The Call

I had been dreading this call for sixteen years.  No, not that call, thank the Lord.  I will still be alive, but I will be living a life unable to play the sport that I have been playing for literally 50 years. My bowed legs; the cutting and slashing; the stop and start; all of it has conspired to literally scrape the articular cartilage off my left knee.  The sadness and nostalgia are profound.  Each step is now felt – with pain signals sent to my brain.  An artificial knee is around the corner.

The reason I knew the day was coming was because my teammate from college, an orthopedic surgeon who had operated on my knee once before, predicted that he would make this call. He told me to stay away from the high impact activities. He warned me that I would be an early candidate for a knee replacement if I didn’t follow his advice. Guess what. I didn’t follow his advice — entirely. I gave up basketball and tennis, but not soccer. Sixteen years later he had to make the call. Why didn’t I follow his advice? When you are in love, the heart almost always wins over the head, and I have been in love with soccer since the age of 7.

Because I love the sport and not because I doubt my friend’s professionalism, I tested out the prognosis. I went out and played with a new team against an old team. I knew and respected everyone on the field. The level of skill was terrific for 50+ year olds. It was competitive and intense. I had not played in a year because of COVID, and it showed in my game. I loved every second on the pitch, but my knee didn’t. I could tell from the first step. I could feel bone hitting bone, but I relied on the adrenaline that had always pulled me through. The pain was put in a little box at the back of my brain, and I ran through it trying to drink in the experience – knowing without admitting to myself that it would be my last. Then, as the body is crafted to do, it sent me the ultimate signal. As I compensated for the knee, my other calf cramped to the point that I could not continue.

Unable to run, I went to one knee and called for a sub. I was done. I felt regret. I wanted to continue. I wanted to run unencumbered as I had for five decades. I missed that feeling of just accelerating with no pain. I had so many conflicting thoughts and a profound sadness as I limped off the field nodding to teammates and opponents alike. The manager said “get a stretch and we’ll get you back in.” I knew that my calf simply would not allow it. My teammates and opponents, some of whom I have known and played with and against for 30 years, did not realize what was happening. I did. My body had pronounced the death sentence, overwhelming a heart that had beat for the game for 50 years.

What will I miss?  Not the drinking after the match.  That was never my thing.  I will miss the little things that experienced soccer players will recognize.  I will miss 

  • The decision as the ball is approaching – look up; go wide; pass back; trap, dribble and move.
  • On defense, seeing the give and go develop, realizing that a step towards the ball will mean you’re beaten, and being tricked into taking the step anyway.
  • Seeing two players flood the zone behind me and realizing that I have to pick one and praying I pick the right one.
  • Flicking my eyes periodically to the sweeper to make sure that I am not holding some threatening forward onside.
  • The flood of rage as I am hit too aggressively and then the realization at how ridiculous a fight would be at 57.
  • The self-interested absolute whining to the referee, led by myself, when I feel wronged.
  • The intentional “professional” foul when I have been beaten, increasing in number with every passing year.
  • The smell of the grass; the nod to teammate and opponent alike after a nice move; the clap on the back from the goalie when a shot is blocked.
  • The camaraderie of people giving their all, even as talents, fitness and energy begin to deteriorate.
  • The lights and mist of an evening game because the fields are needed for the young and energetic during the day.
  • My teammates in New York, in DC, on G.B.U, Rangers, ZAM, Curmudgeons, Land Warriors, Ex-Cavs, and many more.
  • The whole beautiful experience.

So, now I have to look to the next chapter.  I ride my Peloton – as hard as I can sometimes. I am buying a gravel bike.  I will work hard at it and enjoy the riding, but it will never replace the comfort, combat, and camaraderie of the world’s most beautiful game, played by me for half a century.  It is a day I have dreaded for years.  It signals aging, change, and deterioration.  I have not gone gracefully.  I have resisted the inevitable with literally every fiber of my disappearing cartilage, but my time has come.  I will now watch the beautiful game wistfully, wishing I could be on the pitch, wondering why my body gave out faster than others, wryly admiring the amazing skills of those still there.  

Goodbye beautiful game. It was an honor playing you. Never the most skillful, never the most artistic, I played you intensely, and you gave so much back. To those still playing, take care of the game; enjoy it; relish every moment; because sadly for all of you, that phone will ring one day.

“On The Solitary”

This is a really powerful piece written by my son, Brian.

Brian Leibold

“A Poet is the most unpoetical of any thing in existence; because he has no Identity – he is continually in for – and filling some other Body – The Sun, the Moon, the Sea and Men and Women who are creatures of impulse are poetical and have about them an unchangeable attribute – the poet has none; no identity – he is certainly the most unpoetical of all God’s Creatures… not one word I ever utter can be taken for granted as an opinion growing out of my identical nature – how can it, when I have no nature?”
John Keats

There is an expression I sometimes hear: ‘Can you meet my needs?’ I feel this very question is false and cannot be asked. Needs cannot be met by another. Another can only meet transient wants, desires. Others can only meet you where they are, which will leave…

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“The Gift”

A worthy poem on the gift of snow.

Brian Leibold

The snow drops from the sky,
And the earth receives the gift.

I wonder:
Is the gift given by one and received by another?

Who is the giver?
Who is the receiver?

Who is the one that lets go of the gift?
Who is the one that holds onto the gift?

Is the gift separate from the one who holds it?
Or:
Is the gift separate from the one who is held by it?

Unlike rain, snow makes little noise as it drops.
The gift is silent, wrapping up in silence whoever uncovers it.
Yet:
Was the gift ever covered?

The birds chirp the silence into song,
The stream carries the silence into movement,
And the trees are held motionless by the silence,
As from the sky continues to fall
The gift
Which transforms everything that receives it.

Nothing is the same when the gift is being given,
Yet nothing…

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The 2015 Version of “I Have a Dream”

Asked to do a reflection at a recent meeting, I re-read Dr. Martin Luther King’s “I Have a Dream Speech.” This timeless speech, edited for brevity and adapted to address today’s challenges in Ferguson, Staten Island, and many other communities, provides amazingly relevant guidance for us in how to approach racial justice and racial healing 51 years later.

Seven and a half score years ago, a great American who casts a symbolic shadow on the Reflecting Pool in Washington, DC, signed the Emancipation Proclamation. This momentous decree came as a great beacon light of hope to millions of slaves who had been seared in the flames of withering injustice. It came as a joyous daybreak to end the long night of their captivity…

This sweltering summer and fall of the African American’s legitimate discontent will not pass until there is an invigorating winter and spring of freedom and equality. 2014 is not an end, but a beginning. And those who hope that the African American needed to blow off steam and will now be content will have a rude awakening if the nation returns to business as usual. And there will be neither rest nor tranquility in America until the African American is not only granted his citizenship rights but also has those rights respected equally by those who enforce the law. The whirlwinds of revolt will continue to shake the foundations of our nation until the bright day of justice emerges.

But there is something that I must say to my people, who stand on the warm threshold which leads into the palace of justice: In the process of gaining our rightful place, we must not be guilty of wrongful deeds. Let us not seek to satisfy our thirst for equal justice under the law by drinking from the cup of bitterness and hatred. We must forever conduct our struggle on the high plane of dignity and discipline. We must not allow our creative protest to degenerate into physical violence. Again and again, we must rise to the majestic heights of meeting physical force with soul force.

The marvelous new militancy which has engulfed the African American community must not lead us to a distrust of all white people, for many of our white brothers and sisters, as evidenced by their presence in Ferguson, in New York and all over this country, have come to realize that their destiny is tied up with our destiny. And they have come to realize that their freedom is inextricably bound to our freedom.

We cannot walk alone.

And as we walk, we must make the pledge that we shall always march ahead.

We cannot turn back

There are those who are asking the devotees of civil rights, “When will you be satisfied?” We can never be satisfied as long as the Negro is the victim of the unspeakable horrors of police brutality…

You have been the veterans of creative suffering in New York, in Ferguson, MO and throughout this nation. Continue to work with the faith that unearned suffering is redemptive….

Let us not wallow in the valley of despair, I say to you today, my friends…

And so even though we face the difficulties of today and tomorrow, I still have a dream. It is a dream deeply rooted in the American dream.

I have a dream that one day this nation will rise up and live out the true meaning of its creed: “We hold these truths to be self-evident, that all men are created equal…”

I have a dream that our children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character.

I have a dream today!

… With this dream and with our faith, we will be able to hew out of the mountain of despair a stone of hope. With this faith, we will be able to transform the jangling discords of our nation into a beautiful symphony of brotherhood and sisterhood. With this faith, we will be able to work together, to pray together, to struggle together, to go to jail together, to stand up for freedom together, knowing that we will be free one day.

And this will be the day — this will be the day when all of God’s children will be able to sing with new meaning:

My country ’tis of thee, sweet land of liberty, of thee I sing.

Land where my fathers died, land of the Pilgrim’s pride,

From every mountainside, let freedom ring!

… And when this happens, and when we allow freedom to ring, when we let it ring from every village and every hamlet, from every state and every city, we will be able to speed up that day when all of God’s children, black men and white men, Jews and Gentiles, Protestants and Catholics, will be able to join hands and sing in the words of the old Negro spiritual:

Free at last! Free at last!

Thank God Almighty, we are free at last!3

May our nation on this anniversary of Martin Luther King’s birth listen anew to his timeless advice so eloquently delivered in the shadow of Abraham Lincoln’s beautiful monument. The journey down the road to racial justice and racial healing is a long one, and we must march it purposefully, with dignity and discipline, never giving in to the understandable temptation to drink from the cup of bitterness and hatred. My guess is that Martin Luther King would be a little disappointed that we are not farther down this road, but he would not let that disappointment deter him from putting one foot in front of the other, perhaps with both hands in the air.

It is Relationships that Count

This article was published in July of 2000 and was one of the first where I emphasized the importance of relationship-building in associations.  

Over the last several weeks, my family has witnessed two tragic deaths. The first was the death of 11-year-old Hannah Knudsen in our neighborhood.  She lost control of her bicycle as she rode down a hill near our house and collided with a van. Hannah loved life and lived it to the fullest. In the outpouring of emotion from the Falls Church community and from friends after her death, Hannah’s family learned just how many people she had touched in her tender 11 years.

The second death was of my wife’s uncle, Michael Collins.  He was a lawyer and a magistrate from Wilkes-Barre, Pennsylvania. He died at the young age of 58 of pulmonary fibrosis, leaving a wife, six children, and three grandchildren as his survivors. Close to one thousand people came to his wake to pay tribute to a fair-minded lawyer and jurist who loved music, his family, and his community.

Like Hannah’s family, the Collinses were extremely touched by this outpouring of support from their community.  Why do I mention these two individuals in this column about the American Health Lawyers Association? I do it for two reasons. The first is to pay them tribute. Each was a gifted and kind person who enriched the lives of those around them. They deserve to be remembered and celebrated.  Second, I mention their deaths because their loss has reminded me about the importance of relationships in our lives. This thought has led me to think more about the underlying purposes of associations in general and Health Lawyers in particular.

I have now worked at two associations, the Catholic Health Association of the United States and Health Lawyers. The staffs of both have worked tirelessly to bring members more tangible benefits for their dues dollar. As I have said in the past, Health Lawyers’ membership brings several tangible benefits. It has a rich Web site, listserves, weekly e-mails, an online Health Law Digest, and this magazine, Health Lawyers News.

The Association provides excellent programs. Health Lawyers also has Special Interest and Substantive Law Committees that provide benefits for an extremely modest fee to those with a specific interest in an area of law.  Yet, over the last several weeks, I have also given more thought to the intangible benefits of belonging to an association.

The noun “association” comes from the verb “associate”, which means “to join in a relationship, to come together.” I am sure that David Greenburg and his colleagues formed the Association’s predecessors not only for the information and education it could provide, but also for the opportunity for friends and colleagues to form relationships and friendships. At their core, associations are about people with similar interests and professions establishing a forum through which they can establish contacts with one another.

Educational programs, listserves, and conference calls are opportunities for individuals to form bonds with one another. Bob Johnson of Catholic Healthcare West was one of the first people to talk to me about the benefits of belonging to what was then the American Academy of Healthcare Attorneys. While briefly discussing the educational benefits, Bob focused mainly on the friendships that he and his wife had established through attending its events. He focused on the honorable, talented people he has come to know through this association.

It happens all of the time at Health Lawyers events. Old friends see each other again and catch up on family and practice developments. People who have not seen each other since law school reestablish ties and relationships. Individuals who meet each other for the first time at a Health Lawyers program establish friendships and introduce their families to one another. Those familial friendships can last a lifetime. This does not only apply to inperson friendships. Individuals can establish ties through our listserve program or on telephone seminars.

In the end, it is relationships that count. When you leave this life, people will remember you through the lives of people whom you touched while you were here. That is as it should be. Two people for whom I have great affection have left this life. Although they were taken from us too soon, they touched an enormous number of people with their enthusiasm for life while they were here. This association gives its members the opportunity to touch some good, talented, gifted and funny individuals from across the country. This touch can be in-person or through e-mail. It is an intangible, yet perhaps the most real, benefit provided by the associations to which we belong. Let’sremember to take full advantage of it.

Peter M. Leibold

 

Can You See the Flowers?

Written October 2012

 David Barry died as he lived – honorably, responsibly, prayerfully, and at peace.  In August, I penned a column on Martin Bayne’s emotionally devastating experience living in an assisted living facility for the last eight years. Too often, as health lawyers, we see a flawed health system at its worst. Today, I want to write about our healthcare system at its best – competent, caring, comforting, providing the space and opportunity for a wonderful man to say goodbye in a dignified, loving and planned way to his children and his grandchildren.

To understand this story and most importantly the ingredients for seeking to replicate it in your own lives and those of your loved ones, it helps if you know a little bit about Dave Barry.  Dave was my brother-in-law Richard’s father, and they are very much alike. Dave was a perfect gentleman in the classic definition of that term.  He was caring, polite, civil, and courteous. When he engaged you in conversation, you felt as if you were the only person in the room for him at that moment. Every time I saw him at a family gathering, he unfailingly asked after my parents. He wanted to know that they were healthy and happy, and with Dave you knew that it was not small talk or chitchat.

Dave was also incredibly responsible.  He took care of the details, the things that most of us simply do not like doing. He did not boast about it, and likely, he did not get nearly enough credit for his competence and his forethought.  He simply took care of them so that his family and his friends could enjoy his company and their own – which brings us to Saturday, September 1.

Dave had been undergoing treatment for melanoma, and as with any cancer treatment, one has to ravage the body in order to attack the cancer. It is the tragedy of cancer. In this case, Dave’s eighty-two year old body gave out in its effort to accommodate the medicine that fought the cancer cells. Yet Dave in his endlessly responsible way had foreseen the possibility. In his safe, he had left detailed directions about how to handle all of the arrangements that would be necessary after he passed.  All of his papers were in order.  He had thought of every detail. He had to take care of these details because his beloved wife, Pat, had passed three years before.  They had been a couple to behold.

When he was released from the hospital in a weakened state after his last cancer treatment, he received caring, individualized hospice treatment from nurses employed by Vitas. His children had also contracted earlier in the summer for 24-hour care from a duo originally from Sierra Leone who each stayed with him twelve hours a day. The children could not say enough positive things about the attention that their father received from both the general care team and the hospice team. Each was careful and professional; the bedside manner was loving and jovial.

When Dave was initially released, neither the caregivers nor his children realized that these would be Dave’s final days.  But, they now believe that he did.  He could sense that his body was giving out, and his spirit longed to be reunited with Pat. After his release on Thursday, his body weakened further on Friday, and his children began to gather in their lifelong family home. They came in by plane and car from South Carolina; Tennessee; New York; Harrisonburg, VA and the suburbs of Washington, DC.

On the morning of September 1, Dave who had suffered from a high fever on August 31, miraculously woke up and informed one of his nurses that it would be a big day and that he needed a big breakfast. He ate two eggs and cream of wheat, which was highly unusual given his prior appetite. He asked about the whereabouts of the few family members still making their way to McLean, VA. He drifted in and out of wakefulness, but when he was awake, he understood his surroundings. When his daughter gave him ginger ale out of a chilled Budweiser glass, he indicated that a real sip of beer would be even more welcome. Dave asked for a priest to come and give him last rites, or what is now called anointing of the sick. As the priest uttered the prayers, Dave mouthed them along with him. In between prayers, the priest joked with his parishioner. Upon completing the rite, he looked at Dave and said sincerely and good-naturedly, “Dave, you are good to go.”

At mid-morning, Dave looked at his room and put his arm out and said to those family members in the room with him, “Look, can you see the beautiful flowers? Can you see them?  They are beautiful.” One of his daughters ran down to the kitchen to retrieve some flowers that had been given by a friend, but Dave was seeing flowers that were not physically in the room. He mumbled that “he had to get packed.” His nurse and his daughters realized that Dave was preparing for a journey. At that point, the nurses handled Dave’s pain and discomfort, but they melted into the background as the family gathered throughout the day. By being present, but also giving the family the space and time to be with Dave, the nurses embodied the goals of hospice and comfort care.

One of the greatest things about being a friend of the Barrys is that every one of them could compete, and probably win, on Top Chef. They are amazing cooks, and they don’t mind sharing their wares. So, the family cooked, ate, debated, laughed, and told stories, all within earshot of Dave. His house bustled with 27 children and grandchildren, much as it had for more than fifty years. On Saturday evening, as the brood prepared to share dinner together, rather than saying grace at the table, all 27 of them gathered in Dave’s room and said a decade of the rosary. Dave mouthed the prayers soundlessly.

As the family ate dinner in the dining room, Dave was never left alone. From his room, he enjoyed the sounds of laughter and conversation coming from the other room, the din of family stories being told.  As they rejoined him in the room after their dinner, they said another decade of the rosary and gathered around his bed.  He said at one point, “This is how I wanted it to be.”

He had crafted his departure by calling them home, by nourishing himself for the day, by summoning his last bit of energy to engage with those whom he loved most in this world, so in his view, he could join those he most loved in the next. At 10:40 pm, Dave breathed his last, in his own home, surrounded by each of his six children, their spouses and his grandchildren, the family that Pat and he built honorably, responsibly, prayerfully and lovingly.

Every one of us would love the dignity of this kind of parting. Some might structure it differently or have a different emphasis. Dave’s was not the only way to have a dignified death, but it certainly was his way. Not every one of us will be so fortunate because we may not know the hour or the moment. But, chance favors the prepared mind. Dave wrote out his wishes, made the necessary preparations, let his wishes be known, and gathered those whom he wanted most. He engaged his caregivers and his family in this preparation. His caregivers appreciated the clarity, facilitated his wishes, and comforted him and his family as he prepared for his journey. These things are not all within our control, but it is a great reminder that living well increases our chances of dying well.  And preparing for death, no matter what our circumstances, eases our passing for the family and friends left behind.

Dave died as he lived – with dignity, grace, and care. His healthcare givers provided him the freedom to do so. Dave, may your journey home have been a safe one, and may you and Pat enjoy your feast together forever.

Health Care’s In and Out List for 2011

Written January 2011

Every year in the Style Section of the Washington Post, the editors publish the List: What’s In and What’s Out on or around January 1st. The column prepares readers for the hip new trends of the upcoming year so that they can be prepared (stylistically speaking) for the year to come.

For instance, the 2010 List included the following, to name only a few:

Out                                                                                                          In

Jonas Brothers                                                                                Justin Bieber
Cupcake stores                                                                               Cupcake trucks
Detroit auto plants                                                                           Detroit artist communities
Crashing state dinners                                                                    Crashing Climate talks

I look forward to reading the column every year in order to discover the cool new trends and to realize how incredibly out of touch I am – since I usually have no idea that the coming year’s “outs” had ever been “in.” Because I have enjoyed the column so much, I thought I would write a lighthearted List of What’s In and What’s Out in Health Law for 2011. Please enjoy the list and have a wonderful 2011.

Out                                                                                                      In

Physician-owned hospitals                                                                ACOs
Independent docs                                                                             Employed docs
Fee for Service                                                                                 Value-Based Purchasing
Deficit Spending                                                                               Deficit Reduction
SGR Angst                                                                                       SGR Fix
Healthcare as a right                                                                       The right not to buy health insurance
Speaker Pelosi                                                                                Speaker Boehner
Congressional Enactments                                                             House Investigations
Spending more and cutting taxes                                                    Cutting taxes and spending more
Ways and Means and Finance Cmtees                                           Independent Payment Advisory Board
Payment for Services                                                                       Payment for Performance
OIG                                                                                                  OMG!
Readmissions                                                                                  Penalties for Readmissions
Specialists                                                                                       Primary Care Docs
Fraud enforcement to catch fraud                                                   Fraud enforcement to balance the budget
Health reform thru Budget Reconciliation                                       Budget cutting thru Budget Reconciliation
Complaining about underpayments                                                Repaying overpayments (or else!)
60 votes to break a filibuster                                                           50 votes to get a majority
Associate deferrals                                                                         Lateral hires
Coverage                                                                                        Cost Containment
Rate freezes                                                                                  “Alternative fee arrangements”
Justice for the uninsured                                                                Justice Kennedy as the tiebreaker
Quantity                                                                                         Quality
Bemoaning inadequate payments                                                 Fearing bundled payments
ACA                                                                                                PPACA
Corporate Integrity Agreements                                                     Corporate executive prosecutions
HIPAA Privacy                                                                                Meaningful Use
Premium Increases                                                                        Medical Loss Ratios

Democracy is a Messy Business

Written in August 2011

What is the proper balance between revenues and expenses for an organization that wants to grow and prosper? What is the appropriate amount of risk for taking on debt and servicing that debt in an effort both to grow and to serve the mission of the organization? These questions are wrestled with in every corporate board room across the country, and they are the nub of our federal, policy debate. Our Board members continually debate the issue of how the American Health Lawyers Association can most effectively grow while remaining fiscally prudent and serving the mission outlined in our Bylaws and in the strategic plan adopted by the Board.

The genius of our web of state corporate laws is that every for-profit and non-profit entity created across the nation is answerable to a Board that represents a broader group of individuals, whether they be shareholders, members, or customers. The Board is generally a group of respected individuals who are free of conflicts and keenly interested in the success of the organization. Often, they are the most knowledgeable and involved individuals, other than the employees, in the group that they govern. The Board’s job is to set a strategic direction for the organization; keep the employees, especially the chief executive, focused on serving the mission of the organization; and hold the employees, especially the chief executive, accountable to the larger constituency represented by the Board.

This structure is not unlike our representative democracy where the Constitution enshrines a rather complicated set of checks and balances so that a representative group of elected individuals (the legislature) sets a strategic direction for the country; keeps the federal government’s employees, especially the chief executive, focused on serving the people effectively; and keeps the government accountable to the strategic direction set by the legislature through hearings and other accountability exercises.

Yet, the corporate world differs from the policy and political world in at least one extremely significant respect. The chief executive of a corporation is hired by the Board of that organization. There is no ambiguity as to the identity of the boss – that is the Board. Under our political system, the President is elected by the people, the same group organized a little differently, who selects the Representatives and Senators. So, in the political system, the people, with all of their various views, are the boss, and it is highly likely that because the boss is so diffuse, those selected may have radically different views of what the boss thinks on issues, say the proper balance between taxation, federal spending, debt service, and fiscal responsibility.

As I have thought about the wrenching debate that occurred prior to August 2nd, and the near default of the United States on its debt, I have been grateful for the relative clarity that exists in the corporate world. While I may differ from the Board from time to time on important, strategic issues that arise and while I will do everything I can to persuade them to agree with me, at the end of the day, the Board is empowered with the fiduciary duty to set the direction for the organization. Thus, I will go with its considered judgment. This clarity of responsibility helps the organization move in a designated direction. While Boards have multiple people who can engage in raucous debates and at times the direction can veer from side to side, generally, a Board setting direction and a chief executive implementing that direction keeps the train moving towards the defined set of goals for the organization.

A Board and a chief executive all selected by the constituency served, perceiving themselves as coequal and equivalent in power, and having radically different views of both the mission and the implementation strategy for an organization, makes the governing of the organization extremely messy and extremely difficult. This is not a new observation. It was just brought into focus during this debate. As Winston Churchill said, “It has been said that democracy is the worst form of government except all the others that have been tried.”

I make these observations not to make any political or policy point, as this organization properly avoids doing so. I make them because, from time to time, I think we may need to have a little more patience and, perhaps, a little more understanding for our elected officials. After all, they have been elected by us to positions that are co-equal under our system of government. They rightfully believe that they have been empowered to argue forcefully for the visions that they articulated when they ran for office. If we are dissatisfied with the vision or strategy of our elected officials, whether they be Representatives, Senators or the President, we have a couple of options. Apply pressure now to elected officials to align their vision more in line with our own or work hard to elect other individuals at the appropriate time who will more closely track our own philosophy. Yet, as long as we the people remain incredibly divided on the question of the appropriate amount of debt, investment, and fiscal prudence appropriate for our government, we are deluding ourselves if we think our co-equal sets of representatives will have any more clarity on those important issues.

Rest assured that the Board of the American Health Lawyers Association strives to represent the membership’s interest in serving the organization’s mission, and that while I will always articulate my own views on how to serve that mission most effectively, I will ultimately take their direction and do my best to implement their vision.

As I leave AHLA, I will no longer have a monthly column to muse about issues that inspire, alarm, or interest me. Inspired by my son Brian's courage to blog, I will use this blog to record my thoughts on these issues. I will start by reproducing some of my favorite pieces from the last 15 years at the association.