Thanks for the Stupid Question

There is such a thing as a stupid question. And some anonymous person in a webinar hosted by the Self-Insurance Institute of America had just asked one: “What is BUCA?”

Stupid questions are only stupid when reasonable expectations of the questioner are considered — it’s acceptable for a 5-year-old to ask about four plus four, whereas that acceptability is lost if it’s a 50-year-old.

So consider that many of the people who have the most incentive to understand health insurance and healthcare are those associated with self-insured companies. These companies take on the role of insurer for their employees and directly pay healthcare claims. If the company does this well, and doing it well requires a deep understanding of the healthcare system, very significant dollar savings can be achieved. If one knows enough to be working in a benefits role for a company that chooses the more complicated route of self-insurance and attends a webinar about reference based pricing that requires paid membership in the Self-Insurance Institute of America, it’s just embarrassing to ask about something as basic as BUCA.

But this stupid question was quite a useful reminder for how challenging communication is when complex systems require an esoteric language. The insiders speak it so automatically they can’t even remember what it was like to not be fluent.

Think about a stock broker who seamlessly drops terms like “no-load,” “beta” and “collateralized debt obligations” into a client conversation. The broker partially appreciates the client may not comprehend, so he’ll ask something like, “Do you understand?” The client, never wanting to look ill-informed, will almost always nod his head in agreement and say, “Oh yea,” even as he has no idea what a CDO is.

So really, we should all be thankful for people who ask stupid questions; if one never gets answers to unasked stupid questions, good decision-making will be needlessly difficult. And making avoidable bad decisions is actually embarrassing in a way that appearing stupid never should be.

But that’s often not the way it seems as egos fight to maintain the impression of supreme knowing. This reality requires communicators wanting to “fix” healthcare to be extra patient, detailed yet simplistic. To improve the healthcare system, novel solutions are required. Consider, though, that so much of the current system, from health insurance to pricing, isn’t even understood. Layering on extra novelty has the best chance to be successful if one remembers that most people are never going to ask stupid questions.

(By the way, BUCA is an acronym for the largest private insurance carriers: BlueCross BlueShield, United Healthcare, Cigna and Aetna.)

Originally published at on February 24, 2017.