Health care reform protests and how fears and beliefs are exploited

by Abraham Verghese, MD

The unfortunate politicians who have braved town hall meetings 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.

Abraham Verghese is Professor and Senior Associate Chair for the Theory and Practice of Medicine at Stanford University School of Medicine. He is the author of Cutting for Stone and blogs at The Atlantic, where this article was originally published. It is re-posted here with the author’s permission.

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  • Doc99

    The same government that failed miserably to run a Cash for Clunkers program is in the process of failing miserably to enact any reform. Now that the debate has been framed, the question Americans are rightly asking is SHOULD healthcare be reformed and that truly is unfortunate. By attempting to establish yet new layers of faceless bureaucrats between patients and their doctors, the government has found the window’s closing. By insisting on layers of new taxes, or insinuating the IRS into healthcare, the government has helped turn the ire of the public away from the outrages of predatory insurance companies and onto the government itself. It has not been a pretty summer.

    It’s not too late, but as Yogi Berra once opined, “It gets late mighty early around here.”

  • http://www.futurewaredc.com Chuck Brooks

    Might have helped if the politicos at least read some of their own stuff.
    Chuck Brooks
    FutureWare SCG

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Agreed, Chuck. Most of these politicos have not read what they want to legislate – one dimwit even said he wasn’t inclined to do so – because he’d need a lawyer to explain it to him.

    “Yes, I know the audiences were marshaled and recruited to shout down the speakers. ”

    Oh really? You KNOW that? Every single attendee of these forums was a malleable schmuck?

    Professor, I can assure you I’m not “rabid”. I’ve more-than-paid my dues on the front lines of medicine (and I’ve not gotten “rich” doing it). I can tell you that there’s a whole lot wrong that no one is even talking about fixing.

    I want reform. But I want REAL reform. I want reform that does not turn me into a patsy and my collegues into indentured servants – reduced to practicing from cookbooks. I want reform that gets the lawyers out of the exam room. I want reform that protects medical whistle-blowers. I want reform that fixes and standardizes medical peer review. I want reform that holds healthcare executives & hospitals (especially “non-profit” ones) just as accountable for their decisions as doctors. I want reform that holds patients responsible for their lifestyle decisions and medical choices.

    I want reform that does not force the productive/responsible segment of the population (the one that has always paid the bills that kill) to suck up the cost of “universal care” for those who have not acted responsibly. I’d like to see reform where the government can acutally manage it’s way out of a wet paper bag – and effectively oversee the programs it already has (before we dump a whole lot more on the system).

    I’d love for the politicos to get down to the nitty-gritty. I’d dearly love for them to have an appreciation for the details that, if ignored, can put we ordinary folk in court for years (if we can afford it) trying to discern what the law really meant. And OBTW it would be real nice if these lawmakers could conjure up some inkling of the unintended consequences of their actions.

    I’d like for my President to get off TV and get in the conference room and start extending his hand to those who are brave enough to tell him what he doesn’t want to hear.

    And I’m still waiting.

    It’s not “irrational” to expect or ask for these things – and it’s not “fear-mongering” to challenge the current mindset amongst those currently in power – who are, at the moment, choosing to lecture, pontificate and scold citizens who care enought to make a stand.

  • Evinx

    Dr Johnson is exactly correct. This article – and many like it simply state – we need reform so let’s support this reform bcs we surely need reform and therefore, let’s get behind and support the reform that the President says we need. Healthcare reform should be about the details and making them economically viable. We do not need another failed program, ie, war on poverty, Amtrak, Fannie + Freddie, etc.

    As Chuck and Dr Johnson urge, the politicos should at the very least read the bills they are about to vote on. Fat Chance!

    I have contacted my Congressman 5 times to pledge to personally read any bill prior to voting on it. A very simple request – and guess what? Never replies to this question. I just get letter about how they appreciate my contacting them and their standard letter for the subject du jour. Refuses to say a yes or no. That is how we get bills written by lobbyists who work with congressional staff – and both parties do it. Very, very sad!

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Evinx, your first mistake with your Congressman is having the expectation that he/she will respond.

  • Rezmed09

    We are so passionate about this issue precisely because we are a self-centered and materialistic nation. Our concerns are really more about our individual spending ability and taxes (less taxes – its what started the Revolutionary War), our mobility – the price of gas and our many cars, our right to bear arms (now in National Parks), and other personal liberties than any concern about the “common good.”

    I cannot imagine we will have significant health care reform in the near future. It is just as likely as our fixing the budget and trade deficits for the futures of our children.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Interesting theory.

    I’m curious. Are you saying that the concepts of individual liberty and adequate representation in government (i.e. freedom from imperial/despotic rule) that “started” the Revolutionary War (and birthed this country) did not work out for “the common good”?

    And the Founding Fathers (and Mothers) were a bunch of selfish goons?

    I acutally CAN (get it?) imagine healthcare reform. But it’s going to have to incorporate a lot more of the revolutionary ideals and notions that originally founded this country – as opposed to what defines “the common good” now.

  • Anonymous

    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 don’t take any such things or have any such things at home. Am I really that unusual? The last time I had any medication was a vaccine nearly a year ago.

  • abower

    A few comments: a recent study found that Americans spend 34 billion on alternative health care. So Americans are willing to spend on healthcare if they perceive a need.
    Many of those complaints at the townhall meeting were not in regard to the healthcare reform but were directed at government spending, socialism, bailouts and other problems our nation is facing. Finally most of those townhall meeting were on weekdays. Yes they were usually after five pm but by then there was a long line facing those who had just left work. Televisions seem to show a largely senior citizen audience that was very concerned with potential changes to Medicare.