Tuesday, January 5, 2010

How Words Took the Life out of The Health Reform Debate

By James W. Squires, MD

I recently was informed that if I didn’t send text messages, my communication skills were simply out of synch with the modern world. So should I become a “texter?” Sorry, this isn’t for me. I like real sentences where words are carefully chosen for their precise meaning and intent. Maybe it was all those hours I spent diagramming sentences or memorizing vocabulary words. I must admit, though, this texting business, with its shortcuts and abbreviations, raises an interesting question: Why do we choose a particular word or phrase? Three reasons come to mind in the context of the language of health care reform. Number one is to create fear of change, number two is to stop debate, and number three is to demonize change proposals as to force change proponents to defend themselves or explain facts that the listener doesn’t want to hear. What I call Stoppers and Provocateurs are the two leading weapons of choice.

Let’s imagine that I offer an opinion and you counter with a differing argument that is based on a moral principle. This is often checkmate! How so? Because I have to explain the morality of my point of view or claim that your opinion is not based on morality both of which move the discussion away from public policy into our personal value systems. End of the policy discussion!

Now let’s suppose that you characterize my change proposal as something evil. I’m forced to defend my goodness with the same consequences noted above. End of the policy discussion. These, and similar confrontations, have played a crucial role in shaping the outcome of health reform or possibly killing the entire discussion. Quite simply, our choices of words and the frame in which they are used, really matter.

Protecting the Status Quo versus Threatening Freedom: When I hear something like “As far as I’m concerned this is about “freedom,” I’m confronted with the ultimate conversation stopper. After all, who in America isn’t concerned about freedom? This word, as used in public debates is a code for minimal government, minimal taxes and minimal responsibility for one another. Andrew Bacevich has this right (The Limits of Power. Henry Holt 2008, pg 6) when he observes: “In our public discourse, freedom is not so much a word or even a value as an incantation, its very mention enough to stifle doubt and terminate all debate.” Amen Andrew! But, he goes on to say that one response is to ask: what is the price of freedom? This is a very good question. The price of being free to choose any health care provider, to demand any medication, or insist on certain procedures and/or therapy, drives up health care costs. So to get past this, I have to start to explain. And, as an old political adage goes: “When yuh start “splainin” yuh start losin.”

Comparative Effectiveness versus Rationing: “Rationing” leads the list of provocative charges. This word has undergone an astonishing transformation during the health care debate. What rationing really means is: limited resources are equally distributed and everyone receives a reduced share. But the way the word is used in the health care reform debate instills the fear of services being denied. The rationing argument is, for example, currently on center stage are the reaction(s) to policy proposals relative to Medicare Advantage, End of Life Issues, and Effectiveness Research. In the last two weeks, the suggestion to review routine mammography for women in their forties was immediately characterized as “rationing.” Spearheaded by screening clinics, radiologists and manufacturers of imaging devices, a discussion point was immediately turned into policy although no one is proposing any restriction. The result – end of discussion.

Advanced Care Directives versus Death Panels: These two little words, “death panels,” are the great success story for the purveyors of fear and provocative language. Tapping into our culture’s fear and denial of death, this effort blocked Congressional efforts to make information available to any senior citizens who wished to become informed but couldn’t pay for it. By offering to pay for a consultation that would explain ways to approach dying (living wills, durable medical power of attorney, etc) somehow the government was assuming a role of deciding who would live and who would die. The result? Patients will continue to spend their final days trapped by family disputes or, if there is no family, the physician will be asked to make decisions about a patient’s wishes that are unknown. The defeat of this sensible proposal is a triumph of language.

An Affordable Option versus Socialism: Socialism means, to most of us, government ownership of the means of production. It is, of course, linked to the former Soviet Union and the “Red Menace” of the first part of the twentieth century. An uncomfortable and ironic truth is that, here in America, we have two socialist systems of health care, both of which provide excellent service. The first is military medicine. And how about the hypocrisy of members of Congress who rush off to Walter Reed Medical Center and Bethesda Naval Hospital, two of our most “socialist” hospitals. The second socialist system is the Veterans Administration that, like the military, own hospitals and-outpatient centers.

As this is being written in late December, words have helped eliminate the Public Option and any change in Medicare eligibility. Are we really going to get health care “reform?” Last summer I watched a video of a ‘Town Hall” meeting hosted by a Congressman from Ohio. He was being lambasted by an elderly woman who repeatedly expounded on her distrust of “Government Run Health Care.” The Congressman asked her if she had Medicare. Yes! How is it working out? The answer: “It is wonderful!”

Here in a nutshell is the problem. A single word, socialism, with a coded four-word subtext, “Government Run Health Care,” has replaced reason and thinking.

I’m worried. If our elected officials and large numbers of the body politic think we can address our nation’s problems in this manner, we are in deep trouble. Complex problems require complex solutions. Catchy words and phrases that cripple conversations, instill fear, and render impossible thoughtful discussions, bury perhaps the most important question of all: what happens if “reform” ends up being more about politics than policy? And worst of all, what happens if nothing happens to health care reform efforts?

Tags: advance Care Directives, elected officials, Government Run, Health Reform, Health Reform Debate, medicare

This entry was posted on Tuesday, January 5th, 2010 at 11:30 am and is filed under Health Reform. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.