My early childhood memories hit and miss like a receding dream until four years of age when I boarded my first airplane flight. Our family landed in Mexico City to live. The experience was the first of many jolts which awakened my dreamy complaisant memory.
Within weeks I started kindergarten. That first day was filled by my ceaseless crying. Much to my relief, I had mastered the art of playing hooky by the next morning. A week later I matriculated into the American school. Scary but at least fifty percent of the day was in English. It wasn’t long before a Mexican classmate invited me to his birthday party, complete with a piñata. I was too young then to understand that a piñata holds as much in life metaphors as candy and little did I realize then that this metaphor would resurface again in my life decades later as the efforts to reform the embattled U.S. healthcare system.
Like so many things that first year in Mexico, the piñata held excitement mystery and possibility. At that first party I was an eyewitness to a mob. The instant the piñata broke open the school of piranha-like children devoured the innards so fast that I was left dejected, clutching only a little scrap given to “the gringo” by some benevolent adult.
At the next party, when it was piñata, time, I was in the mix; I dove in before the final coup de grace and caught a piece of the bat. My strategy turned upon being first one in but missing the bat, only to learn that this transferred the piñata to the one embracing almost all the candy. I was jumped, kicked, whacked, gouged, and crushed to smithereens while all those greedy hands and bodies piled on me and plied the precious treasure for my hands. Once again I emerged with tears and a few scraps.
Finally by the fourth party I’d gotten adept with the bat and with a super satisfying whack disintegrated “the Toro” to shreds. Pay dirt at last. By the time, my blindfold was off, the scrum was well underway. The school of hard knocks was one more time teaching me a lesson.
Few activities can compete with a piñata party in a child’s imagination. It offers the opportunity of unimaginable candy treasures. After years of practice and experience the master can be picked from the crowd. This child can be seen as cool, calm, and collected. They bat early, never trying to break the treasure open but enough to soften it up. Once back in the pack they make subtle repositioning moves as the batter swings in different directions blindly thrashing at the swaying and bobbing papier-mâché animal idol. At the right moment they dive into the scrum usually coming up with a lot of candy. Winners keepers losers weepers. That’s the rules.
There are many strategies at the piñata party, the imagination of greed can get the best of you when all those marbles (or candy or money) sit inside that single collective pot.
Fifty years later I cannot help but reflect that the rules and spiritual lessons gained within the piñata experience are very applicable to the US healthcare system. With thirty years of healthcare experience I remain awe struck at observing the same sets of behaviors demonstrated at children’s piñata parties.
Be you the patient, doctor, hospital, pharmaceutical company, lawyer, supplier, coder, consultant, or insurance company, each party fully play out their perfect, “what’s in it for me” expression, “Don’t worry what this is costing, we’re just attacking the piñata. Everything in the party has been fully covered. Cracking a few of heads to reach the object of my desire is just good party fun, no offense.” We have become piñatas inside of piñatas, with of course the patient metaphorically becoming the ultimate piñata, after all the party is thrown for each and every one of us willing to pay entrance to the ever increasingly expensive party.
Next week I will start with my personal experience and then move to the global great American health care healthcare piñata gala bash. Let me get the party invitations sent out and also invite you to attend the grand gala 2009 healthcare piñata party.
I’ll let you bring the pinata to my party if I can bring mine to yours.
Alan Dappen, MD