The Dialogue Venture

Posts Tagged ‘health insurers’

The other day I felt sympathy for health insurers.

This almost never happens. Far more often, I fall into the trap of blaming them for all the brokenness in the U.S. healthcare system. Insurers and I have a history, and it isn’t pretty.

Then I started helping a loved one select a health plan. This person has pre-existing conditions, requiring treatment options that—even though well established in the medical community—some insurers have apparently never heard of, let alone cover.

At one point in the process, the old rage began to boil up in me. Suddenly, who knows why, my mind flashed on all the challenges the insurers face: paying for millions of expensive tests and procedures for millions of people with a pot of money that, however large, is also finite. Perhaps this was more about a broken system than about one corrupt player, or set of players, in that system.

To be sure, health insurers must bear some responsibility for the system’s vicious cycle. But many others contribute as well: doctors who order tests to avoid malpractice suits, lawyers who push for extravagant awards, pharmaceutical companies whose necessarily high-risk research pushes drug prices higher, all of us just for living longer and needing more of these tests and procedures. None of these parties is necessarily evil, or maybe even blameworthy. More to the point, we’re all caught in this system that no longer works on a grand scale. We all do what we can to make our corner of it work. Sometimes we do this for noble purposes—for the benefit of others.

Why do I bring this up now? As a cautionary tale.

We can commit our whole lives to dialogue. We can prepare our souls to be people of reconciliation, of peace, of reaching across divides. But the slings and arrows of life’s outrageous fortune keep on coming. We get wounded along the way. It is so easy, no matter who we are, to react with anger and bitterness and recrimination.

That can be a good thing. Some systems, organizations, and people are thoroughly corrupt, and justice demands that we stand up to them in anger. But I think it’s important that we pay close attention to the slings and arrows and take away all the lessons they hold. In my case, this meant pushing through “the evil insurance companies denied me coverage” to the reasons behind denials like this, and the ways we can reform the system so people have access to the coverage they truly need. Often, when we go through this process, the reality of these lessons gives us a larger perspective—one that avoids the simplistic trap of blaming a single scapegoat.

What do you think? Am I being too soft on health insurers? Have you ever scapegoated someone or something when the issue turned out to be much deeper than that? How did you find your way through it?

Can the way of dialogue make any impact on health care reform? Consider its effect on one human mind (mine) and tell me what you think.

When the latest version of the debate heated up in earnest, I had no grasp of the issues whatever. So I started reading, listening, and thinking—and discovered some interesting insights. One article, written by the president of a regional health center, came out in favor of single-payer as a way to cover everyone and drive costs down. On The NewsHour with Jim Lehrer, Richard Armey (one of my least favorite politicians) talked about allowing insurers to compete across state borders, thus giving people more choice and driving costs down. I read about the Massachusetts model and what it might teach us. Because I learn by writing, I also wrote an article to ask questions about the issues.

At first, and through most of this process, I’ve leaned in the direction of single-payer. Now, after hearing other good ideas, I’m not so sure.

And that’s the point.

Preparing for authentic dialogue means absorbing ideas and perspectives from many parts of the ideological spectrum, even—especially—those that drive us crazy. It’s critical to hear from conservative and liberal, doctors and hospitals, government officials and poor people, those who have been denied coverage and the insurers that denied them.

This is hard work. It asks us to set aside our vested interests and emotional stakes. For instance, I resent the health insurance industry because a family member was denied coverage for desperately needed treatment. But to sort out issues as complex as this, I have to set that resentment aside…and listen.

How do we get to the point where we can do this? By cultivating certain attitudes of heart, especially openness to others—and the willingness to take on the risk that such openness involves. When we absorb other perspectives and listen to other people, we might find out we’re wrong. In my case, I might learn that health insurers include good people with honorable intentions. If I do, I’ll have to let go of my resentment permanently.

Which, by the way, will bring more peace to my soul and more generosity to my spirit.

If we do this hard work—if we approach the health care debate with an open heart and an inquiring spirit—we give ourselves the chance for good ideas to emerge. Good ideas sometimes lead to good policies. By contrast, the current climate of shouting and misinformation actually distracts our attention from listening, weighing alternatives, striving for consensus, and letting good solutions emerge.

We have nothing to lose by applying the way of dialogue to health care. And we have much to gain—maybe even a workable, compassionate policy, worthy of the name reform.