Monday, April 25, 2011


Do you wonder why the discussion of healthcare reform revolves around money--who pays for what--while the actual process, the intimate contact between patient and physician, seems to have no relevancy at all?

It's because the medical examining room has in recent decades gotten crowded by third parties. Government agents, lawyers, insurance minions, and a horde of sharply dressed sales reps have worked their way in, importing their particular language, a tongue rich in self-serving euphemism. 

Take "affordable" medical insurance, for example. You can actually afford a policy provided you shift your budget from decent food to bulk carbohydrates, but its deductible and copay requirements can edge you toward bankruptcy. That "oral administration fee" on your hospital bill is twenty bucks for handing you your aspirins. When hospitals lay off nurses in order to pay larger bonuses to administrators, they call it "downsizing," which sounds cleaner, like calling a car "pre-owned" rather than used.

Language is both descriptive and prescriptive. It expresses what we make of our world and also influences what we see. Call members of the other tribe "cockroaches" enough, and eventually they'll look subhuman. In the same way, labeling medical practitioners "providers" and those they serve "consumers" has gradually reduced our concept of the healthcare transaction to the transfer of a commodity, a standardized, generic product. I'd like a quart of healthcare, please. This practice enriches the examining room's interlopers at the cost of the original occupants' well-being.

I'm happy to learn that on this subject I'm not just another curmudgeon in the wilderness. Economist and Nobel laureate Paul Krugman, wrote in the NY Times a few days ago (,

"The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough."

The next time you hear "consumer" and "provider" in the same sentence, then, please take a breath and set the poor speaker straight.

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