Messaging on the subject of health care reforms matters

[eridani]

http://economix.blogs.nytimes.com/2009/06/19/in-health-carereform-language-matters/?pagemode=print


Sitting at breakfast last Sunday morning and listening to my soliloquy on President Obama’s radio address of the previous day, my wife impatiently interrupted me to administer a tongue lashing on my sloppy use of English.

“Why do you always speak of reimbursing hospitals?” she queried. “When have you last said ‘May I reimburse you?’ when checking out of a hotel? And what do you mean by Medicare payment cuts? Does it mean spending by Medicare actually goes down? If so, why does Medicare spending always go up after such ‘spending cuts’?”

To my complaint that she was being pedantic, she responded: “Language matters, because it induces habits of the mind and actions that follow from them.” (On this point, see this marvelous little book).

On reflection, I agree that there is something to this argument.

Organizations that are paid for the goods and services they deliver project the total future revenue implicit in expected future payments and then work back from that projection to determine what operating expenses and capital budgets can be supported with that revenue. Their executives do not lament that “our payers reimburse us only 90 cents on the dollar,” by which they would mean “costs.” Instead, they adjust their costs to the projected payments.

By contrast, organizations that are reimbursed for their services add up whatever expenses they incur and then expect to be made whole for those expenses, usually with a profit margin. Military contractors on cost-plus contracts, for example, think and operate this way. But surely the leaders of the health industry have more pride than to liken themselves to military contractors.