When/Should Academics Take a Stand?

Austin Frakt has a nice post highlighting a question/response he had with Mark Pauly at ASHE yesterday about health economist’s (non universal) support of the ACA. Austin says what he had in mind is this fundamental question:

could there ever be anything important enough to warrant putting aside the standard academic equipoise? (“On the one hand …, yet on the other …”) If so, what? Could making substantial progress on the problems of the cost and quality of and access to health care be in that category? Is it or should it be relevant that a failure of this health reform, like all comprehensive attempts in the past, likely means at least another decade or two before it is attempted again?

For me this answer is a reflexive no brainer–yes–in the case of the ACA. At least my actions imply that because I wrote this piece on January 27, 2010 when I was writing columns for the Raleigh, N.C. News and Observer about health reform that ended this way:

The House should pass the Senate bill because it is a good step ahead, whose passage will ensure the continued focus on the health system that will be needed to take further steps to slow cost inflation and create a sustainable health care system.

There is actually plenty of what Austin calls equipoise in the piece, but it does finally say “pass the damn bill” warts and all.

However, Austin’s question is an important one that has many aspects and attributes, and is worthy of more thought and discussion. I am mostly comfortable with my advocacy and anyone that reads what I have written closely knows that I have said the ACA is a first step, not the last one. However, their are costs and benefits of academics taking these more public stands on issues, especially in the case of my writing serial columns in the newspaper.

Harold Pollack read Austin’s post and tweeted to Austin the following this morning:

I wonder if law profs had similar debate re civil rights act….” still it’s a good question.

Austin responded that we should be talking about and debating the many questions related to when/should academics say “this is what we should do.” I agree

Here are a few jumbled thoughts that represent my first thoughts on this; they are thoughts thrown into the hopper and not final words:

  • Disciplines have very different claims to quantitative precision, and reproducibility. I cannot decide which direction this impact goes in terms of likelihood of advocacy, and then reasonableness of same.
  • Universities have rules against lobbying, and this is of special importance to investigators with federally funded research. This likely means the professors have to be more cautious, the more closely related a policy issue is to their field of expertise. This is a paradox for sure. For example, I have been active in opposition to the death penalty in N.C. and don’t worry a bit about a lobbying restrictions there; I am just a citizen, though I certainly invoke being a professor of public policy. In health care, especially in the area of hospice and palliative care where most of my funded work now lies, I am more cautious.
  • The strategic plan of Duke is titled Knowledge in the Service of Society.  I really believe in this notion, but that still does answer the question of when/if academics should go “all in.”
  • The main side effect for me personally of writing in the newspaper about health reform and of blogging has been in my teaching. I used to pride myself of being about to present arguments in ways that students could not tell what I thought. Last fall, when I taught intro to the US health system, students were always saying “you wrote this, or you wrote that” on your blog/in news paper column. Did this engage the students or put some of them off? I am unsure.

More questions than answers from me, but it is an important conversation.

 

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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