By Gary Gunderson
I headed north in order to head west in order to drive east. The day in Hartford with one of the great insurance companies in the land turned out to give me a key to the whole trip. Hartford is not a party town with entire city blocks dense with actuaries thinking about risks. The basic idea is that we could jointly invest in order to create shared protection from some of life’s trials that are at an individual level inevitable, unpredictable and, frankly, unfair.
Any one life is as distinctive as a fingerprint. But we all have fingers, nearly all of us 10. When you see the big pattern, we can find comfort in being part of the herd. Maybe I won’t get cancer, but if I do, and if I have shared some of my treasure with those that don’t, they might stand with me and bear the cost, if not the pain. That’s the logic of insurance and why we want it, why life seems precarious without it, why even states that are terrified of people who don’t look like them just voted to expand Medicaid.
There are other ways of finding comfort and accountability besides highly sophisticated computation of disease analytics. There was a time when we found hope in a shared identity focused on faith. The early versions of that, at least until Isaiah focused on hoping that God would protect US—not them. Indeed, against them, if it came to it; who god loves enough to bless and who god does not.
Insurance companies don’t think about you and me unless we are or might be members. So there are a lot of things about us they haven’t cared to know. They haven’t thought much about the most obvious factors driving health—the color of your skin and census tract. Until now.
If you’ve got is piles of data and money you’d think you could do just about anything. But data is just numbers about the past until one asks about the future. ”Predictive analytics” promises more, but still projects out of the past and works best with things like gravity, like a bomb from a fast moving airplane. If you know enough about the speed of the plane, weight of the bomb and density and turbulence of the air, you can predict where it will land. You could, if you knew enough variables, arrange for it drop right down a smokestack, as the military likes to show us in televised wars.
Humans and our communities are more complex, capable of moving against social gravity. And sometimes we do things entirely unimaginable, not just unpredictable. The iPhone didn’t exist. And then it was imagined. And then only ten years ago it became. And you are probably reading this on one. Libraries were like that. Democracy, too. As was public health. Who could have known?
Imagining and hoping
Data can tell you in exquisite detail what is likely given the wicked stew of factors of culture and place and all the biomarkers of accumulated insults of stress and stigma amplified by poor food, uncertain employment and hostile memes blowing like a blizzard from every screen big and small. But data do not imagine, cannot hope against inertia with anything but flight or containment. Humans make up things all the time, gravity be damned.
A couple of blocks from the squadrons of actuaries is a historical park with like a carpet beneath the exquisite state capitol, still surrounded by a forest of campaign signs. I noticed down to the left a few dozen men quietly lined up, some walking away with a plastic bag food. One was speaking loud and brashly enough to to be a President. Nobody paid any attention (a good idea). A few waited patiently for a haircut, offered just as the food and just as necessary for dignity in a tough time in their life. I couldn’t tell if the one cutting the hair was one of them, or one of those humans who does this kind of unpredictable things—caring, that is.
The data will not tell you that one human will cut another’s hair, or give away food or shelter or eye contact. But that happens, too. And it pretty much always has in the ragged gaggle of human communities.
The arts of partnership
Insurance companies see vast amounts of data and thus very large patterns. Exceptions can be just noise, distractions from reality. But they can be clues that the data is incomplete. Insurance companies are not the only ones staring a vast pools of data looking for opportunities to get us to place our bet on our health with them. Amazon sees health mostly as a problem of medical management and figures it can mail medicine like it does everything else. And they have data they think will allow them to bypass pretty much everything to deal directly with you and maybe me, too.
What if you did the opposite and combine an insurance company with 10,000 drug stores that would get you within three miles of nearly three quarters of everybody in the country. You’d have a social strategy with a social network that might work well with social creatures. Drug stores are not much more social than Amazon these days, florescent with no chairs, the only one worth talking to contained way at the back (the pharmacist).
There are, of course, things called congregations within a two-minute walk of nearly everyone. With only a few exceptions, they are friendly and practical. They’ll watch your kid; half of them keep food on site to give away for free. They encourage their members to do things like that. The guy cutting the hair probably got the idea reading the old books they keep on hand.
On the way west, I joined Jerry Winslow at Kettering Health Network, a member of Stakeholder Health. Like every Stakeholder partner, it is trying to learn its way across the sidewalk into the communities it cares about. Nobody knows more about what faith has to do with health than an Adventist. But like insurance company that thinks about health all the time, too, a faith hospital struggles to know how to get social, how to be present where we now know health is formed and sustained. Kettering has a well-earned reputation for quality and compassion, but the arts of partnership are a whole new craft, just as it is for an insurance company or a public health agency. You can’t buy it, as it is not just locations, but social qualities, human phenomenon. You have to live into it, learn into it, craft it as a shared creation.
That sounds improbably and unnatural, but grown-ups do this kind of thing all the time, even within sight of the state capitol down the block from an insurance company.