A few weeks ago, I gave a guest lecture to a class of grad students from the School of Public Health at the University of California, Berkeley — it was so much fun! Public Health (PH) 116 is a student-driven class, and their curiosity guides the topic and speaker list every quarter. While these are students from all over the university, and not just public health, it’s safe to say that most of them want to make the health care system work better.
This semester, they invited me to come and speak on healthcare policy. While I am not a policy expert, I do have a working knowledge of the healthcare system, the role of law and regulation, and most importantly, the need for patients to be directly involved in policymaking.
The first thing I tell students about the health care system is that I don’t demonize any parts of it. An old boss taught me to say, “It’s not the health care system anyone would design,” which is so true. It is, however, a health care system born of organic need for services, innovative treatments, access and equity, and the trade-offs are happening all the time.
(NPR named their health care policy podcast “Tradeoffs” for a reason. It’s so good!)
Personally — and there’s nothing more personal than health care — I depend on the whole system. I have multiple advance care practitioners, so I’m not going to talk bad about doctors or nurses; I take medication every day and every vaccine I can get, so I’m not going to talk bad about pharma, and I’d be scared to death to live without health insurance, so I’m not going to talk bad about them either.
All to say: thank you to all the providers who keep me healthy, the insurers who help me manage costs, the hospitals who are there when I need them, and the scientists working away on the next generation of life-saving drugs. The first thing to accept is that there are many good people and organizations working in a flawed, complex, interdependent and hard-to-change system.
I told the students if they want to improve health care, it helps to understand that in the U.S., we don’t have a health care system, we have a health care marketplace.
Before the real experts yell at me, a disclosure: part of my job is to explain complex systems, and one way to do that is to start by oversimplifying things. Broad brush first, then detail and nuance.
A smart friend of mine put it this way: In the U.S., we have not decided whether we think health care is a utility (services available to everyone) or a marketplace (individuals buy what they need and can afford). To really over-simplify things, most health care policy is about balancing the need for expensive services to be available to everyone, regardless of ability to pay.
Most of the complaints about the health care system are valid. We’re also challenged by the fact that a lot of our health issues have root causes in the world — in other words, we’re sicker before we even walk into the doctor’s office. Racism, sexism, lack of access to affordable, nutritious food, pollution, stress... it’s a lot.
The Washington Post’s package about the decline in U.S. life expectancy is a must-read.
I told the students that too often in policymaking circles, the different parts of the health care system argue amongst themselves about who to blame for bad health outcomes. But in all of that, they talk above patients, and all without listening to patients.
We need experts who talk like people, and experts who listen to people. If you want to change law and policy, that means influencing elected officials, which means being straightforward, understandable, and person-focused. If you meet a fellow expert, by all means, go down the jargon rabbit hole and have a great time. But if you want to inform or persuade any other human, you must make yourself understood without being condescending.
Are there bad players and bad ideas? Of course. But we can make better, lasting improvements when we understand the problem that “the other guy” is trying to solve, communicate clearly, and collaborate for progress.
Good luck, PH116!