UNC is still a force for good

I have an op-ed in the Raleigh (N.C.) News and Observer today that is reproduced below.

By Donald H. Taylor Jr.

Carolina was the only college to which I applied while a student at Goldsboro High – UNC-Chapel Hill was my dream school.

When I arrived, I was interested mostly in not living with my parents, enjoying newfound freedoms and pretty girls. Four years later, I was passionate about health policy and on my way to graduate school (also at UNC) and a career as a professor.

UNC-Chapel Hill changed my life in ways that were unimaginable the day my parents dropped me off at Winston dorm. That has always been the promise and the reality of Carolina. However, I fear that the difficult budget situation of our state, and the choices that could be made by our General Assembly going forward, could jeopardize the realization of that promise for students in the future.

 I have been deeply embarrassed by what I have read about my alma mater over the past two years. Whatever has happened that is wrong needs to be laid bare, and strong plans made to ensure the same mistakes are not made again. I very much affirm Holden Thorp’s commitment to making things right during his remaining time as chancellor and accept his decision to step down at the end of this academic year.

My biggest fear is that these scandals will be front and center in the minds of the people of North Carolina when the General Assembly has to make the truly difficult budgetary decisions facing our state. It is tragic that the headlines of late have not been of the incredible things that UNC does – both for its students and the state as a whole.

I am fearful that we will essentially “eat the seed corn” instead of making the continued investment necessary to maintain a world-class research university that educates our children while also making discoveries that help the people of North Carolina, the United States and the world.

It is an expensive endeavor to maintain a research university like Carolina, but it is worth it. Further, given recent budget cuts, the next few years are particularly crucial in maintaining the school’s excellence, and it would be far more expensive to try and rebuild later if we reduce our short-term investments. Our strong university system (all of the campuses) has figured mightily in helping make North Carolina a leader in the South, and it can lead the way to the future.

I would like to say thank you to all the people of North Carolina who have paid taxes to support our state’s great public university system, especially those who themselves did not attend these schools. I join you in expecting that this season of scandal will end, and that the many stories of the good being done by the students and faculty at Carolina will move back to the fore, where they belong.

Donald H. Taylor, Jr., associate professor of public policy at Duke University, holds three degrees from UNC-Chapel Hill. He blogs at www.donaldhtaylorjr.com.

RIP Neil Williams

Neil Williams, Chair of the Board of Trustees of The Duke Endowment died unexpectedly on Sunday Aug. 26, 2012. A memorial service will be held on Thursday Aug. 30 at 11am in Atlanta.

I met and interacted with Mr. Williams in my former role as Director of the Benjamin N. Duke Scholarship, a program that focuses on getting the best and brightest future leaders from North and South Carolina to attend Duke. Mr. Williams grew up in Charlotte and was a Duke grad, so he had great interest and insight into our recruitment goals and challenges as well as our efforts to encourage young leaders. What I most appreciated about Mr. Williams was his direct and frank manner, delivered from a countenance of his love of Duke.

Taking a blog break ~Aug 1

I am leaving tomorrow with my boys (ages 15 and 11) and my dad for a 2 week trip to Sequoia, Kings Canyon and Yosemite National Parks and then some time in San Francisco. Planning to go fairly far off the grid….the blog will pick back up around August 1.

Travelling the rest of the week

so posting may be light after one this afternoon on corporate tax reform.

If You Knew Suzy

The post below appeared on October 24, 2010 in my old blog. We read the book described, If You Knew Suzy last week in my Introduction to the U.S. Health Care System course, and used it as a lens through which to view the entire semester so far. I highly recommend it.


If You Knew Suzy: A Mother, A Daughter, A Reporter’s Notebook, by Katherine Rosman, Harper, 2010. ISBN#978-0-06-173523-3. Amazon link. Less of a book review and really more of an encouragement to read this book….

If You Knew Suzy is a beautiful book, that is also important. These two attributes don’t often describe the same book for me. By beautiful, I mean that it is well written and tells a story that drew me in, and touched me deeply. If you can read this one and not cry, there is something wrong with you. It is important, because it provides an honest glimpse into the health care system of the United States, or more accurately, into the system of how care is provided to persons who are said to be ‘dying.’ Expectations, hopes, fears and realities are all described as they occur, often in disturbing detail, and with an honesty that I can only describe as ruthless, and appreciated. The book is at the same time funny and irreverent.

This book is worth reading for its beauty alone, but you would then be avoiding the many profound questions raised in this book about the how, where and why of our health care system; especially care provided to persons with advanced life limiting illness. If you bring to the book pre-conceived notions of how people should react when facing their own mortality, or a situation that seems ‘hopeless’ the book provides an important reminder that people are distinct, and don’t fit into neat boxes or roles. At the same time, the individual decisions each of us make affects all of us when it comes to health care decisions, both on the macro level as well as what our choices imply for our family and friends.

I met Katie Rosman in May, 2010, when she came to Duke University’s Institute on Care at the End of Life to give a presentation about her book to a group of providers and advocates for end of life care. This is a round table, blue ribbon type of group that is seeking to advance the research basis of end of life care and to promote better policy. From different perspectives, the participants are mostly interested in improving the quality of life of persons who are suffering.

Into this group, with much experience in the reality of dying and how care is provided just before death, Katie managed to bring a fresh voice, the story of her mother’s death from lung cancer. While her story and this book provides glimpses into the medicalized world of an ICU and interactions with physicians and nurses–some good and some bad–the story of Suzy’s death (Katie’s mother) is told as a part of her life.

The occasion of her mother’s illness and death motivated Katie Rosman to investigate chapters of her mother’s life about which she had not known a great deal. And it seems that in her mother’s death she seems to come to know her mother much better. Intertwined into the story of the decline of her mother’s health and and the families attempts at navigating the health care system are glimpses of Katie’s childhood, her relationship with her sister, father, stepfather, and mother all told to honor the memory of her mother and to preserve it for grand children that will never meet Suzy.

As a person who spends quite a lot of time thinking about policy related to the provision of hospice and palliative care, and who believes that our culture is profoundly bad at having honest and thoughtful discussions about the limits of what medicine can do, there are all sorts of lessons that could be drawn from this book. Bashing off a list of policy changes that I was for before I read the book and claiming the book proves I am right seems inappropriate. I will just leave it where I started: If You Knew Suzy is a beautiful, and important book.

A pharmaceutical story

About 2 years ago, the health insurance that Duke University provides to employees instituted a mandatory policy that you had to use a mail order pharmacy for recurring medicines, or pay a very large penalty (on the order of $100/prescription). So, I switched the one pharmaceutical I take to this service (Fexophenadine 180mg/once per day [generic for Allegra, a seasonal allergy medicine]). I could obtain a 90 day supply of Fexofenadine for $20 via mail order under this year’s benefit structure.

When I went to fill this prescription a few weeks ago, it was denied because Allegra is now available as an over-the-counter medicine. The other day I went and bought a 90 day supply of the medication, but could only find name-brand Allegra. I bought it from Sam’s Club and it cost $32.50, a great deal more than the generic did as a prescription medicine (found OTC Allegra at several other places for a higher price). I did not find generic Fexofenadine 180/mg per day anywhere.

Is this unusual? Was it just Allegra brand name that is available over the counter? Is it typical for the price of newly-over-the-counter meds to be higher than their prescription generic price under insurance? Or does this just mean that Duke has very nice benefits? Obviously the mail order company will receive volume discounts. Will the generic brands also sell over the counter? Can they?

Walking to work

I walked to work today, as I do about once per week.* It takes me around 40 minutes, a nice head-clearing trip. The first 10 minutes are on the shoulder/ditch of a busy road that I wouldn’t let my 10 year old walk along, but I am comfortable doing it (Cornwallis road between Old Erwin and 15-501 in Durham, N.C.). The rest of the walk is on a nice wooded trail and then across Duke’s campus.

The odd thing is that 3 people whom I knew stopped and asked me if I needed a ride today as I walked. This was very nice of them, but it seems to show that purposefully walking to work is largely unimaginable. All of them asked as I was on the busy road, so maybe if there were a proper walking trail or even bike lane it would have seemed more normal. Something is wrong with this story, probably including my reason below for why I don’t walk to work more often.

*the reason I don’t walk to work more often is related to off campus lunch appointments and what I have to do at the end of the day, namely drive numerous carpools to various sporting practices for my three kids just as work is ending. The carpool issue is really the binding constraint.