High Value, Cost-Conscious: Weasel Words of 3rd Party Payers and Their Sycophants

Weasel words are words or statements that are intentionally ambiguous or misleading (The New Oxford Dictionary of English, Oxford University Press 1998) and which can deprive of content any term to which they are prefixed while seemingly leaving them untouched (Hayek, F.A. The Fatal Conceit The Errors of Socialism).

Currently it seems the vogue to say, “High Value, Cost Conscious Care” (Do a Google search of this expression, and you will find a plethora of articles). My view is, when this adjective, high value, cost conscious, modifies the noun, care, it extinguishes thought about the noun’s meaning in the context in which it is being used and focuses attention on the dollar bill, $$$. I believe that is the intent of the people who use this expression.

Some of you may say, “Well, that’s not bad, we have to be focused on dollar expenditure in our healthcare system.” However, the people who foster this thinking want it to be part of the doctor’s thinking when he/she is seeing patients (http://www.nejm.org/doi/full/10.1056/NEJMp1205634 and many of the results from your Google search mentioned above).

Let’s look at the functioning of the doctor  patient relationship:

In the doctor  patient relationship there is an intersection or interchange which occurs and involves an exchange of information via the history, physical examination, laboratory tests, xrays, etc. This is how medicine is practiced and it is where clinical decision making regarding diagnosis, treatment, and follow up occurs. The dollar bill, $$$, is not part of this exchange of information. It cannot be because then the information exchange and clinical thinking & decision making resulting from it is muddied. When this happens, medical care will be suboptimal at best or destructive and/or non-existent at worst. No good outcome can occur from bringing the dollar bill and dollar thinking into this exchange of information. The dollar bill is a non-clinical agenda, whether the dollar thinking is intended to benefit the doctor’s income or that of the 3rd party payer under the guise of the noble sounding rhetoric, reduction in healthcare spending and cost control.

If the American public (not their 3rd party payers and their sycophant politicians and think tanks) insists on dollar thinking as part of their doctor  patient relationship, then they have to bring that dollar thinking themselves and not expect that their doctor should or can do it. Admittedly, they will be conflicting their own medical care, but that is their choice. And, of course, with this we enter Gingrich land, the home of his now bankrupt, Center for Health Transformation (http://www.bizjournals.com/atlanta/news/2012/04/05/newt-gingrich-think-tank-files.html?page=allhttp://www.kaiserhealthnews.org/Daily-Reports/2012/April/06/Gingrich-consulting-firm.aspx). You must have heard of this dollar-green quagmire, where the advocates of consumer-focused health care ply their rhetoric. It’s all the same poison: high value care, cost conscious care, cost-effective care, consumer focused care, etc., etc: Bring dollars or lack thereof into play within the doctor  patient relationship so that clinical thinking is disrupted. Why? Because that’s the proximate cause of dollar spending in our healthcare system. If you control that, you control a gold mine, a greater than 2 trillion dollar annual gold mine.

The question arises, Why should patients or the American public in general bring dollar thinking into their interchanges with their doctors, when they are already sending mega dollars, $$$$$, to 3rd party payers via private health insurance policies (individual or employer based; note the latter is not a gift from the employer but a defined part of the employees’ salary) and via taxes to the public payers, such as Medicare & Medicaid. Why should they do this? They can’t gain anything from it. All they can do is conflict their own medical care.

So, if the powers that be (unfortunately, this is not the American public, except for the bogus notion that the voting system gives individuals some sort of say) and their sycophants really desire Cents and Sensitivity (http://www.nejm.org/doi/full/10.1056/NEJMp1205634) as a modus operandi, then simply delete all 3rd party payers from our system and allow the American public to become lone first party payers (Lone, as opposed to this greed-driven mixture of cash-out-of-pocket spending via deductibles, co-pays, account management fees for high deductible insurance policies, pharmacy, and uncovered services all of which benefit the payer and its sycophants and disadvantage individual Americans). With the American public acting as lone first party payers, we would surely have what the purveyors of these weasel words want: Medical care conflicted by the dollar bill yet somehow also carrying the label, high value, cost-conscious care.

R. Garth Kirkwood,MD



Leave a Reply

Your email address will not be published. Required fields are marked *