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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