Leadership and Crisis

by Bobby Jindal

  In his 1958 book The Affluent Society, John Kenneth Galbraith said that with a home, car, television set, and a family member in college, Americans had reached their economic pinnacle. Stanford University Professor Paul Ehrlich warned us in the 1970s that the immediate future would bring widespread famine, shortages, and despair. He wrote in his book The Population Bomb: “By 1985 enough millions will have died to reduce the earth’s population to some acceptable level, like 1.5 billion. ...” In his book The End of Affluence, Ehrlich said Congress would be dissolved “during the food riots of the 1980s.”16 In 1977 Jimmy Carter warned, “We could use up all of the proven reserves of oil in the entire world by the end of the next decade.” Of course, there were no food riots in America in the 1980s. Our oil reserves expanded, they did not evaporate, despite our still growing dependence. And at last count there were approximately 6 billion people on earth, including, surprisingly, Paul Ehrlich.

  Yet today there are still some people who want to harp on America’s limits. They still say that our best days are behind us. These big government advocates tell us their failures are the best Americans can do. Forget cooking up anything new—let’s just divide the old American pie into smaller, equally unsatisfying pieces.

  That is all bunk. It’s not a sunset, but a sunrise, that still starts America’s day.

  As Ronald Reagan said, “I do not believe in a fate that will fall on us no matter what we do. I do believe in a fate that will fall on us if we do nothing.”17

  Western European nations did not decide one day to embrace what they now call “democratic Socialism.” It has happened little by little, piece by piece, program by program. I’m certainly not suggesting that this European style socialism willfully pursues the economic rationalization and social interventionism of a completely planned economy. I also would never claim that our European friends do not each have many strengths and positive attributes. I am suggesting that they have in many ways taken a turn for the worse over the past sixty years to the degree they have exchanged the dynamic potential of a free people for the false security of a planned society. Perhaps they are happy with their trajectory and direction? Older, less dynamic societies on the downhill side of their national lifespans might be content with redistributing instead of creating. They might be satisfied managing their declines. That is something our country is still too young and promising to do. Our liberty, like our country, is ever-young and prepared to meet the challenges of a new day.

  I do not want to see America follow Europe’s trajectory and I do not believe that most Americans do either. I don’t want to see us pay more in taxes, expand our government, erode our freedoms, or become weaker in the world. Americans don’t need to become more like Europe. But we will if we do not change course.

  Big government may be broken, but America isn’t broken. Washington may be unable to solve America’s problems, but if we bring real change to Washington there isn’t any problem America can’t solve, any goal we can’t reach, any frontier we can’t conquer. Whatever Americans can dream, we can achieve.

  I believe America should remain the greatest country in the world. When I was a kid, that was safe to say and aspire to. Not so today. There are many political leaders in America today who don’t like the sound of that. They cringe at the thought of American exceptionalism and superiority. It strikes them as unsophisticated, unrefined, kind of “cowboyish.” They think our aspirations of leadership are arrogant evidence of a fundamental intolerance of other nations and their cultures. They believe America should be content to settle into our place as just another country in the family of nations. They are ashamed we would seek to be the greatest country in the world.

  I am not ashamed. I am proud that America is exceptional. Global leadership is not a responsibility America can discard. It is a responsibility we must cherish. America is the hope of free peoples everywhere. Without American leadership the world around us would be more dangerous and less prosperous. The stronger America is, the safer the world is. We have a moral responsibility to make our country stronger and unashamedly export our ideals of freedom, democracy, and self-determination to all who would fulfill the divinely inspired potential of every living soul on this planet.

  And Americans are not victims. When you look in that mirror tomorrow morning, I hope you see what I see: the strength of the greatest country on earth.

  CHAPTER 11

  REAL CHANGE FOR HEALTHCARE

  I magine for a moment you are standing in a quiet hospital room holding your three-month-old son in your arms for what could be the last time.

  He is looking up at you with his beautiful, innocent brown eyes. And you stare down into his tiny face and wonder how you, his parent, are so powerless to save him that you need to entrust his life to a complete stranger. Despite having done all you can do, you are scared. And the helplessness you feel doesn’t stop the crushing weight of responsibility that comes with being a parent deeply in love with your new child.

  The time has come to hand him over. You are paralyzed; you love him too much to let him go, but your love for him has led you here, to this strange place full of technology and experts—and other scared families. All you want at that moment is for someone to tell you everything will be all right and that your boy is going to be healthy.

  But reality sets in. He is in the hospital. He needs help. And there is no other way. You must swallow your fears for the moment—just long enough to gently pass your little boy into the hands of the anesthesiologist who will prepare him for surgery. No amount of reason can dull the feeling that a part of you is being torn away as she takes your son through the large operating room doors and out of sight.

  For me, this was not a hypothetical situation. I was standing in that hospital room in 2004, holding my second child, Shaan, in my arms. And let me tell you—letting him go at that moment was one of the hardest things I’ve ever done.

  We had no reason to suspect there was anything wrong with Shaan when he was born only a few months earlier. The birth had gone smoothly, and he looked like any other healthy baby. But a week later, during a regular checkup, Shaan’s pediatrician detected a heart murmur. Later that morning, we took Shaan to a pediatric cardiologist who diagnosed him with a serious heart defect, which would prevent him from breathing or eating normally without becoming exhausted.

  My immediate reaction was that I’d give anything and everything to trade places with Shaan. I was devastated for him, devastated that this innocent little boy had this burden. When we see horrible tragedies happen to other people, we never think it will happen to us or to those we love. Of course, we feel compassion for children afflicted with disease or chronic health problems, and we pray for them and their families. But trust me, it is never truly real until it happens to your own child.

  The cardiologist said the problem might fix itself, but if it didn’t—and in Shaan’s case it did not look like it would—he would need life-saving open-heart surgery. The doctor then gave us one of the toughest prescriptions imaginable: waiting. Three grueling months of it. The wait would increase Shaan’s chances of surviving a heart surgery, if he could keep breathing until then. In the meantime, we would have to watch our son waste away. We watched his strength gradually leave him until he would sleep for hours and it took all his strength just to breathe. We watched his growth slow to a halt as it became harder to get him to eat. We watched him become more and more dependent on medications, and we watched him go into the intensive care unit. Weighed down by the consuming sense that we were failing Shaan, we struggled to accept the reality that there was very little we could do to ease his pain.

  I was running for Congress at the time, so I canceled campaign appearances to focus first and foremost on Shaan. We spent weeks of the waiting period trying every medical option short of surgery. Every option failed, but we refused to sit still, even after we had come to terms with the cold, hard truth that heart surgery was the only path. There was no one in Baton Rouge who could perform the pr
ocedure, so our pediatrician referred us to Boston Children’s Hospital, one of about half a dozen centers in the country that specialize in these kinds of cases.

  From the minute we learned of Shaan’s illness, Supriya left nothing to chance and took nothing for granted. A successful engineer, Supriya has an amazing zeal for data and a logical approach to problem solving. I have to say, as proud as I was of her, she really drove the doctor crazy with technical questions even during one of our first visits. They had been talking for a while before I got there, and when I arrived, the doctor looked at me and said, “Please tell me you are not an engineer. I don’t think I can handle two of you.”

  Supriya immersed herself in research on pediatric cardiology, learning about the endless intricacies of the procedure and all possible alternatives. Seeking precise numbers and facts, she would come to the doctor’s office each week with spreadsheets and a new list of questions. She was highly organized and far more studious than any medical student I had ever seen. I think she probably could have performed the surgery herself.

  I focused my time searching for the best surgeon. One thing I learned is that we can know the details of any procedure, and we can pepper the doctors with every technical question. But let’s face it—once the doctor is behind those operating room doors with your child, there is no turning back. The only power you have as a parent at that point is to make sure you chose the right person to trust—the person who will put your child to sleep, hold his tiny heart in his hands, and use the power God gave him to heal.

  The Bible says that God loves you, He knows everything about you, and He will take care of you. From knowing every hair on Shaan’s head to providing for even lesser beings than a beautiful human child, I knew, no matter what, God had a plan. I also believe God gives us the tools to help guide our course, and I was determined to use everything He gave me. Yet, with the outcome of Shaan’s illness unclear, and with my layperson’s inability to completely understand the available information, I was shaken to my core.

  Now imagine you are in my place again, standing in that room in Boston Children’s Hospital with your little son in your arms and the anesthesiologist standing by to take him through those doors past the point of no return. Only this time, you didn’t get the surgeon you wanted; after your painstaking work to find the best surgeon and the best treatment, your choices were denied by some far-away bureaucrat.

  Let’s be clear. Government intrusion into the healthcare system creates this scenario every day. When federal or state bureaucrats who control Medicare and Medicaid determine the rates they pay to providers based on politics, lobbyists, and federal or state-wide budgets rather than on real market-driven principles, it creates shortages of doctors who will treat those patients.

  Under the Democrats’ healthcare “reform,” government intrusion is set to grow much worse.

  Look at the much-vaunted Medicaid system, which will add around 16 million people under President Obama’s healthcare reform. Even now, before this huge expansion, getting a doctor is so difficult that many people simply opt to get treated in an emergency room. One example we saw was a grandmother caring for a young, autistic child. The woman, a Medicaid recipient, was struck with a brain tumor. Yet no specialists would take new Medicaid patients. Her primary care doctor told her to drive three hours to another city and go to the public hospital emergency department, tell them she has a brain tumor, and get them to find a doctor for her. In light of these kinds of horrifying situations, we are implementing some of the most sweeping reforms of our Medicaid system in Louisiana’s history.

  The single most important question in healthcare is often overlooked: who do we want controlling our healthcare decisions—patients and their doctors, insurance middle-men, or government bureaucrats?

  I’m passionate about healthcare because, for me, it’s personal. Before Shaan became ill, I had begun to devote my professional life to healthcare issues, having served as secretary of Health and Hospitals in Louisiana, executive director of the National Bipartisan Commission on the Future of Medicare, and as an assistant secretary of the U.S. Department of Health and Human Services. I had studied healthcare policy in both America and around the world. But no book, study, or commission can replace the firsthand experience that comes with encountering the system yourself for your own child’s sake.

  I believe everyone has a right to affordable healthcare. We are all created in God’s image, and that makes us valuable, independent of our economic worth or the contributions we make to the economy. It is a question of human dignity granted to us by our Creator.

  But with equal passion I believe this goal cannot be achieved through a government-run system. Government healthcare is top-down: decisions are politicized and are indifferent to the needs of individuals. Medicare and Medicaid have proven that when there is no free marketplace with transparency and consumer engagement, we get an inflexible system that wastes money, reduces choices, and produces poor outcomes. In 2009, the federal government admits around $50 billion was wasted simply on improper payments in Medicare alone.1

  When government sets prices, shortages result. Consider that in the next twenty years, the number of Americans over the age of fifty-five will double, while at the same time there is a projected shortage of more than 125,000 doctors by 2025. More doctors are already refusing to accept Medicare, and the Medicaid program is imperiled even before it enrolls millions of new patients under Obamacare.

  In a government-run system, choices, either directly or indirectly, are made for you without your consent. America is built on choice—where we live, what we eat, what we drive, and with whom we associate. Yet oddly, when it comes to healthcare, choice is usually an afterthought. Disagree? Go online and try to find out which physicians have the best outcomes. It’s nearly impossible to find that information. If choice were paramount in our system, those data would be readily available and the public would be demanding it. But instead, we have a system where we are told what we need and expected to comply.

  My view is pretty straightforward: the more important the decision, the more important it is that you have choices. This goes for the poor as well as the rich. Poor people have few healthcare choices: typically, they either get Medicaid or nothing. The poor are often criticized for neglecting their healthcare, but this is the natural result when people are automatically relegated to a poorly functioning, top-down healthcare program with few choices.

  Some supporters of government-run healthcare seem to believe the poor need this kind of command and control healthcare structure because they can’t be expected to be responsible for their own care. I disagree. Poor people are poor, not stupid. In my experience in public policy, a poor woman, just like anyone else, will responsibly care for herself and her children whenever she has plenty of choices and easy access to information. I certainly trust a mom to do the right thing more than I trust a nameless, faceless bureaucrat.

  There is also the question of proximity—both physical and emotional—in making decisions. The best decisions are made when the decision-maker is close enough to the problem to understand it and has a strong, personal stake in getting it fixed. But when the decision-maker is an insurance or government bureaucrat too far removed from the situation to feel the full weight of responsibility, you can bet you won’t get the compassion of a father or mother fighting for their son’s life.

  Without a doubt, our lifestyle choices are the primary driving factor behind the overall poor state of health in America. But the answer is not a government diktat, which can never replace the sound judgment of an educated consumer. And not only is government control ineffective, it’s un-American. People just don’t want the government to tell them how to live their lives. I work out at the gym, but I also eat chocolate chip cookies and the occasional McDonald’s hamburger. My health would be better off without the cookies and burgers, but it’s my choice and my right to eat them.

  The government’s role should center on providing market-based incen
tives for sound healthcare management, especially for children. That has been the focus of my reforms in Louisiana to ensure parents get well-child checkups for their children and that people with diabetes get their blood sugar tested regularly. We also provided market-based incentives to physicians to improve immunization rates for children, which resulted in our rates jumping from 44th in the nation to 2nd, according to the Centers for Disease Control.

  I’m amazed by the envy some Americans feel toward the health systems in other countries—systems that supposedly function for the overall social good, but often at a great cost to the individual. Great Britain, which has a centrally run National Health Service (NHS), is plagued with shortages and long waiting periods. British newspapers are filled with stories about babies being delivered in hospital bathrooms, parking lots, and in hallways due to a lack of nurses or beds. Individuals who need simple operations, such as for cataract surgery, have to wait years for the procedure; some have even gone blind waiting for this fifteen- to twenty-minute operation.2

  The waiting list to see a dentist in Britain is so long that thousands of people resort to do-it-yourself dentistry. George Daulat of Scarborough, England, for example, contacted twenty public NHS dentist offices to have four painful teeth removed. After they all put him on a waiting list, he was forced to pull them out with pliers, using vodka to dull the pain. Don Wilson of Kent, used fishing disgorgers—the tool used to get a hook out of the back of a fish’s mouth—to pull his painful teeth. Some have attached their own crowns using superglue. The British government estimates more than 2 million people who want treatment for mouth ailments can’t get a dentist.3

  In Canada, the shortage of doctors is so severe that some doctors have held lotteries to reduce their caseload. Canadians who have been diagnosed with brain tumors need to wait up to eight months to be treated. A woman in Winnipeg with clogged arteries was put on a three-year waiting list for surgery. She died before the surgery was performed. “This tragedy could have been avoided,” her son told one newspaper. “My mother trusted the system with her life, it failed her.”4