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“Wouldn’t It Be Great?” A Perspective on Pain

Paul Kalanithi was a husband and neurosurgery resident at Stanford when he began to experience a dire combination of symptoms: a cough, fevers, back pain, and unexpected weight loss. Quick tests confirmed that he had metastatic lung cancer, which would eventually prove fatal.

Paul’s wrote about his journey with lung cancer in a book called When Breath Becomes Air. I read it some years ago and often think about what it says about our shared experiences life, death, and mortality. Shortly after he finished the book in 2015, Paul passed away. He is survived by his wife, Dr. Lucy Kalanithi, and his newborn daughter.

Recently, I read an interview published on the fifth anniversary of Paul’s passing (which is worth a read) which revealed something new about the Kalanithis: it wasn’t until after the diagnosis that they decided to have a child. At first glance, that seems like an strange choice. Now that Paul and Lucy know that Paul will be dead within 1-2 years, they choose to have a child together. There is an important lesson in the details of that decision.

Interviewer: In all of that intensity [of a cancer diagnosis], how did you decide to have a child?

Dr. (Lucy) Kalanithi: It seemed pretty crazy to do that. Paul was more sure than I was that he wanted to have a child. I said, “It’s going to make it really hard. You’re really sick. I worry that having to face dying and having a new baby who you need to say goodbye to is going to make it really hard. What do you think about that?” He said, “Wouldn’t it be great if it did make it really hard?” It was such a lovely statement of what our lives are about. Sometimes you cannot have joy without risking pain.

I love Paul’s perspective on pain. “Wouldn’t it be great if it did make it really hard?”

Pain is a fascinating subject. Our instinctive response to pain is to avoid it all costs. We hide things from others to avoid the pain of being separated from our social groups. We put off difficult conversations that need to happen to avoid the pain of dealing with interpersonal conflict. We attempt to ignore our problems by numbing our emotions through distraction, vice, or even success. We hope that with just enough numbing, we can avoid pain.

And in our frantic attempts to escape the inevitable, we learn that we can never get enough of what we don’t really need. The numbness wears off and we realize we have merely postponed dealing with the root cause of our discomfort.

Paul’s perspective teaches a lesson that needs constant relearning: Our purpose in life is not to avoid pain and discomfort. Our purpose is to find those things that are worth our pain and discomfort. Learning to be ok with ourselves, building healthy relationships, investing in others’ well-being, saving money for the future, crossing a finish line, or dealing with our demons — these things open us up to pain, but they are worth that cost. Paul and Lucy knew this. They ignored the instinct to avoid pain. Paul had a perspective that would bring him joy in his final months: “Wouldn’t it be great if it did make it really hard?” They made a choice to pursue something that would be worth the pain that it would cost.

At 2:11am on July 4, 2014, Lucy gave birth to Elizabeth Acadia, whom they nicknamed Cady. In the last paragraphs of his autobiography, Paul gives us a taste of the coupling of pain and joy that he experienced as a father, watching his own life end while Cady’s life was beginning.

Day to day, week to week, Cady blossoms: a first grasp, a first smile, a first laugh. Her pediatrician regularly records her growth on charts, tick marks indicating her progress over time. A brightening newness surrounds her. As she sits in my lap smiling, enthralled by my tuneless singing, an incandescence lights the room.

Time for me is now double-edged: every day brings me further from the low of my last relapse but closer to the next recurrence—and, eventually, death. Perhaps later than I think, but certainly sooner than I desire…

I hope I’ll live long enough that she has some memory of me. Words have a longevity I do not. I had thought I could leave her a series of letters—but what would they say? I don’t know what this girl will be like when she is fifteen; I don’t even know if she’ll take to the nickname we’ve given her. There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose life, barring the improbable, is all but past.

That message is simple:

When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.

Our purpose in life is not to avoid pain and discomfort. Our purpose is to find those things that are worth our pain and discomfort. And then once we find them, to pursue them with all we have, purchasing with our pain a life of meaning and “a joy that does not hunger for more and more, but rests, satisfied.”

The Right Now Paradox

Time is a funny thing.

Or maybe it’s the way we think about time and make choices around time that are strange. Tomato, tomahto.

For example, sometimes we think there is plenty of time to put off that due-in-a-few-days task. We watch the show, stay up later than we should, and say to ourselves “I’ve got time.” We tell ourselves that Right Now isn’t critical.

At other times, we think there is no time to accomplish our long-term career goals. Any failure now means certain career death and life is surely over. Right Now is all that matters.

Sometimes, these mindsets hit at the same time, which is something I call the Right Now Paradox, where we think the current moment simultaneously isn’t all that critical but is all that matters. When these hit together, the compounded stress often leads to even more procrastination.

The solution to the first pitfall is to learn how to manage ourselves emotionally. And when we need to relax, it’s better to take a deep breath and a screen-free break than to numb our emotions with mindless distractions. In short, minimize the shiny distractions and maximize the leisure activities that have a higher value or more relaxing affect: take a walk outside, read a book, message an old friend you’ve been meaning to talk to.

The solution to the second is to keep a healthy perspective when failure strikes. Look at Lincoln, Morgan Freeman, Thomas Edison, Michael Jordan–all men who are famous for things that happened long after they had attempted many other ventures. Remember that failure is a stepping stone to success in most circumstances, and that success doesn’t have to come early to be impressive.

In sum, if you need a break, take a break that is high-value. If you’re feeling stressed about a potential failure, remember that failure is a key ingredient in the recipe for success. Right now IS critical, but you’ve got enough time to try and fail.

A Coronavirus Meme-Check

A meme has been making its way around social media recently. Perhaps you’ve seen it.

The reaction has been predictable. Many have passed it on in the hopes that it encourages people to wear a mask and avoid gatherings. Others have dismissed it, pointing out inaccuracies in the data.

Seeing the lack of dates and references myself, I decided to dig in to the numbers and see if the data match the meme. What follows is a look at the numbers behind the United States’ deadliest disasters, deadliest diseases, and the deadliest wars.


The Wikipedia page for the deadliest disasters in American history lists these as the top ten:

You’ll notice a mix of natural disasters and war-related events (9/11 and Pearl Harbor). The list doesn’t include death tolls from the Civil War. You’ll have to take that omission up with Wikipedia. Everyone can just note (since it was in the original meme) that there were 3,675 casualties at the Battle of Antietam on September 17, 1862. Additionally, I used the average (9,000) of the estimates of the death toll from the Galveston Hurricane, which range from 6,000 to 12,000.

Here is what that table looks like when we add in the last 10 days of United States coronavirus deaths, according to data from the New York Times, sorted by death count.

Take a second to look at those red numbers and let them sink in.

Four of the last ten days of coronavirus deaths would make it into the new top ten list of deadliest disasters in all of United States history. These specific days aren’t even the highest death tolls from coronavirus since February 3 when the US declared a state of emergency. This is just the last ten days. Given that today is 14 days since Thanksgiving, I wonder what will happen with these numbers going forward.

Also, the sum of casualties from the last ten days is 20,583. For those of us who remember that 2001 Tuesday morning in September, the death toll from the last week and a half is nearly the equivalent of seven September 11s. Seven.

Diseases and “Real” Health Issues

One response to the meme has been to claim that other maladies (cancer, the flu, suicide, etc.) are a much bigger deal than the coronavirus, either because of the death tolls or because coronavirus has such a high survival rate. Let’s take a look at these “real” problems from a numerical standpoint. The following table shows the 2018 death count for many of the health-related societal ills that often make the news, along with the source for each figure.

For comparison, the mean and median daily death rate from coronavirus in the last ten days are 2,277 and 2,620 respectively, both of which would put it at the top of this list by a wide margin.

Taking a more conservative measure, the coronavirus has killed an estimated 293,055 people in the USA since February 6 (the first supposed coronavirus death in the US). Dividing that total by the 308 days since February 6 gives an average death rate of 951, which would still make it more deadly than suicide, opioids, car accidents, homicides, and terrorism combined.

Moving away from issues that make the news, the following table shows the CDC’s top ten causes of death in the USA in 2018, with the conservative coronavirus daily death count.

Comparing all of these numbers, it is clear that coronavirus is currently more dangerous than many societal health issues. It is not the flu, having killed five times more than influenza and pneumonia, so far. It is killing Americans at a rate that merits national and individual attention and action.


How does the pandemic compare to American military casualties? What if the pandemic were a war? How would it stack up against World War II, or the American Revolution?

Since 1775, the United States has been involved in thirteen major wars. The table below includes all thirteen, shown chronologically in the table below with casualties, duration, and annualized death rate.

Source: Wikipedia’s “United States military causes of war” and
A Census Based Count of the Civil War Dead with some revised numbers for the Civil War

Sorting that same table by total casualties deaths gives us the following:

By total casualties, the Coronavirus War of 2020 would be the third deadliest military conflict in the country’s history, with a total death count higher than the sum of every war that is lower on the list (278,173).

Finally, sorting by annualized death rate (calculated using days since February 6) gives us the following:

If the current pandemic were a war, we’d be losing more American lives per year than in any previous military conflict in United States history. More than the Civil War. More than the World Wars.

In fact, the annualized death rate of the pandemic is nearly equal than the combined annualized rate of all 13 major military conflicts. Meaning, we are losing lives to coronavirus about as fast as if the United States were fighting every one of these wars (World War I, World War II, the American Revolution, the Civil War, Vietnam, the Korean War, etc.) at the same time.

So What?

What are we to make of these numbers? What do they mean? And how should we respond?

First, it means that the pandemic is a real problem. This analysis only looks at lives lost. There are some unanswered questions about the long-term side effects of Covid-19. A full cost analysis would also include the economic disruption that has come from an unexpected pandemic. In terms of casualties alone, the coronavirus ranks near the top of our country’s deadliest disasters, deadliest diseases, and deadliest wars.

What else does all of this mean?

If you want my take, this means war.

Our country is at war against the coronavirus. We are not at war with democrats or republicans. We are not at war with Fox News, OAN, or CNN. We are not at war with our neighbors. We are at war with an enemy that is killing Americans faster than any previous military conflict. The recent daily casualties are higher than the daily death tolls from cancer, heart disease, suicide, drugs, homicide, and terrorism.

What is both sad and alarming is that a number of our fellow citizens, including some of our local and national leaders, don’t believe in the war. For reasons that will be studied for years, a number of US citizens aren’t taking measures to combat the virus. Since the disease is contagious before it is symptomatic, and since few of us will die from it, those of us disregarding healthcare measures do so at the peril of our fellow Americans who might not be as lucky as we are. By refusing to fight, we are handing American lives over to the enemy at an increasing rate.

However, and this is important, those of us who refuse to fight are not the enemy. While it is frustrating that some don’t see how many people are dying, their surrender doesn’t invalidate the efforts of those of us who are still fighting. Personally, I’m trying not to let others’ inaction frustrate me. I remind myself that every effort helps. I remember those whose occupations and life situation prevent them from working from home or taking other precautions. As in all wars, there are some who cannot fight. It falls on those of who can to pull our weight and some of theirs.

I find some hope in the fact that these coronavirus numbers reflect only the past decisions we have made. What matters now is what we decide to do going forward. Every mask worn, every unnecessary outing avoided, and every lonely night spent once again at home decreases the spread of the pandemic. Vaccines are coming soon, but the war isn’t over yet.

It is time for us to band together, overcome our differences, and fight to end this pandemic — for our families, for our neighbors, for our country, for our economy, and for our freedom.

What To Do When Someone Is Wrong On The Internet

I’m not sure the rest of you have noticed, but there are these people on the internet…

And they’re wrong!

Crazy, right? Have you seen them around? Run into any of them while you dawdle on the internet?

Maybe they’ve commented on your wall, or maybe you have a mutual friend, and you just COULDN’T let that comment go without a response. So you angrily concoct a retort, armed with the confidence that with your wit and your zingers and your logic, you’ll put them in their place. But it never seems to work.

Here’s the thing.

You don’t have to tell them they’re wrong. You don’t have to convince them. The chance of you changing the mind of a stranger in a mouse-by comment is next to zilch. You don’t have to waste any mental or emotional energy wondering how in the world their reality could be so drastically different from yours.

For the most part…

:::: deep breath :::

… you can just let them go.

You can take that time and energy and put it somewhere else. You can do some tangible good out in the world. You can get outside, away from the pixels and glowing screens. Facetime an old friend. Spend some time on that one project you’ve been putting off. You can put that energy into chasing that crazy dream that scares you, just enough.

And so can I.


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From Chauvet to Today — Are We Happier?

A human handprint made about 30,000 years ago, on the wall of the Chauvet-Pont-d’Arc Cave in southern France.

Yuval Harari’s Sapiens is a brief history of humanity. Near the end of the book he writes:

The last 500 years have witnessed a breathtaking series of revolutions. The earth has been united into a single ecological and historical sphere. The economy has grown exponentially, and humankind today enjoys the kind of wealth that used to be the stuff of fairy tales. Science and the Industrial Revolution have given humankind superhuman powers and practically limitless energy. The social order has been completely transformed, as have politics, daily life and human psychology.

But are we happier?

Did the wealth humankind accumulated over the last five centuries translate into a new-found contentment? Did the discovery of inexhaustible energy resources open before us inexhaustible stores of bliss? Going further back, have the seventy or so turbulent millennia since the Cognitive Revolution made the world a better place to live? Was the late Neil Armstrong, whose footprint remains intact on the windless moon, happier than the nameless hunter-gatherer who 30,000 years ago left her handprint on a wall in Chauvet Cave? If not, what was the point of developing agriculture, cities, writing, coinage, empires, science and industry?

I love the question at the end: what is the point of all this progress if we’re not happier?

Unlike the civilizations that lack mind or thought in Sapiens, as conscious individuals we can deliberately choose our pursuits. Are we taking actions that will lead to an end-goal of happiness? Or are we chasing a substitute for it? Progress, success, and profits are shiny proxies for happiness but do not inherently lead to it.

If we’re not conscious about our goals, we’ll confuse means and milestones for ends. We’ll realize, looking back, we got what we pursued at the cost of what we truly wanted. The opposite is also true. By preemptively asking,“What is the point?”, we avoid the pitfalls of focusing on proxies at the cost of a deeper purpose. We anchor our personal decisions and our business pursuits to worthy and wanted end goals.

Maya Angelou on Complaining

I get a weekly newsletter from James Clear, author of Atomic Habits, which lives up to its claim of being the “most wisdom per word of any newsletter on the web.” (If you’re interested in seeing his latest, you can scroll to the bottom click here

A recent quotation from the newsletter was good enough to go into my notes review system (which I should talk about sometime), and popped up this evening during my review.

“Sister, there are people who went to sleep all over the world last night, poor and rich and white and black, but they will never wake again. Sister, those who expected to rise did not, their beds became their cooling boards, and their blankets became their winding sheets. And those dead folks would give anything, anything at all for just five minutes of this… So you watch yourself about complaining, Sister. What you’re supposed to do when you don’t like a thing is change it. If you can’t change it, change the way you think about it. Don’t complain.”

Maya Angelou in Wouldn’t Take Nothing for My Journey Now

Summary: time is precious, so don’t spend it complaining. If you don’t like something, change what you can about it, or change your mind.

I’m starting to see a pattern in my posts — a lot is about time figuring out how to get the right perspective around it in order to get the most out of it.

I’m ok with that.

We’re All Someone’s Crazy Relative

I’ve been reading a lot about beliefs and about how our minds work, and I’ve wanted to write something about it for a long time. I’m fascinated by the difference between disagreement that is healthy and constructive, and disagreement that is toxic and destructive. I’ve been putting it off, subconsciously thinking I had to wait until I knew everything before I wrote anything. I could then write the perfect article, chock full of footnoted links to research. It would answer every question and explore every nuance.

Could I do that without writing a thousand-page textbook? No, there is too much. So I’ll take the Inigo Montoya Approach and sum up. There are some fascinating ideas from evolutionary history and psychology that explain a lot of the animosity surrounding disagreement in today’s conversations about healthcare, politics, and religion. The source material is a blend of Harari’s Sapiens, Haidt’s Righteous Mind, Kahneman’s Thinking Fast and Slow, and Mark McRaney’s entertaining and insightful podcast You Are Not So Smart.

To begin, Harari says there are three reasons why homo sapiens have been very successful since first showing up 200,000 years ago: 

  1. Homo sapiens learned to harness fire to cook food, which increased our caloric intake and resulted in significant brain growth.
  2. Larger brains led to the development of language, including the ability to tell stories and produce fiction. 
  3. We began to use language, stories, and fiction to coordinate tasks and operate in groups, creating tribes, communities, and eventually cities. 

Those three evolutionary ideas lead to some fascinating psychological results. 

One, our beliefs aren’t built on pure rationality. Our survival historically depended on maintaining group status, not accuracy. As a result our views have more to do with group dynamics than a dispassionate search for truth. When faced with a new idea, our group-centered minds ask, “How will this affect my group standing?” You’ve seen this in action if you’ve ever seen someone base a political opinion on whether or not it came from their party’s leader, as opposed to the merits of policy itself. We instinctively align ourselves with our group.

Two, our evolutionary wiring causes us to trust people like us. Shared traits (skin color, political ideology, country of origin, socioeconomic standing) lead to increased trust. Dissimilarity decreases instinctive trust. These tendencies come from the deeper preprogrammed parts of our minds. While they can be overwritten with conscious reasoning, conscious rationality is not the default tool we use to evaluate new ideas. Trusting people who are different requires work, and our efficiency-focused brains don’t do that automatically. 

Three, we are unable to independently verify all of the things that we know. Due to a vast information surplus of things we could pay attention to, we filter and accept messages from people we trust. Our brains prioritize efficiency over accuracy. For example, I haven’t produced the necessary observations that show the earth is round or that it moves around the sun. I trust the scientific community when it tells me these are settled issues. Nearly everything you and I “know” is borrowed from someone we trust. 

Four, stories are more powerful than facts. The first narrative we hear from a trusted source (someone like us) is likely the one that we will use to decide whether we accept or reject the other facts that come to our attention. In fact, exposure to factual information that goes against our narratives causes us to dig in to our viewpoint even more. Contradictory evidence strengthens opposing conclusions, which is both fascinating and disappointing if you’ve ever tried to change someone’s mind. 

These four points go a long way in explaining why good people disagree about important issues. Our beliefs are more often based on identity, on maintaining group status, and on who we trust as opposed to a dispassionate factual examination. 

It doesn’t mean our beliefs are pre-determined. These are all tendencies we can overcome, with effort.

It does mean that arriving at The Truth (or some approximation to it) involves acknowledging that we have these tendencies and navigating them. 

It should also give us pause about how we arrive at our own conclusions. Do we believe something because it feels right, in spite of any contradictory evidence? Which sources do we believe? And why do we believe them? Is it just because they’re like us? Are they from the same political party or religion? Do they write for a news organization we trust? Or have we done some conscious and rational examination of the evidence presented, putting in the extra work of looking up alternative viewpoints? 

Finally, it means we should be “slow to speak, slow to wrath” (James 1:19) when we run into those who have come to different conclusions than we have. It’s natural to conclude that your crazy relative with different or weird or conspiratorial beliefs has been brainwashed or is evil. It’s completely natural, but also wildly ineffective if you hope to engage in anything approximating intelligent disagreement.

Idiocy and malice are not the sole sources of disagreement. More often than not, we have all arrived at different conclusions as a result of evolutionary tendencies that lead us to adopt the differing narratives we use to make sense of the world. To an extent, we are all someone’s “crazy relative.” Recognizing the psychological processes we all follow to reach conclusions can steer the conversation away from heated animosity and toward examining the underlying and unspoken narratives that cause most differences of belief.

Hope in the Desert

In need of a little motivation?

My brother, Neal Spackman, recently finished a decade-long endeavor, The Al Baydha Project, in Saudi Arabia. The goal was to turn a desert into an oasis. He describes it like this in the linked youtube video:

“The climate is hyper-arid, and the land is non-arable. The ecological degradation is extreme, with no significant natural resources to work with: no soil, no water, and almost no biological capital. It is a landscape made desolate by decades of desertification. Our tools… were nothing but mountains and stone, sunlight, dust, and floods” (from an average 60mm a rain a year).

For nearly ten years, Neal and the 100 local bedouins on his team spent tens of thousands of hours in the heat and the sun with no certainty of success. To make a long story short, it worked! Neal made a prairie of grasses from desert, dust, sun, and a tiny bit of water. You really should watch the 20-minute video to see the story from start to finish. It is amazing.

I find extraordinary motivation in this story. The Al Baydha project shows the power of pushing forward when success is uncertain. None of us knows what will come from pursuing our current dreams. We’re somewhere in after starting but long from being able to see a finish line.

In that space, it’s tempting to give up. You’ve put in hundreds of doubt-filled hours over the years, and you’re not sure anything will come from your efforts. “Will this even work?” The doubt gnaws away at your willingness to push on, but you push on. You push on, driven by some combination of stubbornness and hope and the dream that got you started in the first place. You push on with no certainty of success.

After you’ve pressed on, after you’ve dealt with your demons, after you’ve persevered, and after the project is over, you’re able to see what has come from your efforts. At times that means a change of plans, a pivot to something new, but now with new skills and knowledge that you couldn’t have gained otherwise. And at times, you’re able to look back and say, “It worked!”

To anyone out there in that “in between”, to anyone who’s struggling, who’s gone back to school, or who’s exhausted from late nights, who’s uncertain of the outcome of all their work, who’s seen no rain for two years–to all of us chasing big dreams, don’t give up. Keep pushing on.

Remember the green that blossomed from dust and rock. There is hope for us in the desert.

Rioting, Explanation, and Justification

Recent online conversations about rioting and racism have made it clear that many writers and many readers are unaware that explaining a behavior is not the same as justifying it. I’ve seen commentators who believe they are engaged in a single conversation, when in fact two separate conversations are taking place.

For example, one person says that rioting makes sense (explanation). Another jumps in to say rioting is wrong (justification). They speak past each other, misreading and mischaractgerizing, and the comment chains get long. You’ve seen these conversations on Facebook, Twitter, and the comment boards of news sites. Commentators escalate and engaging in the anti-social (used here to mean the opposite of pro-social) behaviors of vilifying and insulting the other side. And all this happens when the two groups’ viewpoints are not mutually exclusive. 

Explanation is a search for root causes. In this case, it is linking the recent actions of local law enforcement in Minnesota and the broader context of the nation’s history with racism to protesting, rioting, and looting. Understanding why something happens can help prevent negative behaviors and promote positive ones. Trying to explain why we behave in a certain way, or giving context in which one behavior leads to another, is explanation. 

Personally, I see many factors that explain the riots. For starters, there’s a global pandemic going on, which has lead to record unemployment. Millions of Americans are wondering when, or even if, they’ll be able to go back to work. The healthy and employed have adopted new habits, staying home as much as possible, wearing masks, and maintaining physical distance from friends and family. We’re five months away a presidential election, along with the accompanying political fights on mainstream and social media. All of these factors had already strained the American public when videos of white men killing black men came to our attention. Millions have taken to the streets in protest. Some have started rioting and looting. So, yes, I can a confluence of stresses crashing together that explains why people are looting.

That explanation should not be confused with justification. Acknowledging racial issues (explanation) does not make rioting any less damaging to the lives and livelihoods of the innocent. As a prominent Atlanta resident said, “We’re burning our own house down.” Like him, I do not think rioting is justified. Anger? Action? Seeking for justice? Protesting? Yes. Violence and looting? No.

These two separate conversations get mashed into one, both in the current conversation about rioting and in many other contexts. As a result, we all too often misread the other side and heatedly escalate the conversation. At some point (typically after insults, dismissiveness, and anger) we give up, having accomplished nothing except to further the animosity and division that hurt our society further.

Remembering there is a difference between explanation and justification can save us the time and emotional effort we expend speaking past each other, and it can help us differentiate between effective and ineffective dialogue.

Achieving Flight: Discerning Between Correlation And Causality in American Healthcare

In the opening chapters of How Will You Measure Your Life, Clayton Christensen illustrates why hundreds of years of attempts to fly were unsuccessful and what changed that got the Wright Brothers off of the ground.

“Early researchers observed strong correlations between being able to fly and having feathers and wings. Stories of men attempting to fly by strapping on wings date back hundreds of years. They were replicating what they believed allowed birds to soar: wings and feathers.

“Possessing these attributes had a high correlation—a connection between two things—with the ability to fly, but when humans attempted to follow what they believed were “best practices” of the most successful fliers by strapping on wings, then jumping off cathedrals and flapping hard … they failed. The mistake was that although feathers and wings were correlated with flying, the would-be aviators did not understand the fundamental causal mechanism—what actually causes something to happen—that enabled certain creatures to fly.”

“The real breakthrough in human flight didn’t come from crafting better wings or using more feathers. It was brought about by Dutch-Swiss mathematician Daniel Bernoulli and his book Hydrodynamica, a study of fluid mechanics. In 1738, he outlined what was to become known as Bernoulli’s principle, a theory that, when applied to flight, explained the concept of lift. We had gone from correlation (wings and feathers) to causality (lift).”

Reading through the passage, I immediately connected this principle with the US’s attempts to implement a national healthcare system.

Now, currently, no policy makers are making moves on Medicare for All. The country is nine weeks into a pandemic. Some states are slowly and cautiously reopening, and it seems we’re going to be in The Dance for another six to eighteen months. Oh, and in case you’ve forgotten, we’re six months away from a presidential election. Medicare for All isn’t at the top of our list of problems.

But once the political and healthcare dust has settled, the debate (or online rage-fest) of a national healthcare system will startup again. I wouldn’t be surprised to see both sides using the pandemic to support their position.

After reading the above passage from Christensen, I wondered. Would mimicking what other countries have done be like strapping wings on American healthcare system? Or would it be like applying the principles of lift? Will doing what other countries have done solve our problems?

What exactly are the problems the US system faces?

For one, value (measured in quality over cost) is low. Costs are higher than anywhere else in the OECD countries. And for all that extra money, outcomes seem about the same or worse. Second, roughly 27.5 million Americans (about 8.5%) are uninsured, which distributes costs to the rest of the system. Third, the incentives between who payers, patients, and providersmeans that consumers and providers often make decisions free of the monetary consequences of their choices, decreasing the power of free market tactics to cutting costs or improving quality.

In addition to our system’s issues, the US is unlike other OECD countries in its geographic and medical makeup. At 327.2 million citizens, we’re fifty times larger than the UK (6.5 million), and sixty times larger than Norway (5.5 million). About sixty million Americans (19.3%) live in rural areas where expensive healthcare services are harder to efficiently distribute. Add to the population issues a host of medical problems the country struggles with. For example, we’re close to the top of the list of most obese countries, with 36.2% of the population at a Body Mass Index of 30 or higher. Compare that to Canada (29.2%), Mexico (28.9%), and the UK (27.8%).

The unique problems and characteristics of the United States are significant. The ideal US healthcare system will need to be different from those of other countries that don’t share similar challenges. In other words, policy makers will need to craft incentives and systems to suit our unique situation in order to achieve flight, and not just mimick the surface characteristic of the healthcare systems of the OECD countries.