The current Republican victory either threatens healthcare access success or saves the day. Perhaps it depends on what ideas you have to form an opinion on the matter. Thousands of people inherit political and controversial opinions from their parents or grandparents. But this is not our grandparent’s America. Leadership today, and ideas to formulate solutions to our society’s most vexing social and economic challenges, must be as innovative as the ideas our forefathers forged to build our constitution. They broke new ground to form a more perfect union.
America needs help in being more perfect today. We need new ideas to help us support new social investments to address our collective responsibility to make sure that our form of government, and the leaders we put in charge, keep a fair balance regarding the social contract that makes us the greatest nation on earth. Perhaps reading the current book “Scarcity: Why Having Too Little Means So Much,” by Mullainathan and Sharif, could help?
Jus about a year ago an important book was published regarding scarcity. We were all probably a bit busy, so it did not cross our minds. Interestingly, the book is about the very social and psychological reality that caused many of us to miss the opportunity. We just don’t seem to have enough time in the day to do the things we need to do to make our life more manageable, more simple and, perhaps, more enjoyable. Without mentioning the dated and overused thought model, “Maslow’s hierarchy of needs,” we are reminded of a person’s lack of efficacy when overwhelmed by environmental stimuli that dictate how we feel and perhaps what we do. Such is the case in this important book on the effects on our minds and how our mind works when confronted by daily challenges. The mind, the book’s thesis goes, has limits (“bandwidth”), and its focus is bound by our fixation on what matters among the many things coming at us. The book is important for public health, healthcare services and health education, for example, because it gives us a less pejorative and judgmental way to look at people misbehaving. Especially behaving in ways that seem irrational, or worse, lazy or undeserving, to us. Perhaps as health professionals, funders, planner and policy makers, we are distanced from the daily lives and realities of those confronted with our well intentioned helping systems and recommendations. It can be daunting and frustrating. This book may give us hope.
Mullainathan and Sharif elaborate on a conception of the haves and the have nots that is nuanced, insightful and perhaps more pragmatic than any construct we have heretofore seen; Yes, in the war on poverty. To be sure, decades have passed since our last great poverty reform (PRWORA, 1996 or Bill Clinton’s Welfare Reform Law). We now have the ACA reform (Barak Obama’s Law). This second salvo on our nation’s efforts to address the needs of the “have nots” is once again putting the poor under the looking glass. Back in the 90s version we were looking at people, being helped, being too lazy and needing to be made to work while getting help in order to get off of the government dole. Millions of people were thrown off of the welfare rolls and when it was all said and done a Government Accounting Office (GAO) report declared that the majority of people remaining on the rolls were ill and not employable. This was an important report, by “objective” pundits representing the federal government; and you would think that would have been enough to usher in healthcare reform to address the urgent plight of this government policy defined and “vetted” group. It wasn’t.
Perhaps due to our national political discourse and the focus on levels of unemployment that could not longer be explained by the “lazy people on welfare” phenomenon, the nation began to focus on working people, many who were not faring much better than people on welfare. The struggling middle class and the “deserving working poor” became the popular political constituency. The increasingly divided electorate called for new issue that could wedge open the door to a new group that could tip the electoral balance. This need fueled to drive for an electoral strategy focus on new votes and created the conditions and demand for strategies promising to move this demographic to the polls. Enter today’s healthcare reform scenario.
Perhaps this is why healthcare reform remains a political fight with uncertainties and future possibilities for failure. Just as the end of the PRWORA’s success, in throwing the poor of the welfare rolls, may now echo the present reality where we will have disrupted thousands of families’ lives, only to throw them off the insurance rolls.
“Scarcity captures us because it is important, worthy of our attention, but we cannot fully choose when our minds will be riveted. We focus on scarcity even when we do not want to. We think about that impending project not only when we sit down to work on it but also when we are at home trying to help our child with her homework. The same automatic capture that helps us focus becomes a burden in the rest of life. Because we are preoccupied by scarcity, because our minds constantly return to it, we have less mind to give to the rest of life.”