The unfortunate politicians who have braved town hall meetings in recent days to talk about health reform seem to have been taken by surprise by the vitriol and volume of the push back. Yes, I know the audiences were marshaled and recruited to shout down the speakers but still the passion on display was genuine and not in the least surprising to me. What the President and our politicians should have known is that our personal health is the one arena of our lives (the other being our love lives) where reason and logic get thrown out of the window. Talk about our health and suddenly our education and civility vanish and we are a mob waiting to be ignited. The incredible thing is you can just as easily incite us to march for reform as you can against reform. All that matters is what button you push.
If you don't believe me, just look in your medicine cabinet and see
if there might perhaps be more than one 'natural' or 'herbal'
supplement that you are swallowing; a pill for which there exists no
scientific data that it works, only the anecdotal hype on the
bottle cover that stirs hope. I know, because I confess that I have a few such products
in my medicine cabinet.
It is instructive that the makers of these
'natural' products are careful not to make a claim to cure or eradicate
anything; they only promise to 'promote' glandular health, or to
'stimulate' metabolism and other such vague terms. If they said 'cure'
or 'treat' their product would then be a regular drug and subject to FDA
scrutiny. And do we know what's in those pills? Mercury? Starch?
Rodent excreta? Your guess is as good as mine, but it does not seem to
stop us as we as a nation consume billions of dollars worth of that
stuff.
Congress in 1994 passed an Act that stopped the FDA from
scrutinizing natural supplements; it was called the Dietary Supplement
Health and Education Act (which the New York Times called the
'Protection of Snake Oil Act'). You can guess who was lobbying for
that: the natural and herbal product industry mobilized congressmen and
senators to pass that law-- and when it did, the industry went from a $6
billion industry in 1994 to a $20 billion industry in the year
2000. Who knows what that figure is today, but no doubt there is more
money to lobby because I just read that the industry group went to lobby Congress recently for preservation of the 1994 Act and for a seat at the table when discussing health reform.
But
that's another story. My point has less to do with that industry than
with us: how for each of us, our magical thinking can displace rational
thinking. We all want to believe that a pill or potion that comes from sea coral or
from the Amazon jungle will cure that pain for which little else has
worked; or that the salve just might grow hair even when your left brain tells
you that if it really worked they would have no need to advertise. Here's the strange thing: when we really do believe, it may actually help.
The flip side of this magical thinking is that we are extraordinarily
sensitive to any suggestion that someone is taking away something we think
is good for our health. Indeed, it is relatively easy to agitate large numbers of
people, easy to exploit our irrational fears and beliefs--just look at the history of epidemics from the plague to HIV to influenza. They brought out the worst in us. It is that kind of irrationality that is most
evident when the topic of health care reform comes up. 
So who exactly is agitating people to react rabidly at the mention of health reform? Well, reason and logic (which are
useful in this narrow instance) tell us it has to be everyone who is making any money on
health care right now. A useful aphorism in this health care debate is
that every dollar spent on health care is a dollar of income for
someone (and we spend 2.1 trillion such dollars, or 16 percent of our GDP).
That is huge money, folks, and it is being made by doctors,
hospitals, pharmacies, insurance companies, nursing homes, nurses and many
others. So why be surprised if the
lobbyists for all those who feed at the trough use every possible
tactic to defeat reform? Reason, logic and education have nothing to do
with this--this is personal!
Perhaps the White House needs to
emphasize more concretely what will happen if we don't pass health
reform: how all the people who are pleased with their insurance now
will soon find it unaffordable; how the rising cost of insuring
workers will hamper business growth and suck up profits. Yes, I know
the President has stated this before and he does it very well. But somehow
that pain seems less personal, and too abstract--it revolves too much around facts. Advocates for health care reform need to get
down to the nitty-gritty and spell it out in personal terms, in terms
of what you and I will lose. Exaggerate, be irrational, make fantastic
claims to incite the mob...and you might have a chance. It's the logical thing to do.
(Photo Credit: Photo 1- John Moore/Getty Image; Photo 2-www.flickr.com/photos/negativz/74267002)
Comments (21)
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Abraham Verghese
Thank you, Mr. Verghese. I did not know that I was so stupid as to think that mere anecdotal experience--i.e., people have tried it and it worked--was so disreputable. I understand now that things can only really work if some opinionated, over-paid official says it does. God does not know what He is doing, has provided nothing for us. Only people like you can tell us what is good for us. Now I get it. I also understand from your enlightening article that the solution to overcharging in the medical field is to really, really overcharge by taking the country from freedom to socialism and then overcharging everyone through taxation for things we do not want. By the way, you are what we are protesting.
Gee, Joly, got a little bit of chip on your shoulder?
I could believe that you are one of the people dumb enough to take unregulated "natural" supplements. The fact that "God provided" arsenic, mercury, as well as a variety of poisonous plants and animals doesn't mean that I want to eat them.
Though I expect he is too courteous to do so in a public forum, Dr. Verghese should return Joly's thanks, for so handily demonstrating his point.
"Freedom": when your insurance company determines what health care you'll receive.
"Socialism": anything that mitigates your freedom.
Actually, you can pay for any healthcare you want in this country. That's freedom. If you don't have the funds, there are millions of opportunities to make money. That's freedom. If you can't make money because you're not bright, hardworking, risk tolerant, and/or willing to make compromises with people who would pay you, that's Freedom to fail.
If other people are strong-armed into diverting money from their own children and parents and other needs to pay for you, even though you demonstrate no worthiness besides mere existence, that's socialism.
Try visiting Europe some day. You'll find that you can pay privately for as much health care as you want, in most of the continent.
I fear that the Republican leaders at this point will prey on people prone to join mobs and exploit them for political ends on any issue they can. I suspect if health care hadn't been first out of the gate, they'd have been able to stir up just as much hate-filled passion, if not more, over immigration and over energy and global warming. They've already shown they can do it on a somewhat smaller scale.
I think you are right: the Administration is way too unemotional. They need to be stirring up passions, as well, or we're all in for a terrible time. They need to rally positive emotions: pride in the passionately good things about the country, pride in its true heroes. Even if they have to exaggerate a bit.
But health care is just the beginning. The Republicans who rabble-rouse are simply out to destroy the Administration and they don't care how they do it.
I believe there is wisdom in your post, buddenbooks.
The Republican response is from the gut - not logical or fact-based, but a frenzy of "anything we can throw at him." I recognise this because I felt it for W. Bush as well - there were many times I reacted unfairly and instinctively with anger and criticism at anything he did. Only on sober second thought could I (I think) force myself to be more objective and fair - and sometimes (rarely, admittedly... perhaps 10% of the time) I had to admit that his actions weren't that bad.
The Republican response is from the gut - not logical or fact-based...
There's reason behind the opposition, you just have to make an honest inquiry and you will find it. One of Obama's gifts is the ability to see, understand and acknowledge the sincerity of multiple viewpoints. Its admirable.
If you want to discuss reason and logic, perhaps you can provide some here?
I'll concede that conservative sites - such as this one, I might add - are advocating that individuals go to Town Hall Meetings. If you want to refer to that as "Marshalling," go ahead.
But recruiting? Let's not be foolish and claim 0%, but where's the evidence that shows that even 1 in 20 of the people protesting aren't there of their own free will, with no recruiting involved?
It's not just the PASSION that's sincere, the whole MOVEMENT is sincere. Unlike ACORN and the SEIU, there is no significant organization recruiting ANYBODY. That's what makes this so significant. It's huge, and it's real.
And it's not just because people don't want their health care "weakened," although that's certainly true. And it's not just that people don't believe Obama and this Congress when they claim that "we won't TOUCH (whatever)" when we all know that it would be impossible to provide any form of "reform" without making all kinds of changes to Medicare and Medicaid coverage or eligibility.
There's also the very-real fear of economic collapse.
People are starting to realize that trillion dollar deficits are insane.
It's not about our love lives; it's about our progeny. We are enslaving our children. For what?
Rob, in case you hadn't noticed: the health system, as it is presently constituted, is fiscally untenable. Premiums for those who are insured are going up three times faster than wages. As a country, we pay more and get less than anyone else in the industrialized world. In 2007, 62 percent of U.S. bankruptcies were medically-related, and 77 percent of those in medical bankruptcy had health insurance (usually private insurance) when they first got sick. Is this really the system you want to leave your kids? And, by the way, I didn't hear Republicans complaining much as George W. Bush was doubling the national debt over his two terms.
medically-related is not the same as caused. Since a bankruptcy petitioner lists every possible debt, I suspect more than 62% are credit card related.
We get a lot for our medical expenditures, including superior medical outcomes for diagnosed cases of breast, prostate and other cancers, heart disease, AIDS and most diseases. The OECD study that most people unknowingly echo is junk science. Life expectancy is largely behavioral dependent. The OECD gave about 1/5th of the weight to unequal health delivery, which means Tanzania (which is uniformly bad) outscores the U.S. Where the ultra rich get the best care in the world. Where do you want your children treated?
The irrationality in this debate erupts from those using fear of unending price increases and threats of imminent disaster to radically reform the best medical sector in the world. Those who demand a solution in less time than President Obama used to find a family dog. Resources often increase and then decline. Go buy a sandwich and use your receipt as a book marker for a book by Paul Ehrlich; that'd be delicious irony.
Baba, you've obviously made a serious effort to get your head around the issue and that's a big improvement over the usual level of discourse surrounding healthcare these days. Not gonna do a point-by-point, but here's what I can tell you about the medical bankruptcy numbers:
> These bankruptcies are termed “medical” based on debtors’ stated
reasons for filing, income loss due to illness, and the magnitude of medical debts.
> Many of these folks had mortgaged their homes to pay medical bills, a situation that eventually led to technical bankruptcy.
> Based on this analysis (by three docs and a lawyer from Harvard Med School, Ohio Univ. and Harvard Law School), the incidence of bankruptcy due primarily to medical causes rose nearly 50% from 2001 to 2007 and over 700% between 1981 and 2007.
I think you will agree that this data contain food for thought.
As for Americans getting a lot of bang for our healthcare dollar, we'll that's an unsettling story for another day. But if I needed to find treatment for my child and had a choice of either Tanzania and some U.S. clinic for the "ultra rich," I think I'd choose ... France.
Read that study's definition of "medical cause". Its behind a wall, but I've read that it includes the financial difficulty arising from addictions to gambling, alcohol and drugs; I think a commonly accepted medical expense would be a debt owed to a medical provider, not bookie, bar or coke dealer. Hard to say what their definitions are, but unless I read it I'm not convinced by a description in Reuters or in WSJ. People see what they want to see.
Incidentally, it was published in the same issue that had this study: "Following a Healthy Lifestyle Is on the Decline in the US".
This is actually directed at asterix54, but the thread is too deep to reply directly;
I definitely agree the health care system is approaching fiscal untenability. My problem with the current legislation is that it is, as has essentially been admitted by the administration, health insurance reform. What we need first is true health care reform. We need to study and fix a Medicare/aid system that is single payer and "negotiates" (read: dictates) lower prices, yet still has expenditure variability as high as 30% from region to region with no discernible difference in health care outcome, after controlling for confounds. We need to address the broken fee for service system that vastly underpays primary care physicians and somewhat over pays specialists, especially surgeons. Dr. Atul Gawande made the point that surgeons in an OR debating between ordering or not ordering a test don't think about where the money comes from, government or insurance. However, even the best surgeons may lean toward ordering an expensive test they are almost positive is unnecessary but is justifiable and a money maker.
These are the types of decisions and practices that are driving the health care into an untenable situation (although I don't think we're there yet). Why put the cart before the horse? There's a reason the Mayo Clinic sent a letter to the administration disagreeing with current reform efforts. The government has the power to reform Medicare/aid practices now. And, because most insurance payment schedules are based in some way on Medicare/aid payment schedules, this type of reform may even preclude most of government involvement in insurance.
After that, I do think some insurance changes are necessary, rescission, one of several pro-reform battle cries, actually occurs less than most seem to think despite the anecdotes one encounters everywhere. Instead, I would love to see insurance detached from employment, and the state restrictions deconstructed (I've heard some insurance companies are written into state law). This would encourage an actual market, with the same pressures that drive all the other insurance markets that seem to work fine in this country.
Anyway, I wanted to show there are many conservatives that have thought this through, and are currently furious at our representatives (Republicans) for not formulating a plan of their own (other than Jindal, I guess). Even more infuriating are the Congressman saying things like "If we beat Obama on health care, he won't be able to do anything else." Both sides do it, but it's deplorable. My 2 cents
I find the passionate Town Hall outbursts (Michael Wolff calls them “paroxysm of raw emotion,” http://www.newser.com/off-the-grid/post/239/the-nutters-are-coming-to-get-you.html ) bizarre.
Sincere but bizarre.
Have those with insurance never experienced the indignities of the current health-care system? Have those without insurance ever worried about how, exactly, they would pay for what they might need to stay alive?
A.H.: you are right when you say that “The flip side of this magical thinking is that we are extraordinarily sensitive to any suggestion that someone is taking away something we think is good for our health.”
But I also wonder if the irrational sensitivity is less about what government will take away than it is about what government is giving to others who are, in magical thinking, less deserving. The angry, forceful questions about “illegal” immigrants in ERs, and abortion coverage have nothing to do with what the quivering questioners will keep or get.
Verghese makes a good point. The plain truth that our healthcare system is a scandalous, inefficient, profit-driven mess is, to some extent, beside the point. The changes that are required are unfortunately fraught with political associations, largely irrelevant though they may be. And make no mistake, this brouhaha is really much more about politics than rationally reforming the system. If you try to talk facts, you are accused by the Right of being "smug," "condescending" and, inevitably, a "socialist." As such, progressives need to get more emotional, more visceral and a little more clever in packaging the message. Plain, old-fashioned earnestness has already been tried. It does not work. Time for Plan B.
I think that most of the people on this comment thread are missing a point that will start to show it's face as opposition to Obamacare continues: These Townhall protests were set off by the 1,000 page piece of legislation thrust upon the public and rushed towards a vote in both houses of congress. However, the anger behind the protests is clearly being driven by an undercurrent of intense mistrust between a large swath of the voting public and the out of control Obama administration. People are showing up in droves at these meetings because until now there has been no single hot-button issue to react to en masse to slow the expansion in government in D.C. A fire has been lit, albeit one that may not last long. This issue affects all, hence the energetic involvement.
One multi-hundred page piece of legislation after another has been churned out by this administration since inauguration day and approximately half of the country saw it coming long before the month of January 2009. This is the natural reaction to a president and a congress that is out of touch with a big part of the American public. This is the natural reaction of people who are sifting through the complex, twisted and complicated lines of the health care bill (among other bills) and saying to themselves "Are you kidding me?" Is a 1,000 page piece of legislation that nobody can explain and nobody can agree as to what the ramifications will be, really what is best for the American people? Many think not. Keep putting the breaks on the runaway train in D.C. and thank goodness for the protests.
Did I mention the expenditures in one of the health care legislative drafts that included subsidizing broadband access in the Mid-West? Might that not piss people off too?
I think this is an excellent point. I think an appropriate counter to the claims that "a single payer system isn't even on the table" is the fact that, neither was a specific cap and trade bill, until that week when the Democratic leadership decided it was on the table, and voted on it a few days later. I understand and give credence to the concerns that Republicans are trying to slow the process in order to kill it, because undoubtedly some are. But I think the majority of the constituents protesting are genuinely concerned that, among other things, this huge piece of legislation written by multiple disparate interests might have a few things worth examining and changing now, before the inevitable bargain with the Senate version. The administration has been less than forthcoming on the promised "transparency", evidenced by the campaign promise of posting any passed legislation on the internet, open for comments, for 5 days before signing. Instead we get an email address where we can "report any misleading statements about health care reform legislation."
I agree with Cranialoutlet that a large portion of the public outcry might be attributed to the general sense that a "sacred cow" of sorts is about to be sacrificed on the altar of "Washington liberals know what's best for us". It is clear that burying reforms in thousands of pages of legalese is NOT the most effective way to create lasting and credible systemic reforms. Precisely because this issue is one that so thoroughly and intimately penetrates the lives of every citizen, it is necessary to illuminate the public discourse through a marriage of facts and emotional appeal, elements not as mutually exclusive as some seem to believe.
So what do we do?
For starters, the discussion needs to take place in a public atmosphere cleansed of the sense that Democrat-written reforms are already a foregone conclusion. For an issue this intimate and all-encompassing, bi-partisanship is non-negotiably imperative. Similarly, the discussion will not be possible without opponents to the current bills believing that anything other than the status-quo need be torpedoed as "socialism". We need not scare the insured that they
stand one step from possible financial ruin, nor do we need to cynically condemn the uninsured as "undeserving" because they've failed to sufficiently pick themselves up by their bootstraps.
Deficits? The Bush administration correctly calculated that deficits, however distasteful, are sometimes a necessary evil when american lives are at stake. Well, it seems to me that providing quality pre and post-diagnostic care is at least as connected to protecting american lives as spending trillions to prevent terrorist acts in a theoretical future. It isn't the cost of saving lives through these initiatives that is the problem, but rather the cost of less-ciritical programs that must be eliminated to pay for our priorities..ie...our very lives. You want to pay for a NEW and QUALITY system that is sustainable for all? STEP 1 - Emphasize prevention...an ounce of prevention is worth a pound of cure. Period. STEP 2 - CUT other PORK. Period. Corporate welfare? CUT it! Farm subsidies for Pa and Ma Kettle? CUT it! Save the worm subsidies for wildlife refuges in Speaker Nancy Pelosi's district? CUT it!
Another tremendous obstacle in most public debates continues to be the potential to distort statistical data to suit particular agendas. If one decides to use the aggregate number of "crack babies" born within a nation as a litmus test to gauge a nation's quality of healthcare, then nations in the jungle with no access to crack will surely seem superior. Conversely, one could make a system that encourages appointment-in-advance preventive screenings look like it results in average waiting time for doctors of weeks or months, if one chooses not to make the distinction between preventive and emergency visits.
There are ways to approximately compare apples to proverbial apples, such as how much it costs to treat X disease in country Y, as opposed to country Z, to achieve the same outcome. But rather than merely emulate any system that scores better on certain scales, it might be helpful to ponder completely new and innovative approaches to systemic weaknesses exposed by these global comparisons.
“I believe that every free-born man has a clear right, when he is ill, to seek any sort of treatment that he yearns for. If his mental processes are of such a character that the theory of chiropractic (seems plausible to him then he should be permitted to try chiropractic . . . .To preach any contrary doctrine is to advocate despotism and slavery” (H.L. Mencken in Chiropractic, 1919). In the same essay he also said he that Chiropractic (and I think today we might extend that to include homeopathy, ayurvedic, acupuncture, and "integrative" medicine of all sorts) is buncombe and the fools that practice such ". . . “are badly wanted in heaven” (also Mencken--same source).