Better debatesAugust 5, 2019
If you are like the overwhelming percentage of Americans, you did not watch the Democrat debates. What you have heard are soundbites and what you have seen are out-takes. The news cycle has now fully moved on and in the end there is this: we need better debates.
What would make for better debates? Let’s start with an actual debate format. Ten people cannot debate. They can play basketball 5 on 5 but they can’t debate. That’s not how a debate works. Let them go head to head for 30 minutes so we have a substantive introduction to their policy positions and get a sense of how they engage one on one.
And we need less engagement by the moderator. Let there be extended uninterrupted opportunities for each candidate to present a policy idea and then respond to questions by and critiques from their opponent. Points would be scored and neither Google searches nor viral clips would determine the winner. And while I understand the temptation to suggest that someone not on the stage won or lost the debates, that is ultimately not fair to those who are on stage competing.
Real debates are competitive. They have rules. Those competing practice in advance under the training of coaches. Ask any high school or college student on a debate team.
I wasn’t in debate club in high school. I wish I had been. I think I would have excelled. I read voraciously, I’m endlessly curious, process ideas quickly and turn them over in my mind to see many sides, speak cogently with relative ease, know how to make eye contact and move a crowd emotionally with a story and – maybe most importantly – I’m highly competitive. (Confession: I don’t relish winning so much as I hate to lose. It’s not about beating someone else so much as knowing I could have done better.)
Debate is an important skill in all kinds of careers from management to law to public policy. Debate is also important when we think about how we all engage in public discourse in the public square (largely now taking place on social media which is an inherently poor substitute for genuine conversation where you can look someone in the eye, listen to their argument in depth and respond in thoughtful kind). And in a real debate, the best idea wins.
Therein is the crux of the matter. For our political debates to get substantially better they must center on ideas – and the pitting of ideas against one another – not the people proffering them.
But what exactly do we mean when we say that is our chief concern?
Good healthcare is a good idea. But what does good mean?
Healthcare for all is a good idea. But how do we define healthcare and who is included in the all when we’re talking about the provision of healthcare in nation of 330 million people? Are we just talking about the body or does healthcare include mental and behavior health, addictions and super-longevity? What level of care is going to be provided, to whom, at what cost? How are providers, drug companies, hospitals, doctors, nurses, ambulance drivers, pharmacy and lab techs, medical device manufacturers, people to translate into dozens of languages… going to be paid – and by whom, through what process? Additionally, in a nation the geographic size of the United States of America, how will everyone actually have access to similar levels of healthcare with similar immediacy and who will cover the cost of patient transport and lost time at work when families have to travel considerable distances to access treatment or care for loved ones? Is family leave a part of the healthcare conversation or some other public policy? And where does the conversation about research institutions and those developing new drugs and protocols? Where is the incentive to invest in the development of new drugs or medical devices if we remove all the economic incentive for doing so? And how do we protect the conscience of healthcare providers in a time of rapid development in ethically questionable directions? And what happens when consumers demand treatments or drugs contra-indicated but which they believe will alleviate their condition and they sue – needing only to convince a jury of their peers that the customer is always right?
My family – just my family – has needed childhood cancer treatment, heart transplant, brain surgery and care for early onset Alzheimers. Just this week my uncle required medical transport across four state lines following an accident in Georgia over the 4th of July and my stepson had cranial surgery this week at Vanderbilt. I’m writing this in the PICU. Healthcare debates are not theoretical. Real people are dealing with real stress right now. They are accessing care for themselves and their children they know they cannot afford. They are incurring what will become crippling debt that will lead to ruined credit, foreclosure, bankruptcy, homelessness, divorce and despair. But there’s no menu of costs when a provider presents the options as “this will save your child’s life” and “if you don’t do this, your child will die.”
I had a conversation with a parent in the Ronald McDonald room just a day ago. Exhausted but unable to sleep she had literally worried a hole through the edge of her shirt with her index finger and thumb. Without disclosing anything overly personal, suffice it say her teenage daughter who just last week was practicing with the cheerleading squad for this weekend’s opening game now lies paralyzed from the neck down. This mother is being told there are things that must be done quickly. Her child needs a feeding tube and a trach tube to breathe – in the initial surgery they already fitted her with a colostomy bag. But she will never recover. And her daughter is asking to simply be allowed to die. Not to accelerate her death but to do nothing to prevent death from coming. Who helps her make that decision? To what counselor does this mother turn?
I ask the only thing that comes to mind? “Who is with her now?”
She answers, “Her dad,” and then she hesitates, “but we’re not together and we don’t know how to talk about it. I don’t know what to do. How are we going to make these decisions and then how are we going to live with whatever decisions we make?”
I sense she’s not looking for me to answer so much as speaking the brokenness of her heart and the anguish of her broken family into the room.
She starts to apologize, “I’m sorry. You’re here too. You have a child here too.” I stop her. “Yes, but he’s going to be fine. We do this a lot. It’s become the regular rhythm of our life.” And with that she stops. I mean she stops. She stops crying. She stops wimpering. She has a sudden clarity and she stands up purposefully and strides toward the door.
I ask, “Are you okay?”
“Yes,” emphatically. “I do not want this to become the regular rhythm of her life. I do not want her to be captive to doctors and hospitals and experiments and therapy. I’m going to talk with her dad and we’re going to talk with her and we’re going to do what she wants. I love her too much to allow this to become her future.” And with that, she was gone.
Just because we can does not always mean we should. But just because it’s going to be hard doesn’t always mean we shouldn’t either. We need a constellation of counselors walking with us but most of us are walking alone. How do we address that concern as we are seeking to overhaul both the system of healthcare delivery and the means by which we pay for it? All of that would make for a better debate than the ones we’re having now.