Friday, April 10, 2009

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.


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

1 comment:

Brittanicus said...

Health care insurance companies have had it their way for far too long. Prior to 13th century the Barons, freeman and fettered surfs of England genuflected to every whim of the King John of England. In 1215 Magna Carta changed all that, just as we have reached a precipitous point today with the health care. WE desperately need freedom from the businesses that prey on the the average American?. We need a Single payer system, just like most European developed nations our insurance entities have subjected people to deceiving paperwork that would null their agreement for any pre-existing conditions found. They would delve deeply into any scrap of information, to cut off a person potential surgery--specially those items costing $100.000 dollars.. Not satisfied with that, under the watchful eye of the stockholders "bean Counters", would hit you with co-pays and premiums.

Governor Schwarzenegger should listen to the association of nurses and remove any insurance company from participating in the health care committee. Insurance companies are a cold dispassionate for-profit business that has no intentions of releasing their hold on a trillion dollar industry. Shortly we will be bombarded with gross lies, rhetoric and propaganda in every corner of the media. To even think of even enacting a single payer system is supposedly anti-American. In truth the estimates of Americans uninsured has reached a disastrous proportion. Then we have the shuffle of free health care for illegal foreign nationals that also have a massive financial impact on all taxpayers.

One monolithic pool of people is far better than the chaos of health care system we have today. England, prior to the ingress of illegal and legal commonwealth immigrants, the island had a true excellent system of health care for everyone. Your job paid insurance stamps, same as the employee who gave you access to a doctor, a surgeon, eye or dentist practitioner. No money, no insurance card, no state picture ID changed hands. A small payment for medicine was all that was expected. The only difference was a short waiting time for specialists that the well-heeled are completely isolated from.

Indeed, I had 2 minor and one selective surgery that cost nothing out of pocket. Here Americans live in frightened anticipation of debt collectors and bankruptcy for bills unpaid. Health care drains the country each year of trillions of dollars-- much going to insurance companies, archaic billing companies, and a whole cornucopia of middlemen. It will not be easy to change the broken system? Just like illegal immigration, the open-border proponents have everything to lose, that includes politicians who are major stockholders in hospitals for profit. Call the President, Senator or Representative and demand a---SINGLE PAYER SYSTEM: 202-224-3121