Some thoughts the day after the election

This is going to be long, but I hope you’ll bear with me. I have a lot on my mind, and I have some thoughts I’d like to share with you. Clearly last night was a shock for many, many people. I’m being bombarded with questions from family, friends, and people I don’t know, about what will happen, both with health care and America at large. Rather than try and handle those queries piecemeal, I’d rather make use of the blog – something that’s been hard to do during the election.


I have written more than once on this blog that “we do not strut” when things go our way. We don’t “celebrate”. We acknowledge the policy gain and then we get back to work trying to make the health care system of the United States better than it is now.

The same still holds when things don’t go our way. We don’t sulk. We get back to work trying to make the health care system better


The last day or so has been a lesson in humility. As the ACA passed, I scoffed at those who argued that it was “shoved down our throats”. After all, it had required a supermajority in the senate, the house, and Presidency to pass it. When legislation is passed that I disagree with in the next few years, I’m sure I’m going to have moments where I feel it’s been forced on us. I will think it’s unfair. Clearly, that will be somewhat hypocritical.

Similarly, I have argued repeatedly on this blog that government is us. There is no “them”. I’ve also said that we live in a democracy, no matter what those who opposed the ACA said. I argued that this is how a free society works. We pass laws and see what happens. If people don’t like the outcomes, they can elect people who agree with them to change the law.

That seems to be what has happened. If health care is changed in the coming years, the same will still hold true.I expect that in 2017, many changes will come to the United States. Clearly, the power is there to dismantle the ACA. There are likely votes to replace it as well should the Republicans desire. We’ll see what happens. If people don’t like the outcomes, another election can change that again.

I don’t want to minimize what might happen in the interim. Clearly, real people will be affected by these changes, in real ways. I wish no one was ever harmed by policy. I know people are afraid. I get that. But this is how America works, for better and for worse.


Over the past few months/years, I have felt that some of my more conservative colleagues/friends were living in an information bubble. The fancy word is epistemic closure. They surrounded themselves with people who felt similarly and got their information from sources that confirmed their prior assumptions. I, on the other hand, prided myself on trying to get my information from a much more diverse group.

I also have the benefit of living in Indiana. I live in “real America”, unlike many of you coastal elites. I knew long ago that my state would go red. I have friends – good friends – that I knew were going to vote for Trump. I thought I was therefore protected from the same epistemic closure that I saw in others.

This election has shown me how wrong I was. Even with a “wide net”, nearly every source I trusted believed that Clinton was going to win. I was clearly in an information bubble myself.

I’m going to have to spend some time thinking hard about how to change that. I’m also going to have to start to question the methodology of polling in general. Clearly, the science has value. But something has changed in the US so that the old methods don’t work. Almost no one saw this coming. That’s a huge problem, and if we don’t spend some time fixing it, there’s no point in all of those models next time.

But I’ve been through this before. I thought I’d learned my lesson, but clearly not well enough.


Way back when I was a fellow, I was pretty conservative politically. In 2002 (I’m pretty sure), I was at this small fellowship conference in Chicago, attended by about 20 of us in two sites from the RWJF Clinical Scholars Program. The topic of the conference was “universal health care”. We were ridiculously privileged, and the group of speakers they got to talk to us was way, way above our paygrade.

A few of the speakers were true single-payer believers. I thought they sounded crazy. I was sure that there was no way that physicians nationally would support this hippie-idea. I was positive that these experts were flat out wrong.

But I was also training to be an empiricist. So I set out to do a massive survey of physicians, to gauge their support for national health insurance. When the results came back, it turned out I was wrong. More physicians supported it than opposed it.

It’s hard to describe how much this affected me. It was the first time that data – my data – showed me that everything I thought was true was incorrect. It shattered my world view. It made me question everything, and wonder what else I was wrong about.

I wound up looking into other policy issues, finding out that I was wrong about so much. My politics somewhat flipped. More importantly, it changed what I would do with my life. It’s why I write – here, and at the Upshot, and on Healthcare Triage. I want to understand the world, and I want you to understand the world – as it really is – so that we can make things better. I still believe that we can use science – hard and medical and social – to do that.

The world has shown me that I was wrong about a number of things in the past few days. So be it. I’m going to try and figure out why. I’m going to try and do better.


I started blogging on September 12, 2009. You should go read my first post. I could probably repost it today, and it would still be relevant, even more so after yesterday. The world is going to change. There will be tradeoffs. It will be up to people, on both sides of the aisle, to talk about policy proposals and changes in terms of the benefits and harms. That’s what TIE was made for.

It’s what we do, especially with respect to health and health policy. We will continue to do that. We will endeavor to live up to that promise to be a trusted voice that offers a point of view grounded in data and evidence.

I’m not a pollyanna, and I can be massively cynical. Even so, although it may not always be clear, I’m a true believer in America. When President Obama talks about the promise of America, and the arc of history bending towards justice, it resonates with me. I’ve felt that way for a long time.

At the end of that conference on Universal Health Care in 2002, after I was all-fired-up and hatching a scheme for the survey, the organizer announced that a little-known state senator wanted to talk to us. He had a special interest in health care reform. We’d spent the day listening to national luminaries, huge experts in the field; I remember we were actually a bit annoyed at having to listen to a local politician.

I wish now I had paid closer attention, of course. It was Barack Obama. He spoke to the small gathering, and I was too full of myself, my importance, and what I was already sure was right, to listen to him closely.

I regret it to this day. I’m somewhat ashamed, to be honest.

Let me say this for the record: President-elect Trump will be my President. I may not always like everything he says or does, but from this moment on, he will be given the same respect in my writing that I afford President Obama. I want him to do well because he represents my country, and his actions will affect my fellow citizens, my state, and my family. I hope he surrounds himself with knowledgeable advisors, especially when it comes to health care. We should applaud their commitment, and support them in their efforts to serve our nation.

I am sure I will not always agree with them. But I will remain civil, and I will try and convince them to do what I think the evidence says is right.

I hope you’ll all join me in that effort.


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