political language - Meaningful Health Reform: The Meaning of "Meaningful"

”Starting in 2011, physicians can receive extra Medicare payments for the ‘meaningful use’ of a ‘certified’ EHR that can exchange data with other parts of the health care system.”

“Thus, physicians demonstrating meaningful use starting in 2011 could collect $44.000 over 5 years.”

“Meaningful use of EHRs in 2011 will earn hospitals a one-time bonus payment of $2 billion plus an add-one , which phase out over a 4-year period, would apply to every admission up to a (yet-to-be designated) maximum amount.”

“Much will depend on the federal government’s skill in defining two critical terms: ‘certified EHR’ and meaningful use.”

David Blumenthal, MD, M.P.P, Adviser to the Presidental Campaign of Barack Obama, Director of the Institute for Health Policy, Massachusetts General Hospital –Partners Healthcare System and Harvard Medical School, National Coordinator of Health Information Technology, “Stimulating the Adoption of Health Information Technology,” New England Journal of Medicine, April 9, 2009

I shall begin by distinguishing between Health Care and Healthcarereformanship.

Health care concerns serious matters of maintaining health, preventing disease, treating illness, speeding, and coordinating convalescence.

Healthcarereformanship, on the other hand, is a politically-based word game. Reformers use words to press the cause for“meaningful reform.”

Meaning of Meaningful

“Meaningful,” of course, is an adjective meaning “ full of meaning, significance, and purpose, as in a meaningful wink, or a meaningful choice.” Progressive politicians and think-tank wonks, gurus, and analysts favor “meaningful” because it shows their work has overriding social significance.

Indeed, its significance is well above the common fray and mundane, even plebian efforts of caregivers or profiteering health care suppliers on the ground, whose work tends to be “meaningless.” – meaningless because it focuses on self-interest and personal and business survival rather than the interests of the public-at-large.

Meaning of “Meaningful Reform”

On the other nad, all ‘meaningful reform” efforts are directed towards the “common good,” rather than toward selfish individualism, free choice, innovative entrepreneurmanship, or gasp! profit.

What’s Required for “Meaningful Reform”

According to the Robert Wood Johnson Foundation, a meaningful think-tank, “meaningful health reform will require a comprehensive approach to extend coverage, improve quality, and emphasize prevention.” Needless to say, “meaningful reform” is a key phrase for Obama officials.

Before his untimely and forced departure as a candidate as head of HHS, former senator Tom Daschle repeatedly used “meaningful reform” as a political catch phrase. Now, in the recently enacted stimulus bill –the American Recovery and Reinvestment Act of 2009 (ARRA) - “meaningful” has become an official part of the language in the $19 billion all-out-push to promote the adoption and use of health information technology (HIT) and especially of electronic health records (EHRs).

This use of “meaningful” reflects the shared and serious (I have never know “meaningful reform” advocate to show the slightest glimmer of humor) of the Obama administration, Congress and many health experts that information systems are essential for improving the health and health care of Americans.

In pushing for HIT –collectively called HITECH in the stimulus package - meaningful reformers are going full-steam ahead in spite of these obstacles As noted by David Blumenthal, President Obama's Natinal Coordinator of HIT,

“However, proponents of HIT expansion face substantial problems. Few U.S. doctors or hospitals – perhaps 17% and 10% respectively – have even basic EHRs, and there are significant barriers to their adoption and sue; their substantial cost, he perceived lack of financial return from investing in them, the technical and logistic challenges involving in installing, maintaining, and updating them, and consumes’ and physicians’ about the privacy and security of electronic health information. HITECH addresses these obstacles head on, but huge challenges await efforts to implement the law and fulfill Presient BRACK Obama’s promise that every American will have the benefit of an EHR by 2014.”

Don't Sweat The Details

Never mind that most EHRs have proven to dysfunctional and counterproductive. Never mind that 30% of those installed to date have been dismantled and discarded. It's still full-steam ahead.

“Meaningful reform” is, after all, meaningful, i.e, noble, cause and requires persistence, bonuses for adopters, financial punishment of non-adopters. What’s good for the government goose is good for Americans, and nothing should stand in the way.

Should physicians and hospitals continue to resist the intrinsic self-evident goodness and ignore finacial rewards of HIT and EHRs, reformers can always resort to the artful use of language, particularly to the use of the word “meaningful “ in concert with other health reform buzz words.

Deploying “Meaningful Reform” through Words

Nearly 40 years ago, a member of the U.S. Department of Agriculture first described “buzz words.” These words can be used to advance bureaucratic or political causes. The words attractive, abstractive, and sometimes meaningful. In the case of health care reform, these words are best used in combination with other reform words. To use these words effectively, arrange them in three columns – two qualifying adjectives and an abstract noun. If anyone should ask a question about the value of reform, drop them into discussion in any combination.
1 2 3
meaningful managed care
universal supportive mandates
total health coordinator
Primary integrated analyses
comprehensive ambulatory centers
national resource services
coordinated pilot priorities
quality involvement projects
interdependent paramedical planning
interdisciplinary extended reform
preventive effectiveness indicators
systematized digital utilization
feasible electronic effectiveness
unmet scientific implementations
community evidence-based objectives
centralized algorithmic systems
longterm comparative parameters

Using these words in any combinations, the noble cause for “meaningful reform” will be advanced and will prevail.

Conclusion

Health care reformers insist they seek to do something “meaningful,”

something noble and socially significant yet with serious political pull.

something that is system-wide, universal, coordinated and comprehensive,

something that puts them on the political offense but is socially inoffensive.

something which they can control and manage and get credit in full.