I was a low level bureaucrat trying to get Exchange networks to work for UPMC Health Plan.
I was exhausted that first fall as we were scrambling with interim solutions for several months after the ACA individual market went live. We then had to go crazy to ramp up HealthyPA, a convoluted Medicaid expansion waiver program in Pennsylvania.
I was in Pittsburgh living an anonymous life.
I thought I would only have a couple dozen health insurance related posts spanning twenty or thirty thousand words in me.
Now I’m in Durham.
I’m now at 1,550 + Mayhew on Insurance posts and several hundred other general purpose posts. My health policy word count is closer to a million words than half a million words. There is a mostly written book somewhere in these posts and I will sooner or later need to convince myself that I can write a book on health policy.
Then, I could never be quoted nor would anyone want to hear what I wanted to say besides a couple of co-workers as we slammed espresso shots before another analysis run cycle. Now, I’m part of the usual quotable suspects when major ACA news breaks out.
Writing here at Balloon Juice has been and continues to be an amazing experience. I get to play with ideas that fascinate me, and John gives me the keys to write to an audience.
One of the big changes since I’ve come to Duke, beyond saying good bye to the persona of Richard Mayhew, is that I’ve changed my writing targets. When I was Richard Mayhew, I had to write at Balloon Juice. I could and would poke a few people here and there that something big was coming down the pipe but I was limited. Now, the audience is sometimes all jackals. Other days, the intended audience is a few score of geeks and policy professionals who need to know about some esoteric corner case. I apologize when I take over the blog for those purposes as I feel like I am hijacking your attention to pay the cost of entry into conversations that I want to be in.
As I have been drafting this post over several days, I’ve talked to reporters from local and national general interest press, I talked to a reporter from the trade press, I submitted a pair of long and very technical pieces to Health Affairs, and a revise and resubmit just went back to the editors of a good peer reviewed journal. If you spend enough time reading Balloon Juice, you could figure out 85% of the article excluding some of the regression based analysis.
I feel guilty about this at times.
Last week, was a good example. I wrote a Medicare shared savings post that I was aiming at a few dozen academics and several dozen think tankers, journalists and very targeted policy wonks. It is a very specific, nerdy, and incomplete idea. It was not worth an op-ed as it it too geeky. It was not a Health Affairs blog or a journal perspective piece as the idea was not polished enough for that purpose, so I went Balloon Juice. And that post got three comments. And I was fine with that as this was not a general purpose post but a very small part of a very different conversation that I participate in.
I’ve moved away from some general purpose health insurance and ACA blogging and at times over the past year, I’ve chased personal shiny objects down rabbit holes. And you guys put up with that. And for that I am greatly appreciative as I love writing here at Balloon Juice. I have a scratch pad and a place to get first drafts (seldom second drafts as you see my grammar and spelling) of reactions and thoughts. I can dig into something that fascinates me on my own time and my own schedule until it makes sense to me. I hope that this is not pointless intellectual public indecency as this entire creative process is extraordinarily valuable for me.
Balloon Juice is a very different form of writing than writing a journal article. Under the best case scenario, a fast journal timeline from “umm, that is a cool question” to publication is a year or more. It is very different writing than a multi-author Health Affairs blog where commas can become fighting marks while the critical point that I want to make might be the lead melody or become subsumed as a backing bass line. It is a very different writing process than pumping out a New York Times op-ed where I first truly appreciated the value of a wonderful editor. That process makes me sound a whole lot smarter by the end. The final 750 words are a tight 750 words instead of a 5 post, 3,000 word series here. But I was worn out both times I went through that process. This is a fun place to write and it allows me to get into awesome conversations of a variety of stripes.
But mainly, I just want to thank all of the jackals, the front-pagers and John for a community where I can nerd out on something that I find fascinating. I’ll figure out what Year Six looks like, but the first five have been wonderful.