I hardly go through a day where one of my dad’s one-liners doesn’t go through my head. You know those tidbits of worldly wisdom so simple and true that even a six year old can understand them? He’d tell me, “Nothing worth doing is ever easy,” “Do what you love and the money will follow,” and “If something sounds too good to be true it probably is.” Well, the past few weeks I’ve had another of his sayings circling through my head. “If you can’t say anything nice, don’t say anything at all.”
See I’ve been frustrated the past few weeks. At a lot of things, really, not the least of which is the area in which I’ve dedicated most of my professional life, and that’s health care. Perhaps it’d help if you understood where I’m coming from.
My dad works in biotechnology. Until today (congrats on your new job, Daddy!) his jobs were always with small start-up companies hoping to bring to market a miracle cure for HIV or cancer or hemophilia. And not just any cure, but one that used the newest technology. It was from him I learned phrases like Phase I clinical trial, good manufacturing practice, quality control, and gene therapy. And it was from him that I learned that a lot of the money that funded his job, my family’s sustenance, came from big pharmaceutical companies who were gambling that his little company’s technology would turn into something they could bring to patients worldwide. And until today, a day almost 31 years after my birth, he worked for only one company that had a product on the market.
My mom has worked at hospitals in finance as long as I can remember. She dealt with contracts between insurance companies and physicians, and later with how money moved between a teaching hospital and the well-known university with which it is affiliated. Like many wives and mothers, she made the health care decisions in our family, but I always knew it was because she actually understood this stuff and not simply because my dad was too lazy and we were too young.
My mom also hooked me up with the best high school job I could have imagined: working in said hospital’s heart and lung transplant department. What started as a job filing turned into a position where I helped people hoping to get onto the transplant waiting list get through all the tests and bureaucratic hurdles to do so. Those hurdles included securing pre-authorization from their insurance companies for their transplants. No easy task when you’re talking about a surgery and recovery that costs hundreds of thousands of dollars. Don’t get me wrong, I pushed papers. But I pushed enough of them to know which insurance companies were and were not likely to say no right away.
When I discovered my love of politics and policy, it seemed only fitting that I combine them with my family background and my own work experience in health care and pursue health policy when I enrolled in the masters program at Georgetown. As I’ve mentioned before, I spent the first five and a half years of my adult life working for the pharmaceutical industry’s trade association and the past almost 3 years working as a consultant on a number of health care projects. What I haven’t mentioned before, I don’t think, is that I’m a moderate in about any way you can think of. I’ve voted for Democrats and Republicans for every position from city councilmember up to president. As my husband can attest, I can play devil’s advocate with the best of them.
So it is with that background that I’ll tell you why I’ve had a hard time finding my voice the past few weeks.
Both sides have crazies. And I have too little patience (extra bonus points if I get through this whole post without writing patience when I mean patients and vice versa) to deal with crazies. You know what I mean. The people who are holding Nazi signs at townhall meetings. The people who think anyone who compromises in any fashion is a sell-out no better than the Nazi sign-holders. Seriously? Is this what this debate has come down to? I may as well just quit life and go hang out on the playground with my soon-to-be-kindergartener.
Health care is complicated. It involves many many moving parts. (Oh, if only it were so simple that we could just blame the insurance companies and be done with it. But alas, reality gets in the way. It’s not.) So as not to go all health economics 101 on you without your permission I’ll just say this: the policy behind health care reform is complicated enough. It’s hard to align incentives with actions. It’s hard to be efficient and effective. It’s hard to fight against the predictable when the unpredictable is just as deadly. Add politics to the mix and it’s damn near impossible. Except it’s not. We can make some big improvements to how health care is delivered in this country if we’d all just cut the crap and focus on real solutions that are viable and valuable.
If you believe that President Obama is a Nazi, this post is probably not for you. If you think that, for better or for worse, there’s any chance that in 2009 the U.S. government is going to nationalize health care (and by that I mean nationalize like hire doctors directly and be one big health care system and stuff), I doubt you’ll find what you want here either.
But for the rest of you, how does someone who doesn’t know much about health care policy know how to judge the proposals being considered? First, go read Joe Paduda’s post about the top 10 misconceptions you’ve likely heard about health care reform. Then, let me take you back to college philosophy. There’s this dude named John Rawls. (I’ve gotta believe Backpacking Dad would agree that any discussion of philosophy should start with “There’s this dude named…”) To completely paraphrase the man (no disrespect, Mr. Rawls), he had this idea that if you didn’t know your place in life, if you lived behind a “veil of ignorance,” then maybe you’d make just decisions.
The idea here is that if you’re constructing a policy and you don’t know how that policy will affect you because you didn’t know where you stand, you will make that policy as equitable as possible so as to maximize the likelihood that you’ll save your own ass.
So, just for shits and giggles, next time you think, “I love the insurance coverage that I have through my employer. Why would I want to pay more money and not get anything for it?” just step behind the veil of ignorance and ask what policy would be most appropriate for someone who in five years, five months or even five minutes from now will lose their jobs and their health care coverage. Because hundreds of thousands of Americans have been laid off and lost their coverage over the past few months. They are good people who have had bad things happen to them. And they? They could be you.
Or try this: next time you’re tempted to say, “I’m healthy. Why should I pay for people who are fat and lazy and eat too much and don’t exercise?” step behind the veil of ignorance and ask what policy would be most appropriate for someone who does everything right and still draws the short straw and ends up with breast cancer or a fatal infection. Because hundreds of thousands of Americans haven’t done anything wrong and they’ve still gotten sick. They are good people who have had bad things happen to them. And they? They could be you.
Or when you say, “We should limit the profits of drug companies and just take generic drugs to save money,” step behind the veil of ignorance and ask what policy would be most appropriate for someone whose ailment hasn’t yet been cured and whose only hope lies in that drug for cancer or Alzheimer’s that’s still being tested in pharmaceutical company laboratories like that ones that my dad worked in. Because hundreds of thousands of Americans’ only hope lies in some scientist, some company, some patients taking a risk to move a medicine from lab bench to clinical trial to the market. And they? They could be you.
Or the next time you think that all of “those people” that we’re debating making expensive changes for are some strangers, ask around to your friends and family. You’ll find out, no doubt, that many of them have gone through torturous battles not only with diseases that plague their bodies but with a system that so often adds insult to injury. If you haven’t realized that yet, perhaps you’ve been living in ignorance all along.
Note: There are a number of people online who are doing their best to have reasonable discussions about health care reform. While I may not agree with everything they’ve written, I recommend you check out these posts from Drums N Whistles, Gunfighter, and Overflowing Brain. And if you’ve seen a post about health care reform that you think is especially poignant, please let me know. I’ll keep updating as I come across more of them.