May 26, 2006

... And other lies we like to tell

Add this to the list of found objects of note: from an article in last Thursday's Times, entitled "The Check is Not in the Mail" and subtitled, more helpfully, "Late Payment of Medical Claims Adds to the Cost of Health Care." Do you really need an article after that? I don't. I've seen it. I've screamed about it, even (see this crosspost by way of evidence). And yet examples are always a help. To wit:
Tardiness or refusal to pay what doctors consider legitimate medical claims may add as much as 15 to 20 percent in overhead costs for physicians, forcing them to pursue those claims or pass along the costs to other patients, according to Jack Lewin, a family doctor who is chief executive of the California Medical Association, a professional group of 35,000 physicians.
Don't say I didn't tell you so. The game in this is obvious, of course: the longer they delay payment, the longer they hold onto your money (that is, those mountains of premiums you pay every month), which they're all the while using to make more money, just not for you. In this way have they scored even if they do end up paying the claim. To quote the Times's judicious phrasing:
How is it, as the nation staggers under growing health care costs, that the commercial insurers responsible for paying much of the bill tend to be highly profitable and have stocks that are performing well? Tight-fisted approaches to paying bills may be part of the answer.
"May" indeed. Meanwhile, they've added administrative costs to everyone down the line, not least to the actual physicians who deliver your health care — but also, just in case you care, to you and to your employer, assuming you have one, and assuming the one you have subsidizes your insurance.

I believe the official term for this is waste.

As a rational, free-enterprise- and market-loving American, you're supposed to hate waste. But of course that's only the textbook answer. Off the pages and in the real world, waste can be a business's best friend — as long as it's someone else's waste.

Especially when it allows you to come back next year and talk about the rising costs of health care, especially doctor visits — seeing the circle yet? — which rising costs of course dictate a corresponding rise in premiums. After all, they're running a business here, not a ... well, just not something else.

Thus are you subsidizing, one way and another, the profits of a long list of corporate giants. Thus are you purchasing their executives not just food and wine, but trips to St Bart's, new wings on the McMansion, an extension to the backyard pool, and membership to that country club with the killer back nine.

Class warfare? You bet. But who started it? And who's got all the ammo? And who, in fact, can be said to be winning?

Think of it this way, because this is the way it is: it's in their interests to delay payment of claims. It's in their interests to deny claims. It's in their interests not to do the very thing you believe they exist to do, which is take care of your health care bills. Leaving aside the moral dubiousness of such a strategy — of making profit, that is, from others' illnesses and misfortunes — it's a sorry-ass way to see that anything gets done. Particularly when that "anything" is keeping people healthy, or making them well once they're sick.

It is, on the other hand, a great business model: take lots of money in, let as little as legally possible out. And let's remember that "legally possible" can take ten or fifteen years to define — or it can, at least, when you've got the best lawyers a fat stack of unpaid medical bills can buy.

The VISION Thing

Here's a cute little report in the Washington Post today: turns out not too many industry members are volunteering for the administration's voluntary pollution reduction programs, and thus not much pollution reduction is taking place. Surprising? Of course not. That was the point, after all, wasn't it? But it's discouraging all the same. And it's yet more proof that the one constant to this administration is its replacement of actual governance with governance simulacra. We get slogans and talking points, we get logos and billboards, but we don't get much else.

More than anything in this particular article, though, I think it's worth noting the names of those programs the government oversees. "The Environmental Protection Agency sponsors 'Climate Leaders,'" the Post tells us, "while the Energy Department oversees 'Climate VISION.'" VISION, ominously all-capped, strikes one instantly with the flat heavy hammerback of the acronym. The Post doesn't break it down for us, but internet search technology does. VISION, it turns out, stands for "Voluntary Innovative Sector Initiatives: Opportunities Now."

The first thing we should note is the idiotic fascination with acronyms as such. Or, rather, the fascination with idiotic acronyms. It's not particular to this administration, but it's surely more prevalent here. Acronyms are all the rage in the business community these days. I sit in meetings at least once a week watching whiteboards fill with strings of all-caps jumbles and their lower-case clarifications. Usually, it's the acronym that comes first. Someone tosses one out, and if it's got "ring" to it — which seems to mean it sounds vaguely military, or vaguely sexual, or vaguely rock-and-roll, or just that it makes an actual word that doesn't require cartwheels of the tongue to produce — then you all spend the next forty-five minutes trying to make each letter stand for a word that has something, anything, to do with the topic at hand. They're all colossally, relentlessly juvenile, enough so that the whole thing starts to feel like a kindergarten exercise — you know, the kind that demonstrates our wondrous variations on letter pronunciation — and yet the entire room chases them, and with alacrity. Invariably some exec will develop a liking for one or another (usually one he came up with, of course; I guess there's an acronym hall of fame somewhere to which deskplates are retired. Or maybe they're showing up on resumes, as in, "Holy shit, Bob, did you see that guy in the interview lobby? I checked his resume, dude. He's the one came up with CRACK!"). When this happens, the whole room turns its focus to the exec's personal favorite, struggling mightily to validate it, make it sing, or if not sing then at least just work, just eke out sense, just not sound like the utterly vain and childish arrangement of blocks it certainly is. Sometimes this is not enough. And sometimes it's not enough that it's not enough: we use them anyway. (The colon can be an invaluable tool in effecting this, as we see in "VISION": it permits a complete disjunction in the logic of word flow, which in turn allows you to assign those last two pesky letters, sense be damned.)

Where does this fascination come from? Business school. MBA programs. It's really that simple. The people coming up with them are business school grads (or maybe serve at the pleasure of business school grads), and the people to whom they're ceremoniously presented — they're known as clients, or, in politics, as "donors" — are also business school grads. And no doubt both sides love them so precisely because they harken back to student-project days, to role-playing exercises of the kind reproduced on "The Apprentice." What's the first thing you do? Come up with a name for your team. Make it zip, make it pop, make it zing. Hire a consultant if you have to. Become a consultant, if you find you're really good at inventing words that mean nothing but sound as though they might, like Lucent. Once your team is named, what's the next task? Come up with a name for your initiative. Make it — well, you know.

Who cares? No one and everyone. The fascination with acronyms telegraphs the triumph of the business school mentality in the leadership corps of our current government. The business school mentality believes in acronyms. The business school mentality believes, above all, in marketing, of which acronyms can be a particularly accessible cornerstone. What the business school mentality does not believe in, of course, is a role for government — aside from the redistribution of tax dollars to corporate executive bank accounts.

We live, all of us, today, in a culture defined by the triumph of marketing. It's what we do, and it is, increasingly, all we do. There's a great deal more to be said about that. For now, though, let's look at the actual content of the VISION acronym (as opposed to the actual content of the VISION program, which, as the Post reports, is nonexistent: and thus my point). The goal of a good acronym is to sum up the talking points of your marketing initiative: hit the key notes of the sales pitch simply and concisely, so that each occasion for spelling out the acronym becomes an opportunity for reiterating those notes. What are the key notes in VISION?

First and foremost, of course, is "Voluntary." Here we have the whole enchilada. It means you only do it if you want to (and who wants to?). It's the keyword every exec longs to hear vis-a-vis government regulation. It allows them to say, after all, with a straight face, that they do not in fact oppose all government regulation, and that of course sounds good in any public context.

Next up is "Sector Initiatives." This spells new business, and probably spells government contracts or subsidies for same. Hate government, hate taxes, but love the government checks that are funded by taxes: that's the American business motto. "Sector initiatives" tells the industry that whatever paltry efforts they make at pollution reduction won't cost them a dime: that the bill will be footed by taxpayers: because it's a government program, after all. And you can be sure there'll be plenty of profitable overbilling, and that any investigations of that overbilling which are forced upon the administration by political forces not yet wholly owned will be promptly turned over to the deaf, the dumb, the blind or the well-bribed: so not to worry.

The last and best member of this particular acronymic army, though, is "Opportunity." "Opportunity" is genius. "Opportunity" is multivalent, allusive, scriptural: it means different things to different people, and all the things it means are good. There are business opportunities. There are public relations opportunities. There are political opportunities. Opportunities are what America is all about: the creation of them, the promotion of them. They can be seized or declined, of course; and they conveniently imply no particular outcome (and thus can't be faulted for not achieving one). Opportunities are the sine qua non result in themselves: value-laden, content-free, inarguable and unassailable. They are the American Dream.

Nice work, Bob. See you through my toxin-filtering faceplate* at the hall of fame.

* See? An opportunity — for the nascent toxin-filtering faceplate industry.