We focus on a number of topic areas identified by state health policy leaders as important to population health.
Keep up with news and updates from the Milbank Memorial Fund. Get the latest from thought leaders, including Christopher F. Koller, president of the Fund.
We publish The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to population health.
The Center for Evidence-based Policy at Oregon Health & Science University is a national leader in evidence-based decision making and policy design.
The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
President’s Blog: The View from Here
Oct 3, 2019 | Christopher F. Koller, President
I was looking forward to catching up with my buddy Mark when he switched plans on me. Forwarding an email, he asked, “Do you want to meet at this fundraiser?”
It was a classic twofer on his part—overcommitted people can spot it a mile away. I, however, did not know the beneficiary, a man named Jacob, and only reluctantly agreed. There was also a certain irony to it: We were getting together to raise money for Jacob’s medical care, and Mark and I had both served in health-related positions in Rhode Island state government.
The bar was a nondescript establishment in one of the state’s coastal towns. I had barely entered—my eyes adjusting to the hunched backs at the bar belonging to people who all seemed to know one another—when someone yelled, “Hey Chris, how are you doing?” Mike, a guy who taught with my wife, Colette, was selling tickets to a silent auction. Across the room, Mark was holding down a table for us and hailed me. In a second room, behind the bar, a string band was playing.
After I got my beer, Mark filled me in. Jacob’s parents, with whom Mark shared a mutual friend, were stalwarts of the local folk music scene. Jacob had a serious illness and a series of bands were playing all afternoon and night.
Jacob was in the middle of treatments. He was not at the event, as he had spiked a fever and gone to the hospital that day as a precaution.
Having resolved all of the state’s health policy challenges in the course of the beer, Mark and I went to the back room to listen to some music. The band was playing mostly Irish folk although at one point they went Cajun with “Jambalaya,” and an elfin penny-whistle player—a local legend—led a long line of people to the front room and back. “Son of a gun, gonna have some fun, on the bayou,” sang the band’s vocalist.
A bucket for donations sat at the front of a table of meatballs, pasta, and “gravy.” The walls were lined with items for the silent auction, including high-quality wood furniture and paintings. The non-dancers—several of whom I knew from over the years—sat sociably in around tables and in rows of vinyl chairs.
I sought out Mike, who had greeted me when I arrived. It turned out that he and Jacob were two-thirds of a trio that ran a local arts collaborative, and that he and Jacob had also published a couple books together. This past summer, Jacob had been diagnosed with sinus cancer. Independently employed, Jacob had insurance through the state’s insurance exchange, but needed help with the deductibles and prosthetic dental work. Mike and his friends had been raising funds and had organized this event. Artist friends and local establishments made donations to the silent auction. Between the town and music networks, an online fundraising effort has already raised $35,000. “I have been working at this for weeks,” Mike said. “I have gone back to some of these restaurants and stores for donations two or three times and they give me something just to make me go away.”
Between music sets, people came back to the front room to get a drink or sat and chatted under walls with a mix of sports memorabilia and pictures of bar regulars and local landmarks. “This is not my regular bar,” Mike said. “But they have a nice kitchen and a big backroom—they do a lot of fundraisers here.”
The scene was a bit of a sociological Rorschach test. Depending on one’s perspective there were at least three different narratives to be written.
This is what health care financing has come to. Even when you play by the rules and get your health insurance and even when the government tosses in its subsidy, you still have to walk around with your tin cup to ask people for donations. It is not this way in other countries and should not be this way here: Bring on Medicare for all.
This is what community looks like. Bad stuff happens to all of us. It is part of the deal of being human. All the virtue, personal responsibility, and government programs in the world won’t fully protect you. We have to support one another—materially and emotionally—in times of distress. Insurance, after all, started out as burial societies helping families deal with funeral costs.
This is what community used to look like. This scene may be heartwarming but true community is rare and becoming more so. Income inequality is at its highest in the 50 years it has been measured by the Census Bureau. We are sealing our borders and US refugee quotas are diminishing. Polarization is winning in politics and online. We are retreating into more homogenous real and virtual identity communities and losing our sense of common purpose.
Parts of all those interpretations hold true. Each of us, however, must choose which one we want to act on. That afternoon, I had become part of the circle of friends and acquaintances of a guy I had never met before. Building communities like this makes compassion—and social support programs—more likely, and polarization less acceptable. You’re more likely to give a damn about someone with whom you have shared a conversation (or music, food or a dance). I was glad I said yes to Mark. Sometimes you really do get two experiences for the price of one.
After his band had taken a turn in the corner of the room, Jacob’s dad was introduced to me. Jacob’s prognosis was pretty good, he said. Surveying the filled room, he observed, “We feel pretty lucky.”
It was time to go. As I exited, Jacob’s stepmother stood under a streetlight in a circle with friends. The word from the hospital was that Jacob had no fever after all. False alarm. “Maybe the first reading was wrong,” she said. “What a day this has been.” Standing with her, the friends nodded sympathetically.
The Milbank Memorial Fund is an endowed operating foundation that works to improve the health of populations by connecting leaders and decision makers with the best available evidence and experience.
State Health Policy Leadership: More Perspiration than Innovation
October 11, 2019
The Path to Multipayer Primary Care Transformation: How Far Have We Come?
October 2, 2019
Rhode Island: A Most-Improved State in Health Performance
September 11, 2019
Get the Latest from the Milbank Memorial Fund