A Very Tough Choice


Leonard Zwelling

            The spectacle that Congress made of itself in the first
two weeks of October could well be repeated at year’s end. The government
shutdown/debt ceiling deal that temporarily delayed America defaulting on
paying her debts, is only good for a few weeks.

            With time running short, it might be worth examining why
this is happening now in an effort to head it off—permanently.

            As has been amply described, the shutdown was a product
of several realities of American politics:

government is not uncommon. Either party may hold the power in the Senate, the
House or the White House at any given moment suggesting the adoption of
processes to work together to get past acknowledged political differences would
be advisable.

I have often
written about the 4 Ps of DC, policy, process, politics and personality and
their ascending order of importance. Since personalities are the most
important, perhaps some adults ought to step up, and not at the 11th
hour, to develop relationships with each other that can lead to bipartisan progress
and a better America for everyone.

Acting like an
uncivil ass on national television is no longer acceptable behavior. It isn’t in
local media either. Despite the fact that the film Lincoln suggests that such
behavior is nothing new, that never makes it acceptable. As Joel Osteen said
once in a sermon I heard him give, “If you’re right and you’ re rude, then you’re

In the end, this
means that negotiation will be necessary, compromise will, too, and no one gets
everything he wants.

The only reason
these four things are not occurring is because one political party continues to
win elections in years that end in zero and thus gets to draw election
districts using the Constitutionally mandated census data acquired in those
years. The party members do so to guarantee their own re-election by drawing
these lines around voters with political persuasions akin to their own, no
matter how radical. A perfect example is the district in which many of you and
I live with Rep. John Culberson as our member of the House and a Tea Party supporter
of the shutdown. That’s how these guys get elected and how they stay in office.
Essentially, it’s our own fault. We get the government we deserve.

In the end, it
will be the Republican Party that has to decide why it lost the last two
presidential elections. Was the GOP just the victims of overwhelming
circumstances coming out of the Bush 43 era or were their candidates not
conservative enough? This will likely lead the party either toward someone like
Chris Christie as its national nominee if the Party believes the first or someone
like Ted Cruz or Rand Paul if a lack of true conservative street cred was
thought to be the reason for the losses. This is crucial for it could set the
tone for our political discourse for years to come.

believe a similar choice faces MD Anderson. Both the executive leadership and
the faculty have to decide if the current turmoil and poor morale is a function
of bad choices made by the current leadership in response to what they
inherited from the past leadership (unwieldy fixed costs at a time of
decreasing revenue from clinical reimbursements) or the new leadership has
chosen a direction on its own at an inopportune time in the course of the
history of modern medicine and academia in particular (NIH funding dropping,
ObamaCare, and insurers looking to hold the line on medical loss ratios—the
actual cost they pay for care).

MD Anderson faculty, like Republican voters, have a huge role in teasing out
the best answer to a tough question. If the faculty believe that all of this
was really set up by the poor choices of the previous administration, then
there ought to be a way that they can work with the current leadership to
improve things. Of course, the fact that many of today’s leaders were
yesterday’s as well, might suggest a very obvious fast fix.

on the other hand, the faculty believe that the current leadership is fundamentally
incorrect about its characterization of the cancer problem and MD Anderson’s
role in its solution, then the faculty needs to assert itself with better

like established Republicans, the MD Anderson faculty represent some of the
best and the brightest in their fields. Why is morale so low and pressure to
see more and more patients so high? That’s what you have to figure out and
then, if you disagree with the directions in which you are being led, make your
feelings known.

could argue that just as America gets the government it deserves, MD Anderson
gets the leadership it deserves. I just don’t believe that. The country gets to
choose its leaders, but under the current political system, the results,
especially in the House, are largely fixed with very few seats really contested
every two years. But at Anderson, there’s not even the illusion of democracy,
no election and no mandate for the leadership to even communicate with or
listen to the faculty. I guess that last statement is pretty obvious.

unlike in Washington where at least there’s a Constitution that purports to
outline a representative government, at Anderson there is not. Perhaps the
Faculty Senate should consider changing that.

Leonard Zwelling