I think @MPhilofsky means something else, @Chris_Knoll. She is challenging why we need a concept for each vocabulary, while we already have a record in the VOCABULARY table with vocabulary_id as foreign key to it. Only one should suffice, and we never seem to make use of the concepts for anything.
The answer is this, @MPhilofsky: There is a population in our community who thinks of the clinical facts and vocabularies as one continuous information space. Instead of fixed pre-defined queries, you could navigate and detect connections and knowledge. You use technologies like RDF, OWL and Triple Stores to do that efficiently: here, here, here, here and probably in more places.
The problem is that none of these have produced a successful application to a use case, yet, as far as I can tell. We put all those extra concepts in, with a certain burden to maintain them (we also maintain all tables and fields as concepts and relationships, for all versions), but I am not seeing the stream of tools or results.
If you want to propose to get rid of all this, go ahead, but make sure you talk to the sponsors first.