Some of my favorite reading, especially in the context of the health care reform debate, is authored by Margaret J. Wheatley. She is the co-founder and president emerita of the Berkana Institute, a charitable foundation that promotes a diverse and global discourse on societal betterment using the wisdom and wealth already present in people, traditions and their environment. The Meg Wheatley books that continue to intrigue me include Turning to One Another: Simple Conversations to Restore Hope to the Future (2009) where she promotes simple approaches like listening and cooperation among diverse groups to address societal challenges. Similarly, Leadership and the New Science (2006) explores the impact of new science on the world view and resultant organizing, prioritizing and communicating in chaotic times.
I have never met Meg Wheatley and this is not a commercial for buying
her literature since much of it is available through open sources. But I had the opportunity to think of Wheatley’s
work a few weeks ago during a conversation with a 26-year-old doctoral student
about potential impacts of health care reform on young adults, especially graduate
students and those working part-time to support their education.
The student reminded me of the HealthReform.gov report Young Americans
and Health Insurance Reform: Giving Young Americans the Security and Stability
They Need, pointing out several statistics and
findings that caught his attention. For example,
it is a common belief that young adults are mostly healthy and therefore do not
need primary health care like annual physicals.
Yet there are many important screenings for chronic disease and cancer
that could affect them later in life and should be detected early. These screenings are often neglected when
young adults are uninsured. Young women
are especially at a disadvantage for finding reasonably priced health insurance
that provides real coverage of health care expenses since in most states
insurance companies can risk-adjust premium payments based on age, gender and
health status. Holding all other factors
constant, women in their mid-twenties can be charged one to one and one half
times the premium of men of the same age.
The percent of young pregnant women with no health insurance continues
to grow and one in four young adults, especially young women, report
significant medical debt.
My doctoral student friend asked what I thought about the report
and my immediate social scientist reaction was to defend the research design
and statistical analysis. A 20-minute
introduction included an explanation of the role of the Agency for
Healthcare Research and Quality and how the stratified
random sample and sub-sampling of the National Health Information Survey (NHIS)
approach to the Medical Expenditure Panel Survey (MEPS) provides statistically
significant findings.
Then I explained how the MEPS weighting mechanism worked and
gave a detailed explanation of data reduction methods for linking MEPS to the Current
Population Survey (CPS) of the U.S. Census Bureau to
generate findings about health care usage and challenges of young adults. My lecture included a tutorial on downloading
MEPS data and running correlations and regression analyses with the preferred
modeling approaches. Using a white board,
I diagramed health decision production function models in case he wanted to
consider using the data for course papers, publications or his dissertation.
My young friend listened patiently and even took notes. Then he made a simple statement. He said he had heard about all of the hype on
health care reform and he had studied bills and current media coverage. He just wanted to know the best way to deal
with health care policy reform for someone in their mid to late twenties with a
few more years of education to come. He
had been dropped from his parent’s health insurance policy. He has a young wife. They want to have a baby soon. Should he buy an insurance policy or plan to
take a penalty on his tax return?
There are many upsides of health care policy reform including
the interesting discourse it generates among groups newly affected by the
legislation, but without formal advocacy groups to support them. As I pointed out to this young adult, there
is no AAYA or American Association of Young Adults similar to AARP or the
American Association of Retired People.
He is on his own for the time being and dependent on conversations with
colleagues who understand policy analysis, adoption and implementation. And he depends on those colleagues to listen.
About the Author: Cathy Slade is a
postdoctoral research associate at CSPO and CNS-ASU.
