By Michael Leppert
The Indiana Citizen
February 5, 2025
It’s an old joke, and though I made a reasonable effort to track down the original source, I failed. However, I did find that early versions of it, dating back to at least 1930, centered on indecent proposals for sex. Not surprisingly, and nearly a century later, the anecdote often is aptly applied to policy dealmaking negotiations in legislative bodies across America.
Skipping the indecency of the set-up, this is a family friendly column after all, a version of the punchline goes like this: “We’ve already established what we are. Now, we’re just haggling over the price.”
Healthcare debates in the Indiana Statehouse are primarily an exercise in “haggling over the price.” But like the original version of the joke, the more important part of the debate really is the “establishing what we are” part.
Whitney Downard, reporter for the Indiana Capital Chronicle, succinctly reported last week on a hearing of the Indiana Senate Committee on Health and Provider Services that featured five legislative proposals moving forward that were almost entirely about the price. The bills dealt with financial incentives for patient referrals, tracking the average negotiated charge between healthcare providers and insurers, non-compete agreements for physicians, prior authorization of care by insurers, and finally, two bills regarding pharmacy benefit managers, or PBMs. Whew. I read the story several times and still don’t see the part about Hoosiers getting healthier.
The most important part of the healthcare debate often doesn’t even come up in the rooms where decisions are being made: What can we do to live healthier lives? Anyone who believes that either Indiana or America will magically become healthier by resolving all the debates about price first, should also be shopping for Jack’s beanstalk beans.
Establishing “the price” isn’t the mission. Improving the public’s overall health is.
In Washington last week, the Trump Administration continued to pursue Senate approval of a cadre of nominees to vital leadership posts in the federal government. None of these pursuits better encapsulates the absurdity of this political moment than the hearings on Robert F. Kennedy, Jr.’s nomination as secretary of health and human services. This nomination feels like the administration was amused by the rantings coming from the drunk at the end of the bar and sarcastically decided to put him in charge. My apologies to all drunks at the end of all bars.
Plainly, RFK JR. is a kook. His qualifications as the leader of American health policy apparently come entirely from his willingness to suggest kooky things with an unrelenting arrogance and certainty generally reserved for people with actual knowledge. He isn’t a doctor. He’s never managed anything. He really doesn’t know much. But that dossier of nothingness is politically useful because he confirms the equally uneducated perspective that life-saving initiatives like vaccines are unnecessary, or even dangerous.
CNN’s fact checker, Daniel Dale, along with Danya Gainor, wrote the article documenting many of the absurdities from last week’s hearing in DC. There are so many disqualifying moments included in this fact list, that it’s hard to pick which one to dwell on. While that flooding of the zone appears to be the political strategy to get RFK JR. confirmed, it also appears that what should be the mission is again being blatantly ignored.
I’m not aware of any rational argument about how RFK JR.’s appointment will make America healthier. It would appear to me that the most obvious benefactors to his approval would be a contest between measles and polio. Four years of anti-vax leadership might take forty years to recover from.
And that’s the real danger of the time we are wasting with the misguided haggling. Each diversion away from the mission of improving community health costs precious time and getting back on track often takes more.
Indiana is often ranked in the 35th to 40th range among the healthiest states. Nothing is happening in the Statehouse that has a legitimate shot at improving that, unless under RFK JR.’s leadership, other states get worse at a faster rate than we do. Not much of a rallying cry there, I know.
At the Economic Club of Indiana in November of 2018, a group famously known for its discussions about price, IU Health CEO Dennis Murphy nailed what I think should lead all healthcare policy making discussions. He said, “Today, we are choosing to spend our money on taking care of people when they are sick, as opposed to preventing sickness.”
That was a little over six years ago, but I remember it vividly. We could focus on living healthier, and we could demand policies that drive that mission. But that would require that we make a commitment to establishing a better version of what we are.
Or we could keep wasting time haggling over the price.
Michael Leppert is an author, educator and a communication consultant in Indianapolis. He writes about government, politics and culture at MichaelLeppert.com.
The views and opinions expressed are those of the author only and do not necessarily reflect the views of The Indiana Citizen or any other affiliated organization.
