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Posts Tagged ‘healthcare’

Breaking Through Healthcare Rage

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?

Dialogue in Case of Emergency

I was fast asleep when the phone rang. It was a close friend, hundreds of miles away, having a heart attack.

Or so she feared. Given her health history, a panic attack was as likely as heart trouble. Why didn’t she just call 911? Because she has no insurance and almost no savings. Any medical expense could sink her.

I am no healthcare expert, so I did what I could. I asked her to describe her symptoms while I booted up WebMD on my laptop. I read her the symptoms of heart attack and panic attack. We finally agreed she should at least try 911 and make it clear she could not pay for the service.

It turned out well. The 911 dispatcher was a model of calm and compassion. He told her that, while an ambulance ride would cost her, a visit from the EMTs was free. They came, ran some tests, and determined that it was indeed a panic attack. They got her calmed down. Crisis over.

I don’t think of dialogue in the context of emergencies. You don’t want your EMTs thoughtfully exchanging views on heart function when yours is in full crisis mode. Yet the more I pondered this incident, the more I saw the elements of dialogue in it.

Consider the challenges involved here. The conversation with my friend required my full attention. I had to listen carefully and precisely to what she said: not just the words, but the feeling and thinking behind them. Together, we had to talk through—as calmly as possible—what was happening and the options for action. All of this needed to come from a place of calm within me, so I didn’t add to her stress.

Listening. Attention to the moment. A full focus on the other person. Thinking together toward a course of action. Respect and calm to avoid inflammatory language. All coming from a peace of soul that we have cultivated within us, and with God. Key elements of dialogue as we’ve discussed it here in the past two years.

That messes with my mental categories a bit. Way back when I started writing about dialogue, I worked through a preliminary definition. I think it still makes sense, as far as it goes. But behind the words, I hear a sense of dialogue as something formal, something we intentionally sit down and have. Many practitioners of dialogue think in the same terms: dialogue involves group processes, intentionally convened groups, specific agendas.

All of that is assuredly part of dialogue. But I wonder whether the word dialogue shouldn’t encompass a much broader scope as well. Perhaps it’s less a way of meeting and talking than a way of being—an orientation that equips us to respond in a dialogic way regardless of the situation.

Perhaps, in other words, dialogue isn’t something we do only to determine public policy, or understand other faith traditions, or work out differences with our loved ones, as important as those aims are. Perhaps dialogue is something we live whenever, wherever the situation requires it. Even in emergencies.

What do you think? Is dialogue a set of processes, a formal event, or a way of being as well?

Healthcare Turns Violent

Many pundits and elected officials have condemned the violence of the past week. Have any of them asked whether they themselves contributed to it?

I don’t mean deliberately contributed, of course. Whatever you might think of our legislators and commentators, they do not generally encourage constituents to shoot up offices or mail white powder to their opponents.

But consider the climate that has built up over the past year. Early on in the healthcare debate, public figures raised the specter of death panels. Some encouraged the idea that Medicare isn’t a government program. The dreaded cry of “socialism”—which, thanks to U.S. history, ignites fear and loathing whenever it’s uttered—has come up early and often. So has “government takeover of healthcare.” Indeed, Rep. Mike Pence (R-Indiana) used the word takeover seven times in a short segment on last week’s PBS NewsHour.

Death panels. Socialism. Government takeover. These words shed no light on the specific defects of the legislation. Rather, they carry emotional weight, and the emotion they incite is fear. Fear, in turn, begets anger.

No wonder so many people are so angry. No wonder a few of them, lacking impulse control, cross the line between rhetorical fury and physical violence.

What would have happened if our public figures had cooled the rhetoric and tried to discuss specific proposals? We might have discovered the validity of a whole range of ideas, including those from “the other side.” Voters could have gained a more nuanced view of the pros and cons. Perhaps Republicans and Democrats could have collaborated with each other, resulting in better legislation.

As it is, the fractiousness of the past few Congresses created the climate for the nastiness of the healthcare debate—which, in turn, has had our society running at a fever pitch for more than a year.

Violence is deplorable. Rather than piously condemn it and then return to the language that fosters it, however, our public figures would do better to reconsider the current political climate, the words they use in the public square, and the kind of world we might have if we worked together rather than separately.

Wielding the Key to Dialogue

Previously on The Dialogue Venture, we looked at one of the world’s most misunderstood virtues—humility—and how it holds the key to dialogue. In the process, I boiled down humility to two basic claims about the self: 

  1. I’m only one person.
  2. I am one person.

The first helps us see our perspective as one among billions and, therefore, acknowledge that others’ ideas might hold as much truth as our own. The second reveals the utter uniqueness of our own beliefs, values, and perspectives—and how, rightly used, they could create more robust solutions for the issues that face us today.

Nice theory, right? OK, let’s see how it plays out in the real world.

I knew next to nothing about healthcare in 2008, when the latest hue and cry for reform began to take shape. A single-payer plan made a great deal of sense to me at first. But as “only one person”—and an ill-informed one at that—I could see how limited my perspective was.

So I sought out other voices. Republicans spoke of tort reform to reduce exaggerated malpractice suits, interstate commerce between insurers to boost competition and lower costs, triggers to the public option. Democrats talked about requiring health insurers to cover people regardless of pre-existing conditions or catastrophic illness. As I listened, something dawned on me: all these ideas had merit.

I hadn’t heard anyone say that.

And that illustrates the contribution of “I am one person” to dialogue. I don’t know the technical ins and outs of the healthcare system, but I do have an unusual ability to consider both/and solutions. In a world where either/or is the dominant paradigm, that’s a valuable gift.

So in a grand dialogue on healthcare, or any issue, even non-experts like me have a role to play. The more people we bring to the table, the more gifts and perspectives we have at our disposal, and more thoughtful the solutions that arise.

This also makes humility an essential component of social change. What if a robust policy framework arises from our grand dialogue? As “only one person,” I look at the power of the Congress, the complexity of the bureaucracy, the staggering challenge of swaying public opinion, and I despair. But, in “I am one person” mode, I look at my gifts and realize I can write. So I write op-ed pieces, letters to the editor, and missives to individual legislators. At the same time, I see that I need others with expertise in recruiting volunteers, drafting legislation, and lobbying elected officials—so I join with them to wield exponentially more clout than I could by myself.

In other words, humility opens us to power of we.  

Humility calls us to hear everyone. Humility calls us to contribute what we have while realizing its limitations. Humility draws us together to think and act with power. Imagine what might happen if everyone cultivated that kind of humility within themselves.