HealthCommentary

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Scheining A Light On Health Reform

Posted on | August 5, 2019 | No Comments

Mike Magee

In 2004, Edward Henry Schein, a professor at the MIT Sloan School of Management, advanced a theory and scheme for understanding the contradictions that exist in organized culture.

His system shined a light on obvious conflicts between our stated values, our actual behaviors, and the hidden assumptions, biases and prejudices that sub-consciously anchor those behaviors.

This week, the nation witnessed the harsh realities of the Schein schema in full display. As one commentator described it, “Cultures are dysfunctional when the underlying assumptions don’t line up with the values we claim to hold dear. For a very long time, America was seriously out of alignment. But we slowly worked to change the underlying assumptions. It became unacceptable to refer to black people by racist names, to utter racist tropes, to run for office on racist themes. It took decades, but we got to a place where it generally wasn’t tolerated, in board rooms or in bars. Leaders who said racist things were often ostracized, forced to apologize, to say publicly they were deeply sorry that they acted in a way that offended our culture….the control rods of our culture…reduced the danger…Our  President …lifts the control rods for a deeply cynical purpose: to harness the political energy unleashed.”

These actions are clearly reckless and disqualify Trump. His removal in 2020 is no longer optional if we as a people are to have any hope of aligning our values with our behaviors. But even with Trump gone, the road ahead will require remarkable leadership and a guiding vision. This is because the “control rods” have been lifted at a moment of great change (a moment when technology, globalization and environmental calamity are colliding) and at a time when a sizable portion of our population are at grave economic risk.

While the vast majority of growth in assets in the past three decades went to the top 10% in the US, debt increased by $9 trillion with ¾ of the debt issued to the bottom 90% of American families. For the top 1% during this period, median net worth grew 178% to over $11 million. For the rest of us, earnings have been flat while housing prices have increased 290%, four year college tuition has soared 311%, and average per-capita health care expenditures has risen 51%.

The challenge then must be viewed on two planes: one economic, and the other cultural and value based. These two arenas are far from unrelated. As our hyper-competitive form of capitalism has squeezed out any notion of national solidarity, the gap between the “have’s” and the “have-not’s”, and the visual displays of cruelty and savagery in Texas and Ohio, in Trump arenas and cages filled with children, forces us to acknowledge a modern day reality: We do not like, nor can we accept, what we have become.

To put this genie back in the bottle, we must simultaneously address the nation’s values and economics. The quickest, most direct pathway is now through universal health coverage. Not only would this offer the opportunity to distribute wealth more equitably, but it would also offer the country the opportunity to put Professor Schein’s theories to practice by acknowledging our mistakes of the past, and working anew at aligning our actual behaviors with our stated values of compassion, understanding and partnership.

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