by Stuart Pickell, MD, TCMS President-elect
This piece was originally published in the January/February 2022 issue of the Tarrant County Physician. You can read find the full magazine here.
Our nation is beset by radical polarization and erosion of trust. On Saturday, February 19th from 8:30 to 1:00 p.m., Tarrant County Medical Society’s Ethics Consortium will present a CME symposium entitled “Healthcare in a Civil Society 2022” that will explore the factors that have contributed to our present state of bifurcation.
While political discourse has always been polarized, our ability to voice divergent points of view and find common ground has been a hallmark of American democracy, and an important reason why it has worked.
Healthcare policy has been one topic on which we have been able to find common ground. Starting in World War II, trade unions sought alternatives when Congress passed the Stabilization Act (1942), which prohibited employers from increasing wages to their employees. Successful lobbing led Congress to include a provision making health insurance tax deductible to employers, but not to individuals.1 In 1965, Congress established the Medicare and Medicaid programs, thereby creating basic health insurance for the elderly and poor. In both cases there was broad bipartisan support. When Congress passed the Affordable Care Act in 2010, however, not a single Republican voted for it. What happened in those 45 years that transformed healthcare policy from something broadly bipartisan to incredibly divisive?
One reason Medicare and Medicaid achieved bipartisan support is that in 1965, Congress looked and behaved differently. John Dingell, a 60-year congressman from Michigan, noted that when he began serving in the House in 1955, members saw themselves first as representatives of their state, second as representatives of an institution (the House or the Senate), and only third as members of either party. By the time he left Congress in 2015, the order had reversed.2 Furthermore, in the 1960s, we still had left-leaning Republicans and right-leaning Democrats. Crossing party lines was common. People with opposing viewpoints knew each other because they met together, ate together, and socialized together. The result was good legislation achieved by compromise and trust. This is no longer true. While some congressional leaders continue to work well with people “across the aisle,” this has become more the exception than the norm.
If the political process has created a breeding ground for polarization, the advent of “news on demand” has catalyzed it. People can get the “news” they want when they want it from the sources that provide what they want to hear. There is no incentive for these sources to present complex issues in a balanced or nuanced way. Why should they?
By 2014, Pew Research noted that 92 percent of Republicans were to the right of the median Democrat, and 94 percent of Democrats were to the left of the median Republican.3 It’s certainly worse now. While appealing to their bases, each side fails to take into consideration the fact that, in science, what we believe to be true today may be wrong tomorrow. Political leaders have conveyed or distorted information and created policy based on an incomplete understanding of the facts to the detriment of public health. And the medical community hasn’t always been helpful. Our failure to distinguish accurately and consistently between what we know, what we think we know, and what remains a mystery about the current virus, has undermined our messaging to a politically charged and skeptical public.
The public’s reaction to the COVID-19 vaccine serves as a classic example. Many people allowed their position regarding the vaccine to be informed by political narrative rather than by scientific evidence. Lost in the rhetoric is the amazing story of Hungarian-born biochemist Katalin Karikó who, while working as a researcher at the University of Pennsylvania over 25 years ago, had a vision that mRNA could be leveraged for therapeutic effect. Over the last 15 years she nurtured that vision and refined the technology until it became a cure in search of a disease. With COVID-19 it had its disease. How do you put that in a sound bite? And if you manage to, how does it make it past the political noise?
It would be disingenuous to blame this polarization on any single event like the Affordable Care Act or the COVID-19 pandemic. They didn’t cause it. Metaphorically speaking, they are the hurricane that washes ashore and, in its aftermath, reveals off the coast a long-lost pirate ship. The pirate ship was always there, under the surface, but now everyone can see it.
But there is hope. Patients continue to trust us – the physicians they know – even if they are wary of our media representatives. In fact, because physicians adhere to an ethical code dating back over two millennia, we continue to be among the most trusted professionals in modern society, often jockeying with nurses for the #1 position.4 We have a fiduciary responsibility to our patients, and they know it. Our ethical obligation is to serve them – not an insurance company or a hospital, and certainly not a political party.
I call attention to this issue because it will be the focus of Healthcare in a Civil Society 2022. This CME event will explore how we got to this point and begin to chart a path forward. Kasey Pipes, a public affairs consultant, presidential historian, and former speechwriter for George W. Bush, will help us identify the factors that have contributed to polarization. Pete Geren, former congressman and current president of the Sid Richardson Foundation, will again moderate the expert panel that will address:
- How the media influences public opinion and promotes polarization and mistrust
- The impact of polarization on the public trust and public health
- How polarization creates conflict (e.g., in how people refer to science as an absolute) and how to manage it
- How people in health care professions can mitigate the effects of polarization within their spheres of influence when talking with patients
The event includes a breakout session allowing participants to explore the topic more deeply in small groups.
One thing I enjoy about being a physician is interacting with a diverse group of people. Part of the challenge for me is understanding where my patients are coming from and meeting them where they are to help them achieve their health goals. I make a concerted effort not to see my patients as “cases” – as diseases to be treated – but as people to be valued and loved. I think this ethos underlies our vocation, and it’s one of the reasons why medical professionals continue to enjoy the public’s trust. And it’s this trust that will help us neutralize the polarizing influences our political rhetoric has on public health. Join us in February and help us explore this important topic more completely.
About Healthcare in a Civil Society
Healthcare in a Civil Society is an annual forum sponsored by the Tarrant County Medical Society’s Ethics Consortium. It seeks to engage leaders of varying perspectives in a civil conversation focusing on the healthcare issues that are important to our community devoid of the rhetoric that often undermines these conversations.
References
1. Feldstein, Martin and James Poterba, editors. Empirical Foundations of Household Taxation. National Bureau of Economic Research. University of Chicago Press, 1996. p. 137. ISBN: 0-226-24097-5. http://www.nber.org/books/feld96-1. Conference Date: January 20-21, 1996.
2. Seib, Gerald. “Gerrymandering Puts Partisanship in Overdrive; Can California Slow It?” Wall Street Journal. November 29, 2021. Seib paraphrased Dingell’s comments in the article.
3. Pew Research Center. “Political Polarization in the American Public: How Increasing Ideological Uniformity and Partisan Antipathy Affect Politics, Compromise and Everyday Life.” June 2014.
4. Saad, Lydia. “U.S. Ethics Ratings Rise for Medical Workers and Teachers.” Gallup. December 22, 2020. https://news.gallup.com/poll/328136/ethics-ratings-rise-medical-workers-teachers.aspx. For what it’s worth, members of congress are jockeying with car salespeople for last place.
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