The Man Who Argued and the Man Who Rose Early

I have asked more than twenty attorneys general a version of the same question. It is a simple one.

Does your office have authority to regulate nonprofits operating in your state?

It is not a trick. The answer is written down somewhere in every one of those states, and I wanted to hear them say it out loud, because what happens next in American healthcare depends on the answer.

Almost none of them liked being asked.

I have done the same thing with governors on certificate of need laws. Most of them had never heard the term. That part did not bother me. What I noticed was what came next. They gave me the five things this administration is working on. The speech. The one that has nothing to do with what I said and everything to do with getting through the next ninety seconds without conceding ground.

I have been doing this since 1997. I have taken what I believed to be true, put capital behind it, built companies around it, and tested whether the premiums actually came down. Sometimes they did. There was a stretch where I think we were among the first in the country to say no copay, no deductible, no coinsurance, no preauthorization, and people asked how we managed it. It was math. It was not clever, and it was not magic. It was math.

None of that ever made the questions land any better.

I spent a long time believing that was a problem with the rooms. Some of it was. But I have come to think there was something wrong with the way I understood the whole enterprise, and it took me most of this summer to find the word for it.

---

Here is what I was taught obedience means, and I suspect it is what you were taught too.

Obedience is execution.
Instructions come down.
You carry them out.

The measure of your obedience is the gap between what was asked and what you delivered.

Small gap, good servant.
Large gap, bad servant.

Questions during the process are noise at best and insubordination at worst.

This is not a stupid model. It is how you land aircraft. It is how you run a code in a hospital. It is how a rifle company moves. I lived inside it for years, and I do not regret a day of it.

The trouble is what it does to everything else. Under that model, there are exactly two kinds of people. Some men comply, and some men resist. There is no third category. And so a man who asks a hard question has to be sorted into one of the two bins, and he almost always gets sorted into the second one.

I have been sorted into the second bin my entire adult life.

---

The first crack in this for me came from the English, which surprised me.

Our word obey comes through Old French from the Latin obedire, built around hearing. The idea of listening was sitting inside the word before obedience became mostly synonymous with compliance.

Which brings me to the Hebrew.

The Hebrew word behind much of what we translate as obey is shama: to hear, to listen, to heed. Its most famous form is Shema, the first word of the prayer every Jewish child learns: Hear, O Israel.

In the Hebrew scriptures, hearing often carries response inside it. To hear is not merely to register sound. The hearing is supposed to move the hearer. Hearing that changes nothing is not much of a hearing at all.

So the opposite of obedience, in that frame, is not rebellion. It is deafness.

---

Abraham is the evidence.

In Genesis 18, the man haggles with God over Sodom like a merchant in a market. He starts at fifty righteous men and works God down. Forty-five. Forty. Thirty. Twenty. Ten. He says out loud that he is dust and ashes and then keeps pushing anyway.

God does not rebuke him once. Not one time. The text records no impatience at all.

Four chapters later, God asks Abraham for his son, and the man who negotiated over strangers says nothing. The text gives us one detail, and it is devastating in its plainness. Abraham rose early in the morning.

Under the execution model, those are two different men. One is compliant, and one is difficult, and the difficult one somehow got promoted.

Under the hearing model, they are one man. The arguing and the rising early come from the same place: proximity. He was close enough to know which moment was which. That is the whole trait. It only looks like two traits from a distance.

The most argumentative man in the book is also the most obedient man in the book. Those facts have never been in tension. I just had them filed wrong.

---

This is the place where a piece like this usually turns into flattery, so let me put the guard rail in now.

The tradition saw the problem coming a long time before I did. Pirkei Avot 5:17 draws a line between argument for the sake of heaven and argument that is not, and says the first kind endures while the second does not. The example given for the first is Hillel and Shammai, two schools that disagreed about nearly everything and preserved each other’s positions in the text anyway. The example given for the second is Korach and his company.

Korach’s complaint was not unreasonable on its face. He argued that the whole congregation was holy and asked why Moses and Aaron had lifted themselves above it. Read cold, it sounds like a fair procedural objection. The earth opened and swallowed him.

Same activity. Opposite posture. The sorting is done on motive, not volume.

Which is uncomfortable, because motive is the one thing you cannot see from outside. I cannot always tell whether the man arguing with me is Hillel or Korach. He cannot always tell that about me either. Abraham looked exactly like a haggler.

I have to hold both of those at once. My questions have been misread for thirty years. My questions have also sometimes deserved it.

---

I want to be honest about one more thing, because leaving it out would make this too clean.

Exodus 24:7 has Israel answer with four words that run the wrong direction for everything I have said. Na’aseh v’nishma. We will do, and we will hear. The doing is listed first. The Talmud treats that line as the high point of the nation’s merit rather than as blind compliance.

I do not have a tidy resolution for that. There is hearing that precedes action, and there is action that precedes hearing, and the tradition holds both without apology.

Any version of this argument that comes out perfectly smooth has sanded something off.

---

Now the part I would rather not write.

I get irritated when people ask me questions.

Someone comes into my replies and says he sees me commenting on healthcare all the time and wants to know what exactly I have done. Ninety percent of the time, I do not answer. The other ten percent, I say Great question and give the short version, and I keep it short because I do not want to sound like a man justifying himself.

That reason is true. It is also, some of the time, a way of not listening while looking composed.

Someone tells me single payer works everywhere else in the developed world. I feel the shutter come down. Someone opens with, “Have you ever thought about...” and something in my chest says, “Do you know who I am?”

I have spent thirty years being punished for asking questions and I still get irritated when people ask me questions.

Both of those sentences are mine. I am not going to build a bridge between them for you.

---

Here is what I finally saw, and it came the way these things usually come: late and sideways.

Abraham fought for strangers he would never meet and went silent with his own son. After the mountain, Genesis does something strange. Abraham comes down, and Isaac is not mentioned in the return. The next chapter opens with Sarah’s death, and an old interpretive tradition connects her death to hearing what happened.

Some read the silence as the summit of Abraham’s obedience. Others read it as the one time he failed to bargain. I find the unsettledness more useful than a verdict would be.

Because the distance is the tell. In his case and in mine.

I will fight the system for years. I will chase down attorneys general and governors and sit in rooms where I am not wanted, on behalf of people whose names I will never learn. And then one particular man asks me one clumsy question on a Sunday afternoon, and I go quiet, and I call it not wanting to be a justifier.

It is easier to fight for the abstraction than to hear the particular man in front of you. That is not a healthcare problem. It is not a temperament problem. It is the oldest failure in the book, and the book put it in the account of its greatest man so that none of us could pretend it belongs to lesser people.

---

I did not fix this by building a rule for myself.
I have tried that before, and it lasts about a week.

What changed this summer was smaller and slower.

I stopped assuming the man asking was an opponent. The single payer guy in my replies is upset at the same system I am upset at. He has landed somewhere I think is badly wrong, and he got there honestly, and he is asking clumsily because there is no elegant way to open a conversation with a stranger.

Which is exactly what I was doing in front of those governors.

I walked in with a real question and got read as a problem instead of a man trying to understand. I know precisely what that costs, from the inside, and I have been handing it out for years.

Most of the time, people are not testing me. They have their own curiosity and no graceful way to raise it. The clumsy question is a hand extended badly.

Obedience was never about executing instructions correctly. It was about staying close enough to hear. And the test does not start with God. It starts with whoever is standing in front of you with a question you find beneath you.

He who has ears to hear, let him hear.

The problem was never the ears.
It was whether we were listening.

-Rojas out