Please stop saying "Healthcare is broken"
Healthcare is broken, as so many people like to say – especially those who believe they have some answer on how to fix it. Unfortunately, I think this phrase in and of itself might be part of the problem.
To say that “healthcare is broken” is to employ a metaphor. Well, really you’re employing a huge, imprecise concept along with a metaphor, but let’s stick to just one element for now. We use figurative language in this instance to try and convey something about the state of this massive, multifaceted system – essentially, that it’s not doing what we want it to do.
It’s a good impulse. Metaphors and similes are far more than flowery tools for poets. They are some of the fundamental ways humans use language to understand the intangible or complex. By saying that some difficult idea is like this common everyday thing, or operates as though it were some readily understood mechanism, you tie the abstract to the concrete. You pin down the idea to something you can wrap your head around. So to speak.
In the best of cases, metaphors give us new ways to look at a problem, new approaches to consider, and a deeper understanding of the issues at hand. The trouble comes when we pick a metaphor that almost works. This is far worse than using figurative language that doesn’t work at all. If the metaphor totally sucks, everyone can tell and it drops from the common parlance. But metaphors that almost work stick around, and often remain unexamined. They shape our thinking, throwing us off the track of true comprehension with their half-assed-ness.
“Healthcare is broken” is one such malicious metaphor. How exactly does it fail? Let me count the ways:
By saying that “healthcare” is broken we can disassociate the problem from our own agency. Healthcare becomes this thing over there. That system that got all screwed up by someone else: big bad insurance companies, incompetent politicians, greedy doctors. Pick your villain. It’s an entity separate from ourselves. The same problem occurs when people speak about “the economy” or “government”. These things don’t exist apart from us. The ARE us. All of us.
Saying that something is “broken” implies that at one time it was working. Is there some golden age of American Healthcare that we all are trying to get back to? Can we just push a button to return it to the factory settings? Does anyone have a big ass paperclip? If we speak about healthcare in a way that implies that it merely needs to be restored, how much of an opening are we making for thoughts about wholesale change, improvements or even revolution? Following this metaphor to the next logical step…
If something is broken, it can be fixed. But what does “fixed” even mean? Is this something we can agree on? There can be no one “fix” because there isn’t just one thing that is broken. This also means there is no one person or industry to blame for getting healthcare so screwed up in the first place. Again, working with such a lame metaphor make it hard to keep that multiplicity in mind. Which leads me to my next point…
Big complex systems don’t just break. iPhones break if you drop them in the toilet. My kid’s arm broke when she fell off the couch. The concept of healthcare can no more be “broken” than something like “love” or the “environment” can be. You wouldn’t say a house was “broken” because it had crappy wiring, a leaky roof, peeling paint and termites. You’d say it was “neglected”, “ruined” or “condemned”. The front window of this house might be “broken” but that certainly isn’t the right word to describe the whole structure. This is not just some academic exercise in semantics. Try substituting some of the words we used to describe the house into our phrase:
Healthcare is neglected
Healthcare is ruined
Healthcare is condemned
Suddenly all these questions present themselves. Who neglected healthcare? Does anyone still own it? Was it ruined intentionally? If so, why? If healthcare is condemned, does anyone still lives there? Can they be moved? What will be impacted if we start demolition? If we want to build this house back up, is there anything worth salvaging?
Figurative language has the ability to inhibit or enable thought. So the way we speak about the work at hand demands just as much attention, if not more so, than our ultimate course of action. Words matter. And healthcare is too important to be lost in the fog of a lazy metaphor.
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