Harry Nelson

We did it! A book!

The last few weeks have been a bit of a blur. Besides the usual frenetic mix of client work and speaking gigs, I decided to write a book. It took 3 weeks to write and then a week of proofing and fixing the layout and graphics, but it is done:  From ObamaCare to TrumpCare: Why You Should Care is done. It’s a little bit of a crazy story. My friend, Larry Cohen of Glyphix, suggested that people wanted to know what I thought was next for healthcare after the election. I liked the idea, and, with the help of a few colleagues (Rob Fuller, Sara Hersh, Zach Rothenberg), I put together a summary of ten things to look for under the next administration.

Only one problem: after asking a few people, I went with my gut feeling that the presidential election wasn’t a contest, that Hillary was so far out in front that there was no reason to figure out what President Trump would mean for U.S. healthcare. A few people questioned the wisdom of that decision. It wasn’t until election night, sitting dumbfounded in front of the television that I realized we would need to re-do the piece. But I stayed up late, wrote a draft, got feedback and revisions from my colleagues, and we sent our predictions out on Wednesday, November 9. The next few

The feedback was terrific. I got a bunch of media quotes, an interview with Lori Lundin on Voice of America Radio, and a flood of invitations to speak on what “TrumpCare” was going to look like. I was in Israel over the week of Thanksgiving, and on Monday, November 28, I gave a talk on the future of U.S. healthcare to a group of Israeli digital health entrepreneurs and investors in Tel Aviv. A few hours after this talk, I was on the 15-hour plane trip back to L.A. thinking about the topic. It was clear from the two-and-half weeks since the election that interest was huge: not only from people whose livelihoods depend on U.S. healthcare regulatory and reimbursement changes, but also from people whose primary interaction with the healthcare system is strictly personal, as patients. I felt my message was important because of the anxiety level out there. I hoped that we could clarify and, in the process, calm down some of the needless worry and also give people focus on the battles ahead. I decided that we had an important message, and that short articles and speeches would not do the topic justice or have the kind of impact that we wanted to have. So, after a few hours of sleep at the beginning of the night, I put in a good ten hours or so of writing.

This wasn’t the first time I’d had the motivation to write a book. I started working on a book for the first time in 2010-2011. At the time, my focus was also the future of healthcare, but, at that time, from the prism of the roll-out of the Affordable Care Act. Unfortunately, I got about 100 pages in and just ran out of steam. I put the book aside for weeks at a time, and each time I came back, it was hard to make progress. The biggest issue was that the core of what I wrote expressed what I was passionate and clear about, but once I had organized it into my vision for a book, the gaps and missing pieces came to the fore. These are the things that took more time, and were areas where I needed help. By the time 12 and then 18 months had rolled by, I felt that the situation had changed; the Supreme Court decision in 2012 had defined a new landscape for healthcare. I gave up on the book.

That happened to me several more times over the next few years: I would get inspired to write a more expansive work on a topic that I am passionate about. I would get going. Then I would hit a few roadblocks, and then turn to client work or other deadlines. By the time I came back to the draft, I had lost some of the motivation. And of course, there is always a long list of other projects calling out for time.

This time, I was determined not to let that happen. The key learning that made a difference was pulling more people into the project and not trying to do it myself. As soon as I came into the office on November 29 from my flight home, I buttonholed my partner, Rob Fuller, and told him I needed a co-author. I love working with Rob, because he comes at problems differently, more analytically, with a scientist’s precision. And he may have been taken out of the hospital he used to run, but the hospital administrator has certainly not been taken out of him. Rob agreed to join me, in spite of being in the midst of challenging issues.

On Wednesday, November 30, I also reached out to my sister, Reva, an amazing writer and editor. Reva had been giving me good editorial feedback when I started blogging, but stopped after the first 6 months when I took my frustration and impatience out on her. But I asked her to give me a chance, because I didn’t see how I could get through the completion of the book without an editor I really trusted. She agreed to project manage, but wisely suggested bringing in another writer/editor with a healthcare background, Andrew Bird. My wife, Dorit, also suggested I speak to another friend, Rena Selya. It took a few days, but we had our first call December 6 (as I was about to board a flight to a speaking gig in Florida). And so the team that put together the text of this book was born.

It was a crazy process. We used Google Docs, which was great for a rapidfire collaboration where we were asking for quick feedback. The next two weeks were a blur: lots of caffeine, late nights, and steady progress. Throughout school and early in my career (particularly in the early days of founding my own firm), I had my share of all-nighters.  I tried to avoid them because I would be wrecked the next day, and as my law firm grew, we had a big enough team that they became unnecessary. But the deadlines meant a bunch of very late nights, followed by too little sleep.

Would I have liked another two weeks to proofread? Definitely. But the core concepts came into focus and the timeliness of the message called for getting out something that was great, even if it wasn’t perfect. I already have about a dozen things to add on the second edition. I figure that, assuming people liked what we wrote, we’d have another edition to add what we missed and correct what we got wrong. So we decided to self-publish due to the time crunch of getting it out in early January (the actual release date is, tentatively, January 9), with the belief that there will be an interested publishing house or two once they see what we’ve done.

Aside from our editorial team, I am deeply in the debt of Larry Cohen, Brad Wilder, Eric Sena, Steve Zweig, and the Glyphix team. Larry took me seriously when I told him I wanted this book in print and on Amazon by the first week of January. He pulled his team together to do the book artwork, lay out the text, pull together the graphics, and do the cover artwork in a sprint. And now we are waiting for a hardcopy proof and then the printing of the first 500 copies.

While I am still waiting for the satisfaction of seeing the bound book in hand for another week-and-a-half, it’s a great feeling to have gotten this far. I am anxious for feedback, and hoping that people will find this work to be a meaningful contribution. I am hoping for critical review and sales that will translate into an agent and a publisher. I am hoping to shed the title “first-time author.” But I feel a tremendous sense of accomplishment in having gotten this far. One step at a time.

I have a few takeaways for anyone reading this who feels like you have a book in you, but who can relate to the challenge of how to make the time to do it amid the business of work and life.  First, the accelerated timeframe was critical.  One of my favorite expressions, as a busy person, is that “there are only two times to do something:  immediately or never.” Writing the book took over my life for three weeks.  But the constancy brought the message and the book into focus:  it clarified what would and wouldn’t be part of the book.  This may not work if you’re writing about a topic where you are still working through the ideas in the course of writing the book, but, for me, it was critical.  Would the book have gotten even better with more time?  Yes, but the progress would have been incremental.  The core message was right there on the page after 21 days.  I would have liked another week to proofread, to get some more feedback, to fix the index and put all the terms we wanted into it.  But I stand by the accelerated approach. I am already thinking about my next book and other topics I want to tackle, and trying to identify (relatively) open space annually on the calendar for future books.  So I encourage people to think about this approach.

Second, the key is to get something down on paper (or on the computer screen) as a placeholder, even if you know the first draft falls short. A few people offered the suggestion of dictating one chapter a day coming out of the shower. My topic was a little weighty for this method, but there is a wisdom in just getting something down.  The easiest chapters to write just flowed out, while some were tougher to unpack.  But just getting something down to react to and pull apart was helpful.  Every time I got stuck, I put aside the chapter and moved onto areas where I had more clarity and could make more progress. Eventually, everything came together.  So get something down, even with the knowledge that it’s rough and sloppy and will need work.

Third, I can’t emphasize enough the value of teamwork. Having a co-author was critical, as were the great editors. We got invaluable feedback on what worked and what didn’t, and there was time for all of us to flag and let other people pick up the slack.  Knowing that other people were waiting on my drafts kept me motivated to stay up late, burning the midnight oil to get them drafts.  It created a sense of accountability to each other.

I hope these insights are useful and look forward to supporting other people in their writing process.  In my next post, I will share some thought about what motivated me personally to write, and where it’s taken me so far.  And I hope to be able to share some updates and lessons on the finding a publisher/agent front.

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