Normalized Deviance Has Infected How We View American Health Care
Employers and working Americans too often accept the unreasonable price of health care. It's time to take action!
Space shuttle Challenger exploded in a split second more than three decades ago, but the disaster was years in the making.
The primary cause — an O-ring that failed in low temperatures — was only part of the story. Engineers knew the O-ring turned brittle in the cold, but their warnings were ignored because of what sociologist and author Diane Vaughan calls the “normalization of deviance.”
Politics and a culture of compliance had led NASA decision-makers to determine that the faulty O-ring was an acceptable risk. “They redefined evidence that deviated from an acceptable standard so that it became the standard,” Vaughan wrote in her book, The Challenger Launch Decision: Risky Technology, Culture, and Deviance at NASA.
The way the masses think about the cost of health care in America also suffers from a normalization of deviance. Most Americans have come to accept what’s wrong as right.
It’s not reasonable for Americans to pay more than twice as much for health care than the citizens of other developed nations. It’s also not necessary. But that’s the way it’s been, so people accept it.
It’s not reasonable for working Americans to bear the brunt of those excessive health care costs by paying more than twice as much as what’s paid under government health plans. It’s also not necessary. But that’s the way it’s been, so people accept it.
It’s not reasonable for one patient to pay more than another patient for the same services at the same hospital. It’s also not necessary. But it happens every day throughout the nation. That’s the way it’s been, so people accept it.
I could go on and on.
OK, just one more.
It’s not reasonable that the price of hospital services have gone up more than any other consumer goods and services – more than 200 percent since 2000. It’s also not necessary. But that’s just the way it’s been, so people accept it.
Normalized deviance. It’s infected the way we think about health care costs.
Who’s infected? Policymakers, the public, patients, employers. In general, people are overwhelmed and paralyzed by the perceived complexity of it all.
The biggest victims are the employers, and working Americans who are covered by employer-sponsored health plans, or individually insured, or uninsured. They’re footing a disproportionate share of the bill and being broken by the unreasonable health care costs. It’s estimated that more than 100 million Americans are burdened by medical debt and about 1 in 5 have medical debt in collections.
The greatest tragedy is when these victims are also infected by the normalization of deviance. They remain ignorant, assuming there’s nothing they can do about the unreasonable price of health care, even though it’s causing them great harm. They’re resigned to their fate - the proverbial frogs getting the temperature turned up in the kettle.
There’s good news here. We do not need to be resigned to the ignorant acceptance of what’s wrong. I show how to overcome this normalized deviance in my book, Never Pay the First Bill, and my health care literacy videos, The Never Pay Pathway. We are seeing tremendous wins when people snap to attention and refuse to accept these unjustified health care costs. Savvy advisors and vendors are coming alongside employers and helping them redesign their health plans, so they improve benefits while lowering costs. Individuals are getting educated and empowered to find the care they need at a fair price, and contest unfair or inaccurate medical bills. They’re asserting themselves and coming out on top.
What happens if we don’t take any action, and the normalization of deviance is allowed to persist? In the case of NASA, it didn’t learn from the 1986 Challenger disaster. NASA failed to correct its problems, and on Feb. 1, 2003, the space shuttle Columbia disintegrated while streaking through the Texas sky. An investigation revealed that a large chunk of foam had detached from the shuttle’s external tank and collided with its wing. The problem had been known about for years.
Health care costs are projected to continue their unreasonable rise. Employers and working Americans have the power to reverse the trend, but they must change the way they think about the high cost of health care. They must redefine what they consider “normal” when it comes to engaging with the health care system. Let’s shake off the acceptance of the deviant behavior that dominates our health care system, get informed and take action!
UNCOVERED: Don’t Miss ProPublica’s Series on Insurance Company Denials
My friends and former colleagues at ProPublica are stringing together a groundbreaking series of stories on denials by health insurers. The series is called Uncovered.
The series launched with a harrowing tale of a college student who had payment for his drugs denied by UnitedHealthcare. The story unearthed internal insurance company emails and audio recordings that shed new light on the pervasiveness of insurance denials. The following story in the series showed how doctors working for Cigna systematically denied claims without even reading them.
Want to help the reporters? If you have insights into health insurance denials you can share them with ProPublica.
Want to learn how to appeal insurance company denials - and win? Check out my book and videos!
The Never Pay Pathway Health Care Curriculum
I’m looking for bold employers to equip their employees with my Never Pay Pathway health literacy videos. They’re based on my book, Never Pay the First Bill, and the knowledge will transform the way your employees engage the health care system. (Are you a NABIP member? You can complete The Never Pay Pathway for Continuing Professional Credit.)
The videos are an ENGAGING resource that will save money for your employees, their families - and your health plan. Let’s stop overpaying for our health care, shall we? Email me at firstname.lastname@example.org for more information.
Praise for Never Pay the First Bill
Many thanks to Christopher Lee for posting on LinkedIn such an awesome review of my book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win.
Here’s a condensed version of what he said:
I appreciated this book for 3 reasons:
1. It's empowering. As an investigative journalist, Marshall writes with moral force. He speaks truth to power and guides the powerless to claim what is theirs. When you get bullied, you don't have to take it lying down. Every day patients pay for the mistakes, negligence, inefficiencies, and sometimes outright fraud by healthcare organizations.
2. It's practical. In healthcare, the deck is stacked against patients. You're told that these are the rules. This is how things work. Resistance is futile. Most people obey without question. It can feel uncomfortable to challenge your doctor's recommendation or appeal your insurer's decision. You may also want to believe that they're looking out for you.
But what you're told may not align with your best interests. There may be a more effective treatment than surgery. The same product may cost half as much down the street. Or the cash price may be lower than your insurance copay. Things don't always make sense - and that's the point. This book helps you take control of your care decisions.
3. It's balanced. Having worked on both the provider and insurer sides, I'd say that the criticisms are fair. They're grounded in concrete examples. Some are common practices that wouldn't be tolerated elsewhere - yet somehow, we've come to accept in healthcare. Others are gaps and loopholes that cause perfect storms for a few unfortunate souls.
You can get the book at Amazon or other booksellers. The discounts on bulk orders are great, so let me know if that’s of interest to you!
I don’t think that it is acceptance of a broken system. I think that it is learned helplessness. We have come to “accept” a powerful bully victimizing a vulnerable population. When someone is sick, they don’t have the capacity to deny receiving care based on cost as 1. They don’t know the cost 2. They are sick and need the care 3. After the fact, they cant contest the care they received 4. Limited knowledge base. The system lacks moral and ethical standards and the “system” uses peoples weaknesses (lack of knowledge, vulnerability,..) against them to take advantage of them. The choices people have become limited, to accept care or go without care, which is really no choice at all.