Politics: Bubbles are meant to be popped.
Politics is no different than finance. Ideas that would wither under the gentlest scrutiny find their way to the top of the policy pile, become the received wisdom of often monied interests and are defended more with accusation and ostracism than intellectual rigor.
The cause is also similar; too many policy solutions chasing too few problems. Call it ideological inflation, if you like.
It was, then, always just a matter of the when and where.
Not in a million years would I have imagined the who would be JPM’s CEO, Jamie Dimon.
Last week, Rep. Rashida Tlaib of Michigan asked a hearing table row of bank executives if they would pledge to refuse credit for the fossil fuel industry. Dimon replied “Absolutely not. That would be a road to hell for America.”
In one succinct and unequivocable response, the banker took a hat pin to the bubbly idea that a responsible energy policy includes withholding capital from his customers.
It was a defining moment for policies that rest on weak evidentiary foundations but find footing in the quasi-religious nature of America’s political life.
In the end, any policy that does harm – in this case limits innovation in the energy industry – will never last but often longer than it should.
Mr. Dimon made that much clear.
Policy. Academic medical centers occupy prominent and nearly imperviously positive reputations in their communities. Vanderbilt University Medical Center, here in town, is no exception.
For good reason.
A lot of wonderful things have been accomplished by its researchers, practicing physicians and clinical staff.
Although the American Academy of Pediatrics has recognized “the vast majority” of kids expressing gender dysphoria can be treated without drugs and surgery, thus bringing it more in line with international guidance, Vanderbilt, and a number of other medical centers in the U.S., have continued to offer these solutions, making them the target of a podcaster named Matt Walsh.
(The AAP's overall "affirmative" c. 2018 policy is being hotly debated as some pediatricians would like to see it match that of Sweden's and Finland)
Mr. Walsh released videos from 2018 of an enterprising physician pitching the idea of a transgender clinic as a sound revenue model due to the complexity of the surgeries and extensive follow-up. Other videos featured a detailed explanation of services offered and warnings to staff to leave their ethical and religious objections at the door.
What followed next was outrage and promises of investigations by the state legislature and the Governor. What followed that was surprisingly muted, given how inflammatory the underlying issue.
Most news reports focused on the promised investigations, a few pundits predicted violence (mercifully absent), some argued that a 16-year-old-girl was not, in fact, a child (a loser, as we say in politics), and others offered anecdotes about avoided suicides (oft repeated but not well documented).
Vanderbilt persists in offering these services because they are profitable, just as prescribing opioids once was, despite scant evidence they are salutatory. Put that way, the community and political support Vanderbilt might have expected, mostly evaporated.
Either voluntarily or legislatively Vanderbilt will close its clinic to minors. The reputational damage will be permanent as the legislative process reveals just how far medical practice deviated from AAP's acknowledgement and international standards, with little evidence to support it.
That revenue model comes, it turns out, with a very high price.
Power.
Rep. Tlaib probably spends a good bit of her day in the political equivalent of a Carvana investor day c. 2020, hence her undisguised surprise at Mr. Dimon’s candor.
So unprepared was she that, doing her best Henry F. Potter imitation, Rep. Tlaib called for a run on Mr. Dimon’s bank.
It was a revealing moment. Just a few short years ago, Mr. Dimon would likely have responded with the usual tripe we find in hearing rooms.
Just a few short years ago, parents and patients might have rushed to Vanderbilt’s side. They may still but the march of time reveals the evidence we did not seek but can now not ignore. Poor energy policies leave nations vulnerable to those smart enough exploit the narrative. The absence of a clinical benefit for significant medical procedures becomes hard to ignore as maturity brings regret.
What is left are playground politics; calling names, making threats, doing everything, anything, but addressing the weak foundations of the policy.
It was never a good long-term plan and it appears to have finally reached an end.
Have a great rest of your weekend.
Emily Evans
Managing Director – Health Policy
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