Small fixes for enormous problems

Two quick anecdotes.

(1) In the thick of the health care reform battle, in January of 2010, when Sen. Brown was elected and no one knew what was going to happen, I was home one night after dinner ranting (as I am wont to do) to my wife. At the time, this was all I could focus on. I was on radio quite a bit talking about health care reform, I was writing like a madman about health care reform, I was speaking about health care reform, I was going on TV to talk about health care reform. I read about it all day, I watched TV shows debating it at night, I listened to experts scream about it in the car. I thought it was all anyone cared about.

And then my wife interrupted me to ask, “what’s a public option?”

(2) Just a week ago, my mother called me early in the morning. My parents live on the west coast, so I knew something was wrong. When I answered the phone, she told me she’s been up all night worrying because she’d been told, by people she trusts, that Medicare will be gone by the time she turns 65 in two years. I had to talk her down and convince her that there’s not a single person in elected office who would let that happen.


These are highly educated, smart people. They have both worked in the medical field. One of them lives in the same house as me. And yet, their grasp of what I (and many of you) would consider a basic part of health care policy is not close to complete.

And why should it be? They have plenty of other things to do, and in their areas of expertise, I am equally limited. Why do we think everyone gets this?

One of my good friends is in commercial real estate. I have no idea how that works. When he starts talking about buildings and deals and how regulations impact his company, I shut up and listen.  Another friend runs some B2B aspects of a large trucking company. He’s probably laughing right now at how I’ve mangled that description. Another owns a number of pizza stores. I don’t even begin to grasp the million facts and timetables he’s juggling at any one time.

I’m not an expert in those areas, nor do I have the time to be. I can buy pizza, I can live in a house, and I’m happy when the truck delivers my package, but I don’t know the inner workings of how those things happen. That’s not because I’m stupid. It’s because I’m a busy guy, and learning how those things work is complicated, hard, and would take the time of, well, a full-time job.

Yet we somehow believe that everyone should be expert in health policy. They’re not. So many people have no idea of the intricacies of insurance, how reform might affect them, and how it will all hold together. Moreover, when trying to approach the media for information, they’re treated to a “one side said this/other side said that” feast that mostly focuses on politics and not on substance. So it’s no wonder that my own wife can get frustrated and check out of the whole process, and my own mother can become so confused that she thinks her Medicare might be taken away in two years.

And that is why I can’t get too excited about a nutrition label for health insurance. Go and look at the full version and tell me how anyone is going to actually use this. At my own job, the other doctors with whom I work don’t even understand  the much simpler versions we are offered each year for our own insurance.

We in the health policy bubble believe that everyone understands this stuff. We believe that everyone cares about this stuff. I’m not sure they do. Things are pretty rough out there, and they’ve got plenty of other things to worry about. This is just my opinion, and I’m willing to be swayed by evidence, but I just don’t think that these kind of small fixes are going to do anything about a huge problem. I think they comfort those of us in the bubble, but they’ll do nothing for the vast majority of people out there.

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