One of the most widely recognized symbols of democratic government in the world, the United States Capitol, with its cast-iron dome and stately marble columns, is visible from across Washington, D.C.
“The U.S. Capitol stands as a monument to the American people,” asserts the Capitol Visitors Guide. “It is where the issues facing the nation are considered, debated and written into law.” To an outsider, Washington, and the Capitol, are imposing, daunting places, symbolized by that security and the pomp, protocol and ceremony surrounding the constitutionally mandated duty to “make all Laws which shall be necessary and proper” for the country. The halls of power in Washington, D.C. are filled with the influential and the important: senators, representatives, lobbyists, journalists, political power brokers and politicos (and interns).
That was the view of many of the students in the St. Thomas Health Care MBA program who each spring travel as a cohort to Washington for the program’s Health Policy Seminar. But from the moment the seminar started, those assumptions about political life in Washington were challenged.
Jack Militello, Ph.D., professor of management and senior executive fellow in St. Thomas’ new Center for Business Innovation in Health Care, served as academic director for the Health Care MBA for the past 12 years. The Health Policy Seminar was designed, he explains, to “show how government policy affects health care. It is part of our understanding of how everything fits together in the MBA.”
“What you see depends on where you stand,” former Senator David Durenberger told the cohort.
“I will never forget when former Senator Durenberger said that,” said Caitlin Dattilo, vice president of account management at UnitedHealthcare. “This has been pinned up on my wall in the office since the trip. I found myself making assumptions because of my background in health insurance, and I now try to approach every situation from both perspectives.”
Durenberger, who represented Minnesota from 1978 to 1995, has led this annual trip to Washington since the program’s inception. Though he hasn’t been in office for two decades, it isn’t evident. He can still be counted among the political elite in Washington and is widely recognized across the Hill. His prominence brings some of Washington’s most influential players in the health care policy world to speak at the seminar.
Nearly two dozen politicians, congressional staffers, lobbyists, and industry experts addressed the seminar this year, including Liz Fowler, who, before becoming vice president of Global Health at Johnson & Johnson, was the “architect” of the Affordable Care Act; Dr. Mandy Cohen, the chief of staff for the Centers for Medicare and Medicaid Services (CMS); Chris Jennings, President Obama’s one-time coordinator of health reform; Chip Kahn, president of the Federation of American Hospitals; and Tom Scully, who was administrator of CMS from 2001 to 2004.
“What we try to do is open the minds and hearts of Washington to show a smorgasbord of points of view,” said Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University, who helped coordinate the seminar agenda, “but also show the basic similarity in the way folks do business here.”
“One of the things that you learn about Washington is that it takes virtually everything that you had in your MBA program and it puts it into a package,” said Scott Kulstad ’06 M.B.A., executive director of Musculoskeletal Services at Fairview, who was an instructor in the health policy course. “You can't talk about policy without talking about [other courses in the program].”
Militello echoed that assessment, explaining, “The MBA looks at health care in three ways. First, the policy that drives decision making; the federal government dictates all industry regulations but is particularly noticeable in health care. Second we deal with institutions which we have to manage within the boundaries of policies—legacy institutions. Third is entrepreneurial organizations that challenge policy.”
The Real Washington
The real insight for many students in the seminar was the realization that Washington’s political elite are people, too.
“The people in power are human!” said Molly McMillen, director of public relations for UnitedHealthcare Community & State. “To hear each speaker share their candid insights and lessons learned was empowering. They are subject matter experts in their fields, but none believed they were the only lever in making change.”
“Our health care leaders are people who need to hear from us to make a difference,” said Patrick Coleman, senior neuroscience sales, Allergan. “To make improvements in U.S. health care policy we need to be more proactive in voicing our opinion.” He plans to communicate more “with my city and state officials on topics I am passionate about.”
“The experience of seeing real life people that are dealing with real life problems and that appreciate our input was eye opening for me,” said Dr. John Cumming. “What [our representatives] need is a perspective from people who are doing the work, that are being affected by the policy that's being developed.” Since returning from Washington he has reached out to Representative Erik Paulsen and Senators Klobuchar and Franken.
“I was surprised by the honesty of our speakers, sharing the good, the bad and the ugly about what works (and doesn’t work) in Washington,” said Dattilo. “So often we heard the same frustrations from both sides of an issue about finding a middle-ground and collaborating, but being stilted by some of the external forces at work, like a campaign year.”
“Getting an inside view of the history, politics and decision making around health reform and policy truly was an eye opening experience,” said O’Brien. “Not only did the experience deepen my understanding of the process and relationships by which work gets done in Washington, but I was struck by how, despite very strongly and emotionally held points view, the individuals we spoke with all seemed to fundamentally respect one another and are genuinely committed to improving the health care system.”
Cumming saw it in a different light. The stereotype of Capitol Hill, he said, “is Washington DC. They’re doing the policy analysis and trying to do what's right, but then all of those issues are politicized.” Congressional staffers—“they’re just doing a job. They’re just people trying to learn as much as they can and get through their day and do their work. The politicians,” on the other hand, “are keeping their jobs.”
The biggest change in O’Brien’s thinking is that “I now understand that health care reform is an iterative process – we’ve been working on it in the U.S. since Teddy Roosevelt. It is also clear to me that reform will need all of us, in our jobs, as members of our communities and individually in the health decisions we make to lead the way to a better system.”
“How health care policy gets made is like watching sausage be made,” said Cumming. “You like to eat sausage, sure, but you don't really want to see how it’s made. [But] that’s the part that you need exposure to.”
“You see that policy work is done by talented but normal people. That they're not evil geniuses, they're not grimy lobbyists, they're not dumb bureaucrats,” said Militello. “They're actual people who are trying to do a good a job, and the constraints of the system define what their good job is.”
As part of the seminar, the class took a behind the scenes tour of the Capitol, led by Senator Durenberger. It was a beautiful spring afternoon in Washington as the cohort walked from their hotel and across the Capitol grounds. Colorful tulips and fragrant cherry blossoms filled the gardens around the building and the city. The heavy concrete planters surrounding the Capitol also serve as hidden security measures along with the more obvious security booths and barricades that limit entry.
Cumming recalled, “I happened to be walking right next to Senator Durenberger. It was almost surreal, I was walking along, just having a conversation about his days on Capitol Hill…and you know, I was able to ask him any question at all and we were just having a really delightful conversation.”
For all the security and imposition of the capitol’s halls of power, for the students in the Health Care MBA Policy Seminar, the truth is that their work and input is as important to the future of health care in the United States as is that of the political elite.
For Cumming “that is something that I will never ever forget, as long as I will live.”