Health Care, Communities and the Greater Good
In the United States, we tend to treat health care like a commodity, something to be bought and sold on the market. Doctors and drug companies offer their services, and we as consumers purchase them. We've been trained to believe this is natural and desirable, but it's an abysmal way to think about the health and well being of our communities.
When you treat health care as a commodity, you get laws that regulate it as a commodity. This is why we allow good health to be marketed to us like coffee or wheat, and why it's so hard to get any health care legislation that actually has the greater good (as opposed to business and profits) at heart. Our point of view is all wrong. We need to bring community into our national dialogue about health care.
Health care is not a commodity. Commodities are bought and sold according to the laws of supply and demand and as such, are dependent on the intricacies of markets for their existence.
Health care, on the other hand, is a need, one that doesn't ebb and flow with the markets. Markets have no bearing on when someone gets sick. Wellness doesn't go in and out of demand. You can’t package up a healthy life and put it up for sale on the market, though big business certainly tries. Really, we should think of health care in terms of the greater good. Healthy communities are thriving communities. In toxic communities, everyone suffers, even those who aren't sick.
The business of health “care” isn’t about health. Sadly, health “care” is big business in the United States. We allow insurance companies, pharmaceutical companies, even hospitals to market themselves to us in attempt to drum up demand for their products and services. We refer to patients as health care “consumers”. Doctors “sell” us their services. Drug companies “sell” us their products. We “buy” insurance plans (and hope they’ll cover us when we need them). The few laws we have to protect us are written in this same language of commerce, not that of the greater good.
Communities are an essential part of health care. Real health care, the kind that actually increases well being instead of just selling you another overpriced drug, requires humanity. It requires real relationships with real people: doctors, pharmacists, midwives, nurses, surgeons, therapists, personal trainers, spouses, friends, family, all the people you rely on to make you happy and healthy. In other words, a community of human relationships.
We cannot thrive in isolation. The breadth and depth of human relationships is one of the single best indicators of longevity that we have. Our model of health care should support and nourish these human relationships, this community that makes us who we are. The American health care system, on the contrary, undermines it.
There’s a small, aging hospital in Tuba City, Arizona, that seems to understand this, in its own small way. In a nation of rapidly rising Caesarean rates, Tuby City Hospital manages to keep its own Caesarean rate at just 13.5 percent, well below the national average. There are a lot of reasons why.
Nurse-midwives attend most births, not obstetricians. The midwives know their patients well. Staff here are salaried, removing any financial incentives for surgery. The hospital is federally insured, not privately, which frees it from the fear of arbitrary increases in insurance rates. The Navajo culture plays an important role, too. Entire extended families often gather in the delivery room to support the mother and celebrate the birth. What does all this have in common?
By design, Tuba City Hospital serves its community, not its executives or board of directors. Patients are not profit centers. Human relationships are at the center of decisions and operations. The usual corporate interests are absent. And because of this humanity, these human relationships, one small hospital is making a huge difference.
All the talk we hear of finding cost savings, single payer vs. market-based, giving consumers more choices, etc. - all of it misses the point. These ideas are important, but they fail to break free of our old ways of understanding health care. The one thing we seldom hear about - the thing that matters most! - is the importance of community, of a system that focuses first and foremost on the greater good.
Robin Cangie is a writer, thinker and digital geek who likes to wonder about things and is a new contributor to Bubblegeneration. She writes about 21st century business, sustainability and whatever is on her mind on her blog, robinoula.com. She tweets as @robinoula.