Bowl o’ Cherriesbowl o’ cherries

Two articles in this morning’s newspapers speak to one another — but they don’t know it.  

One is a fascinating piece in today’s Boston Globe focusing on the genetics of an aggressive form of colon cancer. 

Another in The New York Times’ Business section counsels readers how to get health insurance when they’re already dealing with pre-existing conditions.  

The Globe piece highlights genetic research linking descendants of one almost-Mayflower family who suffer from a deadly form of colon cancer.  Scientists combed genealogical archives to piece together the puzzle linking families in New York and Utah.  Now that they’ve isolated the genetic mutation giving carriers a 2 in 3 lifetime chance of developing the cancer, scientists can offer aggressive screening practices in hopes of helping carriers catch nascent tumors before they’ve spread.

The Times piece counsels readers how best to hang onto coverage when they have what insurers euphemistically call “pre-existing conditions,” or medical conditions that existed before application for health insurance.  The definition includes conditions for which patients have sought coverage in the previous six months.  Insurance companies in 44 states may either deny coverage or charge more to those deemed to have a “pre-existing condition” at the time they apply for health insurance.

Most insurance companies — but not all - can’t exclude based on the results of genetic testing. They can, however, deny coverage if applicants actually suffer from the disease for which they’ve been tested.  The thinking, apparently, is that insurance companies don’t want people waiting to sign up for policies after they’ve already become ill. That’s too expensive.  Instead, they want healthy people in their pools.  They are insuring against the potential for future illness.

I suppose some of this makes sense if you squint really hard.  Perhaps these kinds of rules would have been appropriate in the 1930s, when Blue Cross (hospital insurance) and Blue Shield (physicians’ services) were founded.  American health costs were relatively low.  There was no such thing as genetic medicine.  I’m not sure there even was such a thing as a pre-existing condition back then. (I don’t know when insurance companies formulated the concept of “pre-existing conditions” and couldn’t find a history on the web — would be grateful to learn more from those with answers.)

Without a doubt, though, the concept of “pre-existing conditions” makes no sense in the twenty-first century, when advances in genetics change our understanding of health. If, for instance, a person is battling invasive colon cancer, carries the colon cancer mutation identified in the Globe article, and has no health insurance, how is it possible to pinpoint a time when she or he would not have had a pre-existing condition?  The genetic abnormality was there, lying in wait, from the moment of conception. 

I guess this begs an epistemological question.  With many types of illness, knowing what we know about mutations and genetic predisposition, is it still possible to demarcate a before and after with certainty?  Is there just one, long, unbroken line of “condition” stretching back to the original mutant?  If so, how can insurers continue to craft policy based on the concept of “pre-existing” conditions?

For me, this isn’t just an exercise in hypothetical thinking.  I carry the BRCA-2 mutation, conferring about an 80% lifetime risk of developing breast cancer.  I’ve reduced my risk with surgery, but with three teenagers, my worry is not over.  It seems enough to worry about whether or not my kids will be carriers.  It is almost unbearable to have to worry if they will be able to get health insurance because of a genetic predisposition or pre-condition.  I want the Obama administration to bring insurance companies to their knees on this one: no more language about pre-existing conditions when it comes to coverage.  Of course, if we have universal coverage, none of us will need to worry about this concept again.  

I feel like a killjoy when I talk about possible career paths and jobs with my kids.  ”Whatever you pick,” I tell them, “just make sure it comes with health insurance.”  What a terrible way to talk with young people on the brink of hatching plans and dreaming dreams.

There hasn’t been much in the news of late to inspire hope, despite Barack Obama’s assumption of office.  He warned us in his inauguration speech.  He was right.  Unemployment continues to rise, there is still war in the Middle East, people in positions of power — no matter their political affiliation — still don’t seem to understand that, as the newly minted senator for Illinois warned us, “one day a peacock, the next a feather duster.”

And yet.  Three times this week men publicly did the unthinkable.  They apologized.  This gives me great hope.

Barack Obama led the way.  ”I screwed up,” he said over and over again.  He took full responsibility for having pushed nominees toward confirmation even after it was clear they had broken the president’s declaration that there would be no tolerance for even the appearance of impropriety in his administration.  Next thing I knew, Jehuda Reinharz, president of Brandeis University, was apologizing for deciding to sell off artworks in the campus’s Rose Art Museum.  ”I take full responsibility for causing pain and embarrassment in both of these matters.  To quote President Obama, ‘I screwed up.’”  Most astonishing of all, Elwin Wilson, a white man who reveled in his own supposed white supremacy, apologized to African American Congressman and civil rights leader John Lewis for having beaten him to a bloody pulp 48 years ago.  ”I just told him I was sorry,” Wilson told reporters this week

Just.

As if this were some small thing.

Any one of you lucky enough to parent knows how big a thing apology is.  ”Hard” doesn’t begin to describe the task of teaching children to “say sorry.”  They certainly do not emerge from the womb equipped to take responsibility for their actions and repair the emotional damage they leave in their wake.  Who hasn’t heard a small child mutter, “sorry,” chin tucked to chest, eyes darting side to side, torn between furious self-pity and a desire to please authority?  Who hasn’t watched teenagers threatened with the revocation of privileges shuffle from foot to foot as they coughed out the most insincere of “sorries?”  

Getting these wily ones to stand firm, meet a gaze, confess, and apologize is one of the hardest things I have labored to achieve in my life.  Maybe that’s because I came from a family that settled disputes by fist and fiat.  Since I didn’t know how to set things right when I married (and neither did Mark), we’ve both had to work on cultivating civility and extending apologies.  A good read: Douglas Stone, et. al., Difficult Conversations: How to Discuss What Matters Most (NY; Penguin Books, c1999).  Also helpful: the Buddhist concept of “right speech.”  Is it true?  Is it helpful?  If not, don’t say it.  I’m guessing that Barack Obama’s mother and grandmother didn’t need books.  They knew most of the stuff already - and it helped them do an exceptionally good job raising him.  Ditto Michelle Obama’s mom.  

The single most effective way to teach children to apologize is to do it ourselves.  When we say we goofed, when we deploy those powerful words of apology, when we move beyond facts into the realm of emotion and connect our actions to others’ feelings, we show our kids how to heal wounds we have inflicted.  We demonstrate that it’s possible to make really big mistakes and still love and be loved, introducing into children’s black and white certainty a mysterious shade of grey.  For Barack Obama, Yehuda Reinharz, and Elwin Wilson all to name their failures in public and “say sorry” shows a strength that fills me with hope. It is behavior that, as Dr. Aaron Lazare has written in On Apology (Oxford: Oxford UP, 2004), requires “attitudes of honesty, generosity, humility, commitment, and courage” (263).  

Now to get Hillary Clinton, who surely has heard her share of apologies, to start practicing at the State Department.  I invoke John Lennon: Imagine!