health policy

Slow day at work?

I’ve settled into a bit of a summer routine by now. Up at 6:30, out of the house by 7:15. I carpool with my parents, who drop me off outside their office and I walk across to my own. I usually get there well before the office opens, so I duck into a Borders across the street and read till 9. (Currently working on Kate Atkinson’s Behind the Scenes at the Museum; highly recommended to anyone who liked Middlesex.)

I go to a lot of Congressional hearings. They are becoming a commonplace now, but when I stop and think about them, it’s really a remarkable experience. I always seem to arrive just after a tour group of obese Midwesterners; that’s summer in DC for you. After I shuffle out of the oppressive humidity (the city retains the atmosphere of its swampy origins) through metal detectors, I head up a marble circular staircase to whatever committee room the hearing will be in. There’s usually a long line for the public; often I have to stand in the back or along the sides. The committee sits at a large dais, Democrats and Republicans on either side of the chairman’s throne. Witnesses sit facing the committee at a long table, with microphones and water glasses. After opening statements by committee members and testimony by witnesses, the fun part — the questioning — begins. I’ve seen committee members rip into witnesses, and you can really tell when someone loses their cool or has been “rehearsed.” The whole thing takes an hour or six. Then I go back to the office and write up a summary for whoever is in charge of that issue.

What has struck me most about these hearings is the almost total lack of clinical representation. Since these are mostly Health subcommittee hearings, the witness panel usually includes a physician, but generally a researcher rather than a clinician. Lots of MPHs, lots of PhDs. It’s a little surprising, given that members of Congress appear to respond better to “clinical vignettes” about anonymized children than statistics about disease prevalence. So why not bring in the people who actually care for these kids? Demands of the profession? Less experience with law? ‘Tis unfortunate, because it means that Congress is dictating from on high with very little input from the people who would actually be affected by this legislation.

Grassroots stuff — letter-writing and phone calls and petitioning — can work, but there’s nothing as effective as sitting in front of ten or fifteen Senators arguing your case.

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