The Battle Over “Healthcare”

Health-care reform will probably end “health care” as we know—and spell—it

As The Crimson’s only designated copy editor, I came back to school to face the issue that had been confronting most editors all summer: my personal philosophy on health care. As liberals and conservatives in Washington debated the public option, language experts staked out differing positions of their own. In the publishing world, however, what has separated healthcare liberals from health-care conservatives isn’t our political views—it’s our opinion on whether the hot topic itself is one word or two.

Because it’s a question of philosophy, of course, there can’t be a right answer. But in grammar, a field that lives for rules and regulations, it seems strange that there’s no conclusive authority on the subject. As a recreational reader, the copy editor inside me finds that fact frustratingly inconsistent.

The issue is also a personal crisis. I’m a liberal in every sense of the word—political and editorial. I think the Constitution is a living document. I believe in the flexibility and inevitable evolution of language. I even think it’s acceptable to—gasp—split my infinitives. Why, then, do I not embrace the new variant “healthcare”?

Some background is in order. When the term “health care” was first birthed in the early 20th century, no one could deny that it was two words: literally, care with respect to health. As the phrase spread, however, its two components became more intimately linked; soon, the two-word unit became one word unit—complete with its own entry in the dictionary.

You can see where it gets confusing. “Health care” may have technically been two words, but functionally it was one. The distinction was a fine one—and too subtle, apparently, to keep up. Before long, casual writers and professional editors alike started dropping that pesky extra space, transforming what had become a purely semantic nuance into no nuance at all.


The result is a community of editors that’s sharply divided. The New York Times insists on “health care.” Reuters, on the other hand, is an unapologetic convert to “healthcare.” The Oxford English Dictionary—notoriously slow to respond to common usage—lists it as two words.—with its modern, online perspective—says one. (A search through The Crimson’s archive reveals both.)

The grammatical rule governing phrasal adjectives compounds the confusion (no pun intended); multi-word descriptors (such as “health care”) must be hyphenated when they appear before a noun (as in “health-care reform”).

“Health care” is far from the only contentious compound. There’s the Gchat in which your friend excuses herself with “nevermind.” There’s the e-mail from your TF who wants to “follow-up” with you. There’s the hyphenated “e-mail” itself, which looks normal to-day, but almost certainly won’t to-morrow. These combinations and more have vexed editors for quite a while—but the health-care issue may finally have forced us to confront the idea that they are moving in to stay.

I consider it part of my job at The Crimson to bemoan the destruction of language. It’s tantalizingly easy to assume that the exquisite subtlety of English prose was destroyed by a population too unsophisticated to understand it.

But can I blame the language for simplifying? It’s equally possible that society, in its enlightened wisdom, decided not to split hairs—or word units—where it was pointless to do so. This isn’t just the inescapable evolution of the language, as liberal linguists insist so often; it actually seems like a sensible shift to make.

Yet when I pick up my editing pen, I still maintain “health care” for the noun and “health-care” for the adjective. In other words, I cling to the old rules, even as my progressive personal philosophy knows that they’re inevitably being squeezed out.

This summer, I knew where to stand on the health-care debate before Congress. I didn’t know where to stand on the “healthcare” debate. My order-loving personality wouldn’t allow me to break the rules. But could I really reconcile political liberalism with grammatical conservatism? Wouldn’t that be the ultimate sin for a copy editor—internal inconsistency?

Yet I’m not the only editor to face this paradox. Plenty of copy editors have succeeded in combining a liberal worldview with a stickler’s adherence to tradition. They recognize simply that grammar leaves room to maneuver. Like political liberals, linguistic liberals don’t hate rules; they just define them differently. Rather than dictating every last detail, rules protect the framework in which dissent, change, and possibility can thrive.

As a result, the best copy editors aren’t necessarily conservative, as one might assume; they’re instead those who are aware of the conservative rules and consciously decide how to apply them. I’m personally not ready to switch over to “healthcare”—but it’s not a contradiction to say I won’t get in the way of those who do.

Nathaniel S. Rakich ’10, a Crimson editorial editor, is a government concentrator in Cabot House.