October 14, 2004

Putting the buggy before the horse

According to the official transcript of last night's presidential debate, George W. Bush at one point said:

Thirdly, one of the reasons why there's still high cost in medicine is because this is -- they don't use any information technology. It's like if you looked at the -- it's the equivalent of the buggy and horse days, compared to other industries here in America.

There's a substantive point here, as well as a linguistic one. Anyone who's had any contact with the American health care system recently will be surprised to be told that "they don't use any information technology" -- as the president said in another context last night, "it's kind of one of those exaggerations." I'm sure that costs could be reduced by better IT systems for dealing with patient records and the like, but is medicine really "the equivalent of the buggy and horse days, compared to other industries"? Maybe so, I don't know. What I do know, though, is that the usual idiom is "horse and buggy". And despite what he said, I'm pretty sure that George W. Bush knows that too.

Google tells the statistical tale: "horse and buggy" has 61,900 hits, while "buggy and horse" has just 470: 132 to 1. In fact, the whole expression "horse and buggy days" has 5,230 hits, to just 1 for "buggy and horse": more than 5,000 to 1!

There's nothing incoherent about the expression "buggy and horse days", especially if you're speaking literally, as the author of the phrase's one previous citation was:

(link) I worried about mother. It was buggy and horse days, so it took more time to go and see her.

Still, "horse and buggy" is a fixed expression, a collocation, an idiom, and "buggy and horse" is not. This is not an isolated fact -- there are patterns to the typical order of words in conjoined expressions, and the key influence in this case was first described by the Indian grammarian Paṇini about 2,500 years ago -- but that's another story. Whatever the explanation, the preference for the idiomatic order "horse and buggy" is an indisputable fact of the English language as we use it now.

Why do I think that President Bush knows this, even though he said "buggy and horse"?

Well, listen to the sound clip. Here's a more careful transcript of this passage:

uh thirdly [pause 0.339]
uh one of the reasons why there's [pause 0.365]
still high costs in- [pause 0.235]
in medicine is because [pause 0.750]
this is the- they- they- they don't use any information technology, it's like if you looked at the- [pause 0.287]
it's the equivalent of the- [pause 0.790]
of the buggy [pause 0.526]
and horse days [pause 1.364]
compared to other industries here in America, and so we've got to introduce high technology into health care, we're beginning to do it, we're changing the language, we want there to be
[pause 0.542] um [pause 0.475] {total 1.195}
electronic medical records to cut down on error as well as to reduce costs. People tell me that [pause 0.457]
when- when the uh health care field is fully [pause 1.774]
integrated with information technology it'll wring some twenty percent of the costs out of the system

Bush starts out disfluently here. In the span of about 12.3 seconds from the start of "uh thirdly" to the start of "of the buggy" -- 33 words in the official transcript -- he racks up two uhs, six repetitions or self-corrections, and five silent pauses in inappropriate places. I'm sure that he knows what he wants to say, but he's having some trouble putting it into words.

(Parenthetically, before you take this as evidence for some sort of linguistic disability, compare it to Kerry's equally disfluent answer to another medical question, discussed here, which includes a truly spectacular 7-second lexical access failure. Public speaking is hard, especially under the kind of pressure that these two men face.)

Anyhow, the president is in a certain amount of linguistic difficulty from the start of this passage. He gets as far as "it's the equivalent of the". Then he pauses for almost 4/5 of a second, he repeats "of the", and out pops the "buggy" part. It's clear that he's having trouble retrieving the idiom, and "buggy" gets over threshold first, so he uses it. But he knows it's not the right thing, because he pauses again for more than a half a second before "and horse days", and then pauses again for almost 1.4 seconds before completing the phrase "compared to other industries here in America". By now the rest of the mental file card is well activated, so he presses rapidly through several clauses without stopping.

There's just one point that still puzzles me. What did the president mean by saying that "we're changing the language"? I don't understand what that has to do with cutting costs by introducing high technology into the health care industry. I doubt that he meant replacing COBOL with java. And I'm not interested in any snarky remarks about replacing English with Bushian.

My first thought was that a fragment of another sound bite got accidentally disinhibited enough to slip into the flow of his answer. "We're changing the language" sounds like a slogan of some kind, though not one about health care automation. However, searching the web did not turn up any evidence that this is a current White House slogan in any field at all. If you know the answer, email me (myl at cis.upenn.edu) and I'll tell the world.

[I'll indulge myself in one non-linguistic point here. As a part-time computer scientist and full-time taxpayer, I'd be happy to believe that better automation of patient records would save 20% of health care costs -- but can this really be true? If it were true, I'd expect some biomedical Wal-Mart to be out there cleaning up. I haven't seen this point discussed on any of the "fact check" sites.

More important, why is a conservative Republican president talking about introducing high technology into health care as if it were the responsibility of the executive branch of the Federal government? ("...we're beginning to do it...") Is he proposing socialized medical automation on top of a largely private-sector health industry? Given the recent IT record of the FBI, the FAA, the social security administration, etc., this would be a dismaying proposal if it were seriously meant. ]


Posted by Mark Liberman at October 14, 2004 11:59 AM