“So you’re the healthcare candidate?”, Weisberg, the senior reporter sneers.
“No, I’m the candidate, candidate, and I am from Ames, Iowa seeking the right to serve as congressman for this fine district”, Kapoor rebuts with a confidence well beyond his years.
“Nice”, continues Weisberg, “Tell me a little about yourself.”
“I am the son of Indian immigrants who work at a nearby federal research lab here and a native son of Iowa. The farmlands raised me as much as my parents. And I am the proud product of the public schooling system, I graduated from Yale undergrad and John Hopkins medical school.” Kapoor continues in turn, keen to maintain the confidence of fixed eye contact with Weisberg.
“Impressive, so why not stay out east and build a nice private practice for yourself?”
“I see no better practice than to leverage my medical knowledge in the political arena – serve my hometown in a far greater capacity as a clinically trained politician than as a clinical physician practicing medicine.”
“That’s quite admirable of you. You are sacrificing a lot at a relatively young age in transitioning to politics”, Weisberg commends just before pressing his lips together in admiration.
With that Weisberg fits his pen snugly over his ear and walks back towards the center of the open caucus floor – a makeshift political arena created in an enclosed auditorium traditionally reserved for local sporting events. Kapoor is not even close to being the main attraction, finding his platform somewhere between the far corner of the auditorium and the emergency exits, with center stage reserved for a contentious Senate race that headlines the national news.
A race that brings Weisberg out to – for him – middle of nowhere Iowa. And in meandering across the floor, he encounters a host of would be politicians trying to break political ground. For most, the ground will prove unbreakable, but something in Kapoor sparks Weisberg’s attention, and try as he might to focus on the central attraction of the night, he finds his attention drifting back to that Kapoor – that doctor – off in the corner. The boy clearly captivates him. ‘Why would a promising physician stall his career for a life of grueling politics?’ Weisberg ponders while massaging the bald spot on top of his head.
Weisberg is a grinder, and everybody in political journalism knows it. He built his reputation on hard work and his reputation precedes him wherever he goes. At political gatherings, politicians always put their best fronts up for Weisberg because they know they will need it against him.
Grinding epitomizes Weisberg’s trajectory to the heights of political journalism, but it really defines all aspects of his life. As the son of Holocaust survivors, Weisberg always seemed to be grinding towards something – largely because he never saw his parents stop grinding.
Weisberg’s parents, once in the United States, after enduring years of imprisonment and torture, faced discrimination at all levels of American life, and many Americans blamed his parents for dragging the country into war – claiming that his parents owed the families of the deceased for their loses, as though war is a proxy for some sort of social credit system.
Weisberg grew up determined to become a report. Determined he would bring to light what transpired during the Holocaust and the inflictions his parents endured.
With that singular focus, he pursued the stories, the angles, and the editorials – and of course, he pursued the politicians. And over time, he learned how to snuff out a hidden agenda or a hidden weakness.
Which is why he finds it odd that he cannot stop thinking about Kapoor. ‘What is his angle?’ Weisberg fidgets, losing himself in thought, expressing his inner frustration outwardly.
Successful, precociously polished, Obama-like presence, Reagan-esque charisma – yet he is a doctor. To Weisberg it seems too good to be true, and like the tenured journalist he is, he would trust, but verify – trust that Kapoor is what he presents himself to be, but verify that he can live up to the initial billing.
So he goes off to scoop up whatever he could find on Kapoor, forgoing the center stage Senate race for the night, making his way over to the far end of the auditorium.
First observing Kapoor from afar and slowly making his way closer. He does not have far to go, the crowd is already sparse to begin with. But whatever crowd there was, Kapoor is making the most of – effortlessly gliding from one edge of the crowd to the other, fully in command, fully aware of his command.
Weisberg sizes up Kapoor. Indigo dress shirt unbuttoned at the top, sleeves rolled up to the mid-forearms, beige khakis pristinely creased with light brown dress shoes polished to perfection. ‘He’s got the look down’, he acknowledges, raising his eyebrows silently. He walks closer to Kapoor with a careful cadence not wanting to distract Kapoor’s attention nor disturb the townhall discussion. As he settled a few feet away from Kapoor in the front line of the crowd, he begins to focus on the questions fired at Kapoor.
“Dr. Kapoor –”, an elderly man begins, standing on the opposite side of the circle as Aman, but pauses to clear his throat.
“Please, just Kapoor or K – no doctor”, Kapoor quickly interjects in the pause.
“ – given your background, we believe you would help bring strong healthcare reform to this country and to this district, but what training and background do you have on other political issues?”
“Great question”, Kapoor reflexively responds before giving himself a moment to prepare a response. Weisberg notes Kapoor has a small pencil and notepad which he uses to jot notes as he listens to the questions fielded – a seemingly minor act that impressed Weisberg immensely. ‘A politician who actually listens’, he thinks while cracking a smile.
“You assume I know healthcare because of my background”, Kapoor continues. “Yes, I am a doctor after all. But because of my background, I may appear limited on other issues. But a lawyer or businessman would not get such questions because we assume over the course of his or her career, that type of candidate would develop a wide array of experiences to be knowledgeable on – again – a wide array of issues.
“That’s life, we equate experience with knowledge. But let me ask you this – who better to know about the benefits of food stamps and food deserts than someone in the healthcare field? Who better to know about the impact of government subsidized child care than someone in the healthcare field? Not only have I lived these issues, I’ve seen the face of these issues in the patients I care for. A physician is, by nature, a community leader. We don’t just serve patients’ medical needs, we serve the community needs.”
“I like the way you emphasize the community”, a husky middle-aged woman, the type of woman that just looks the part of Iowa civic pride, lauds as she clasps her hands together. “But shouldn’t you wait until you have more years of clinical practice or administrative experience?”
“What is the definition of experience?” Kapoor asks rhetorically. “Experience is not measured by the length of time, but by the quality of time. I’ve been a political staffer before I could even enjoy a beer. When other students were studying or researching, I was campaigning. I learned medicine through the lens of politics. I see the healthcare issues and the problems at a very fundamental level, and at that level, healthcare is similar to the other issues that affect the people of Iowa – agriculture, welfare, fiscal spending. That vision does not come from experience, it comes from a commitment to serving the people.”
With a well-timed emphasis on the last syllable, Kapoor invokes a round of applause from the audience, basking in the adulation with a genuine smile of appreciation. Weisberg observes as Kapoor goes on responding to additional questions with the grace of a dancer and the grasp of a symphony conductor. ‘Impressive’ he contemplates, scribbling a few notes, and then looking up to watch Kapoor in the middle of another response.
“ – We are looking at cost control through quality, basically by doing all the little things well – or at least better – we can improve healthcare and reduce costs. It is basically like saying we will bring out the best in our employees, the best in doctors, the best in our patients, and through each person’s aspirational best, we will improve healthcare. But is aspiration a viable business model? Can we really say that by giving it the old college try, fighting the good fight, that all our healthcare problems will go away? We need to fundamentally restructure how we look at healthcare. Food stamps, government assistance, you name it, should all be benchmarked to healthcare insurance coverage.
“If people see healthcare in their food, healthcare in their jobs, and lack of healthcare in their unemployment, then people will radically restructure how they integrate healthcare into their lives. The angst people feel at work stemming from low job security – how does that not affect their health? Healthcare is social welfare and healthcare insurance should encompass that.”
‘Comprehensive, thoughtful, and substantive’ Weisberg thought as he puckers his lips. He catches himself delighting in Kapoor’s responses noting that he talks like a politician but without the traditional airs of empty-speak like most politicians. But true to Weisberg’s principle of trusting but verifying, he resists his initial impressions, and thinks of a way to craft a question Kapoor would find challenging. And without a moment’s hesitation, he took his shot.
“Candidate Kapoor”, he says in an unusually formal tone, a facetious gesture of respect intended to misdirect. “Do you, based on what I’m hearing, believe in Medicare for all?”
Kapoor responds with silence, forgoing the reflexive precursor in this response. He darts his gaze at Weisberg, maintaining eye contact in silence, increasing his focus and he steadies himself to face squarely in front of Weisberg. After what felt like a moment of eternity to Weisberg, Kapoor begins.
“Thank you for coming – welcome. I don’t agree with the term, Medicare for All. I think it oversimplifies an issue that should be understood down to the details. Healthcare, and the economics of it, come down to issues of productivity and distribution. In terms of productivity, studies show that physicians who are independent, who own their own practices, are more productive and cost effective – which when combined means they are more efficient than physicians employed in hospitals or large systems. I believe, like the farmers here, or the oil riggers down south, that when you maintain ownership over something, you do it with a level of accountability and responsibility not seen otherwise. So I believe physicians should be allowed to practice privately and own their own clinics, facilities, and care plans.
“In terms of distribution, the issue is not so clear. I think the government has to set the terms of the market but let us all have choices in terms of the level of care. But we need to redefine how we think of choice. Think of it thinks way – the government sets the stage, and we all dance on it based on our own preference. Let the government set the initiatives, create the incentives, but let the people decide how they will respond. We should cross correlate food aid with medical care, and premium packages based upon individual decisions. But the actual decision, the healthcare risk underlying that decision, and the impact on that person’s health – based on the decision – reflects a unique financial burden on that person. Let each patient decide what healthcare decisions they wish to make, but then benchmark the impact upon society for that healthcare decision to that individual patient. Free choice, individualized healthcare, and all that – but balance the financial burden with the healthcare decision.”
With that he smiled, and in that simple gesture, invokes another round of applause. He paces around the circle smiling at members of the crowd as they continue in their applause. After a few moments the clapping stops and another question is asked. Weisberg believes he has seen enough, and contemplates a way to exit the crowd. ‘He seems to have it’ he thinks.
He decides to find Kapoor again at the end of the night, after much of the crowd has left and the politicians would be available for more private one-on-one conversations. Weisberg transitions away from the circle but remains in the periphery of the crowd, close enough to be seen by Kapoor, but far enough to avoid any interaction – a mind game he learned after years of studying politicians. It seems to have worked as Weisberg notices Kapoor looking at him throughout the night – watching Weisberg just as Weisberg was watching Kapoor – like two boxers sparing in the ring, eyeing each other closely, watching the other field the game of politics.
Late into the night, after the crowd had cleared, and Weisberg prepares to make his way towards Kapoor, but is caught off guard as Kapoor approaches him nonchalantly.
“Mister Weisberg, right?” Kapoor opens in a pleasant tone. “My staffers tell me you are a prominent figure in journalism – it is an honor.” And without so much as another opening statement, Kapoor asks, “can you tell me what you value in a political candidate?”
The question takes Weisberg back a little until he realizes Kapoor has opened with a master gambit. And Weisberg makes his move in response.
“Honesty and true dedication to the constituents”, he says, but quickly adds, “do you embody those principles?”, attempting to retake the offensive.
“I believe I do, and I hope my actions prove my beliefs correct.”
“Most physicians get into politics after their clinical careers have ended. Do you really think now is the right time for you to get into politics?
“Why handcuff physicians to clinical practice and wait for them to get old? You want fresh, young blood with innovative, bright ideas, not senior citizen physicians who are ingrained in their ways – you want people to advocate for new ways of doing things.”
“Wouldn’t other physicians call you a sell out?”
“If they do, then they are part of the problem, not the solution. Physicians have this erroneous belief that they must somehow remain in clinical practice – a part of society but in some ways isolated from it as well – but the entire profession of medicine has come to realize that society has passed them by. We have lost control of a profession that we are supposed to lead.
“Modern healthcare has become a legal specialty, created by people outside of healthcare, trapping physicians to choose between the clinical and economic world. The two worlds should work together, flow hand in hand. We physicians have become essentially, prisoners of our own device.”
“Eagle’s reference – nice. So you have no problem if people say you are not a real physician?”, Weisberg continues to press.
“Those people do not understand healthcare. The average patient is not a subject in a randomized control study sponsored by the NIH. The average patient lives a very real, very messy life filled with all the trappings and decisions that balance hospital bills with house payments, foods with medications, and doctor appointments with paid time off. These are real issues that you need medically trained, educated professionals to internalize and then to develop laws for patients that make sense.”
Weisberg finds no other angle to press, no point of weakness to push – clearly recognizing the budding talent in Kapoor. But keen not to give any ground, Weisberg closes the exchange with a smile and quips, “don’t quit your day job”, before turning away.
“I never did – shows what you know”, Kapoor responds in stride, catching Weisberg stopping mid-stride, before Kapoor also turns to his staffers to clean up for the night.
‘He’s damn good’ Weisberg acknowledges internally, feeling for his notepad to ensure that it is safe and intact.
After a few minutes of observing the various political teams closing up for the night, Weisberg observes in the corner of his eye a heavy set woman sitting in a chair heaving, her face red, and even from afar Weisberg can see the glistening sweat on her head. And while the woman’s audible heaves catches Weisberg’s attention, it was not the woman who keeps him focused. That would be Kapoor, diligently taking the woman’s blood pressure and comforting her in the process. Weisberg sees Kapoor pointing and instructing a staffer to provide water for the woman. He notices the same ease of command on his face and in his actions that he conveyed when answering questions earlier in the night.
‘He’s the real deal’ he muses while exiting the auditorium. As Weisberg reminisces about his observations of and interactions with Kapoor, his patently obvious potential – he thinks:
Heatmaps showing opioid sub-epidemics by demography and urbanicity
Total number of deaths in each category from 1999 through 2016 are shown in the upper left corner of each plot. The colors indicate age-adjusted mortality rates per 100,000 people. (Synth Opioids OTM: synthetic opioids other than methadone. This category includes fentanyl and its analogs.)