On the morning of March 23, out of the blue, I suffered a subarachnoid hemorrhage (SAH), a condition where bleeding into the space around the brain creates intense pressure. One minute, I was enjoying a relaxing Saturday morning. The next minute, I was on the floor, unable to open my eyes, with a headache a million times worse than any I had ever experienced.
I was very lucky. Only one-third of people afflicted with SAH walk away unscathed; another third never even make it to the hospital. A few months have passed since that morning, and as far as I can tell, I’m almost fully recovered.
Explaining the various ways in which I was lucky takes us into both the health-care system — a policy wonk with a brain bleed is still a wonk — and matters far less economic.
First, I got the to the hospital quickly, where I got incredible treatment. One reason is an ambulance driver who yelled at the cars on Interstate 395 to get out of the way. I was conscious enough to think (a) “if I die because of Saturday traffic, I’m gonna be really pissed!” and (b) this driver is my hero!
But the other reason is because I live in a major urban area with a hospital (in Fairfax, Va.) that specializes in state-of-the-art treatment of strokes. So, shortly after I got to the hospital, doctors threaded a little camera into my brain to poke around for evidence of an aneurysm. Recent research has revealed a growing urban/rural split in economic outcomes, such as jobs, wages and opportunities for advancement. Hospitals and the access to the type of treatment I received also belong on that list. The pace of rural hospital closures has accelerated in recent years, and, notably, such closures occur more in states that have not accepted the Medicaid expansion of the Affordable Care Act.
The next reason I was lucky is because I had excellent health insurance. I’m still learning the full cost of the treatment I received, but absent comprehensive insurance coverage, there’s no way even an affluent family could afford the costs of more than a week in the intensive care unit and all the tests (CAT and MRI scans), drugs, round-the-clock care, etc., that entails.
I’m also convinced that another reason I’m “back among the living” is the tremendous amount of support and love I received from family and friends. When I was finally able to barely open an eye, the first sight I encountered was my three daughters, two of whom had rushed in from afar, lined up by my bedside. I felt as if I was levitated by their care and concern, and I somehow felt assured at that moment that I would survive.
Then followed literally hundreds of cards, notes, gift baskets from friends, co-workers and all sorts of others with whom I’d crossed paths. The receptionist at CNBC (hey, Amanda!), politicians I’ve worked with (including a couple of presidential candidates) — even people with whom I’ve done nothing but disagree over the years — reached out. Some sent baskets with notes saying, “You’re wrong about everything, but get well soon so we can get back to arguing!” The notes from my co-workers took a full morning to read, and it was time well spent.
Finally, I cannot discount the role of white privilege in all the above. That’s not luck; it’s the product of centuries of institutional, systemic racism.
What did I learn from the experience? The lessons are both personal and professional.
Starting with the latter: There are big problems with our health-care system, including access and cost. Reform is essential; the status quo is unsustainable. But there are aspects worth preserving. The challenge is how to preserve the good parts and shed the bad ones. Increasing access to the innovations that I experienced — tiny cameras in the brain — is part of this, but more important is the control of the far more costly treatment of chronic illnesses.
Conservative proposals include a serious policy mistake in this regard. By promoting high-deductible, skimpy-coverage health plans, they lower the cost of insurance, not the cost of care. Only the latter constitutes meaningful, lasting reform.
My experience also led me to think about how we measure productivity, or output per hour of work, in the health-care sector. I saw so many employees during my stay; it seemed I hardly saw the same person twice. Having so many people working to create a given level of output can be a productivity killer. Sure enough, a recent report shows productivity in hospitals growing at one-fourth the rate of the overall economy (0.5 percent per year versus 2 percent from 1987 to 2017).
But how does one reliably measure output in health care? We mostly do so by measuring the costs of the inputs — drugs, costs of treatments, etc. My experience led me to think of these more like “intermediate goods,” or inputs into the process. The “final good” is the outcome, which in my case is being alive and well! In other words, this episode led me to suspect that at least in some parts of the sector, we’re undercounting ongoing improvements in output, and therefore, undercounting improvements in productivity growth.
My big life lesson, however, is personal, not technical. The outpouring of deep-felt support I received was an existential reminder that taking the time to listen, talk to and connect with the scores of people we encounter from all walks of our lives is a lot more important than I realized. In fact, it may be among the most important things we do.
As is often the case, P.G. Wodehouse said it best: “I always strive, when I can, to spread sweetness and light. There have been several complaints about it.”