in our lives.
When it comes to real health, limiting ourselves to notions of buying and selling is inadequate and ill-advised. What are we consuming, for example, in the transactions that fund our resistance to disease through vaccinations or public education campaigns? And what of the neighborhoods constructed to let us bike to work instead of driving or have ready access to an apple not just a biggie slushie? What exactly is each individual buying here and how do we assess how much it should cost?
The debate about reforming our health care system has been largely about money — how much is spent, on what and why. Don’t get me wrong, I like saving money as much as a Congressperson likes talking about it. But by making this the point, we are reinforcing the notion that ensuring our health is largely about producing, selling and pricing some products. And it’s not — it’s about providing access to a public good.
Health is the necessary pre-condition for functioning: to work and wonder, play and parent, vote and volunteer. There are no American workers without it; more importantly there is no America. Why have we turned the maintenance and restoration of health into an industry? Health is by no means a commodity and so why do we allow ourselves to be called consumers of health care?
Until we insist that we are people with needs not customers with wallets, we can’t even conduct the right conversation, let alone craft the policies to fix this mess. Our collective access to everything we need to get and stay healthy shouldn’t be a matter of price, even if it’s discounted. We’ve got to get them to change that hold message, and quick.
Anat Shenker-Osorio is an Oakland-based communications consultant.
*The name of this series derives from Frank Luntz’s book, Words That Work: It’s Not What You Say, It’s What People Hear.
>Why have we turned the maintenance and restoration of health into an industry?
Turned into? What?! Before the healthcare industry people just died young, and were sicker. What’s with this idea that once people were granted health by some undefined force and it converted into an industry?! This simply didn’t happen.
I’m uninsured, and support your thesis, but your argument is so flawed as to tear down the thesis. Please reconsider publically doing your opposition’s job for them. Good god, word absolutely count, and yours disagree with the truth that greed has eclipsed too much. Your article supports an elite few deciding for the many, since such lack of history informs it. Please revise.
Posted by YoureWrong | October 1st, 2009 at 4:19 pm
Schooling doesn’t magically just happen by an unnamed force and we don’t hear people talking about the “education industry.” Our perception that the provision of health care is no longer a service but rather a consumable good is the issue I’m raising. And that’s also exactly where greed not only entered the scene but got invited in to move in for good.
Not sure where you get an elite few deciding for the many — I simply don’t follow you. I’d like us to perceive ourselves as people, not potential profits — and for the restructuring of health care to treat us accordingly.
Posted by Anat Shenker-Osorio | October 1st, 2009 at 5:18 pm
“When we fundamentally alter how we talk about an issue, we eventually alter how we perceive it.”
Ah, yes, my friend, Anat. Hope things are well with you, Anat.
Nothing has been more “fundamentally altered” in Western culture over the last three or four decades than that very most fundamentally important idea of what is meant when we use term, “person”. Trivialized by self-serving elistist women not to include its fullest meaning for fear that it might invoke a sense of guilt for what anyone with half a brain would realize is an act of infanticide, the notion of person can now only be said to apply to those fortunate enough to survive the rigors of a natural birth, and even in those cases there are many that are murdered by by having a ice pick jammed into their brains.
Here’s the motherload of the abuse of language, Anat: Its use to decribe a fully alive human being as a zygote, an embryo or a fetus. It is the obscene victory of utilitarianism over the most cherished visions of human life and it is the very measure of the stinking corpse of what was once the most promising culture to inhabit the world.
Posted by Andrei Vyshinsky | October 1st, 2009 at 5:19 pm
Hmmm…I’m going to try to go back to the topic of health as a consumer good because this talk of icepicks seems a little adrift to me…
So, I don’t completely blame the health care industry for adopting the consumer frame. We consumers in the U.S. have fallen in love with what we perceive as the power of being consumers and so many domains that have not traditionally been thought of as “rational” have tried to adopt a “rational economics skin” as it were to adapt to our consumerist thinking. I’ve seen it happen in public education and it doesn’t surprise me that it has happened in health care. They speak the language of customer service because we, the people, like that. We like it a heck of a lot more than we like having to wait in line at the DMV (an agency that has also attempted to rationalize in the last decade, now that I think of it).
But, like you said, health is not a typical market good; it is a public good in many ways and while the health care industry tries to act like Nordstrom, they can’t really pull it off. Though I do think we have to acknowledge that people do have different utility curves about health care services, and some of those utility curves don’t have any impact on mine. Some folks want to be in a hospital and have a private room to deliver a baby and want every drug available to minimize the pain. Some want to squat in their backyard veggie garden and deliver right into the dirt with no one but their partner and doula onhand. Assuming all goes well, it’s no skin of my nose what either one does. But I surely don’t like underwriting the preferences of the former case just because we happen to be in the same risk pool. I’d like to see us be able to separate out the public from the private good of health care and rationalize what we can and then make sure that the “everything else” can be doled out in a way that we are all better off.
Posted by elisabeth | October 1st, 2009 at 8:03 pm
Right, so plenty of people get healthcare outside of the “healthcare industry.” Like in Sweden, where they get healthcare outside of system that is described as ‘industrial.’ And they don’t ‘die young.’
An industry, for example, would focus on fee-for-service and profits. In contrast, the British medicare providing care and minimizing overhead. So are you saying that by calling it a ‘healthcare industry’ we’re more likely to make people think it _should_ be managed like an industry?
Posted by Andrew | October 1st, 2009 at 8:15 pm
The first poster seems to be very angry, an emotion that seems completely legitimate for anyone suffering the indignities and frustrations of an uninsured person. I’m also uninsured, so I know. I think some of the issues that we’re currently experiencing however are as a result of the fact that many of us are directing our anger towards the wrong targets. Whatever the author’s intentions or whatever you think of the article, and personally I think it’s rather good, surely we should be yelling at the insurers, the HMOs and the lobbyists who are currently buying off congress and the senate. Get angry, but get angry at the right people.
Posted by Laura | October 1st, 2009 at 9:44 pm
Elizabeth,
“Hmmm…I’m going to try to go back to the topic of health as a consumer good because this talk of icepicks seems a little adrift to me…”
Yeah, God forbid if we were to penetrate right through to the heart of the man’s meaning here: That words “mean things. When we fundamentally alter how we talk about an issue, we eventually alter how we perceive it”.
Funny where it takes you when you start from an annunciated principle. Why, on occasions it can even make you feel like a phony.
Posted by Andrei Vyshinsky | October 2nd, 2009 at 12:59 am
Andrew,
Couldn’t said it better myself — and I had a lot more words at my disposal.
Elisabeth,
I take your point on our love affair with being consumers in all arenas. But I think this might be a chicken and egg question. Did the health care and insurance industry grab onto what they saw as our desire to be rational actors in this so-called market-place or (as I would argue) did we begin to perceive ourselves as existing in a market-place with respect to health because their language told us so? Do they speak the language of customer service because we like it or do we like it because they speak it?
But, yes, I agree it’s happening across the board. There seems to be no other obvious way to refer to “person with informed decision-making authority and access to options” except consumer. Unless of course we say citizen — and here’s my point. We’ve gone so far off the deep in the health debate that any notion of democratic rights and participation sounds completely alien.
As far as people’s marginal propensity to consume health care — I hear you. Some people want to go for the gold and others will accept or even embrace adequate care. I’m sure you know, however, that we just can’t parse any collective system to this fine a grain without immense intrusion into what are ultimately very personal decisions. Such is the reality of pooling anything. As millions of progressives have pointed out over and over, they don’t want their taxes going to fund the war in Iraq but you don’t pick and choose. So too within health care.
Posted by Anat Shenker-Osorio | October 2nd, 2009 at 11:12 am
Personally, I find the market-based language very disturbing when it comes to health care. If I’m having a heart attack, am I ’shopping’ for services the same way somebody does when they’re buying a carton of eggs? I don’t think so! Not to mentioned the highly specialized knowledge one would have to have in order to shop and compare effectively, even if one wasn’t dealing with an emergency. No–health care is something different, and as this writer asserts, our language reflects our most basic assumptions - which have to change if we are to have real reform.
Posted by Nellie | October 2nd, 2009 at 4:24 pm
“If I’m having a heart attack, am I ’shopping’ for services the same way somebody does when they’re buying a carton of eggs?”
To them you are. And it wasn’t you that made things that way. It was the doctors that chose to comodify their professional services. Why I can readily recall bedside visits at home from physicians when I was a boy. These were respected professionals acting professionally.Today, the practice of medicine has been reduced to the most awful utilitarianism, the patient envisioned as a transaction and treated as an ambulatory chemical factory. When you’re looking for explanations for developments like these, Nellie, you needn’t look any further than one’s notion of what it means to be a human being. It requires little in the way of a leap to move from a construct of the person as a “fetus” or “a clump of cells” to precisely the kind of depersonalization one experiences at the hands of a medical profession that today finds little difficulty in performing abortions or euthenizing the elderly. Change that and you can legitimately call yourself a “progressive”.
Posted by Andrei Vyshinsky | October 3rd, 2009 at 1:21 pm
Nellie,
Thanks for bringing in yet another dimension of the problem of speaking the language, and employing the logic, of the market: information asymmetry. It’s not only ridiculous to “shop” for health care services — it’s impossible, we just don’t have the information needed to make good decisions.
Another aspect of this whole debate that makes me nuts (and there are plenty!) is that we keep hearing it called “health care reform.” We have yet to talk about health care. The conversation so far, with limited exceptions, has been about health insurance aka paying for health care. Where’s the meaningful debate about provision of care (how long it takes to get an appointment, what happens during it, why it lasts 4 minutes, etc.)? In other words, we have not yet begun to fight.
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