Michael Fine on the nature of health and health care

Michael Fine’s book, the Nature of health: How America Lost and Can Regain a Basic Human Value is an excellent read.  Check out chapter 15–toward a social definition of health on page 145. 

Besides writing good books, Dr. Fine, like CA, has developed a model for delivering care here in RI that addresses the needs of people without health insurance or access to primary care doctor’s visits.  The practice he started, Hillside Family Medicine  has figured out a way to provide care to people without insurance, at a fraction of the cost, while still remaining a viable practice.   Sound familiar?

Right now in the midst of all of the discussion about health care in America, Dr. Fine is working to pass legislation in RI that would provide primary care for all.  

Here is a link to the white paper document on this effort.  There is also a petition to sign via Michael’s website.


In the white paper for Primary Care for All– Michael Fine writes:

There’s nothing inherently valuable about health insurance – it can’t answer phone calls or make diagnoses – it’s simply a mechanism for delivering health care, and has become a very expensive one at that.  But insurance is neither sufficient nor necessary for delivering care; even with insurance, care is not guaranteed, and the seemingly wedded relationship between insurance and care isentirely contrived.  We don’t necessarily need health insurance, but we do necessarily need health care.  Plus, the value of health insurance is largely contained in the primary care delivered; much of the remainder is wasted.  In financial terms, health insurance costs approximately $5,000-$6,000 per person per year, but the value comes almost exclusively from the $300or less that primary care now costs most Americans.  Which means, we can provide primary health care to all Americans at one twentieth of the cost it takesto provide health insurance to all Americans.  And as health insurance reform now stands, even including the public option, 25 million Americans will still be uninsured by 2019, which is not to mention how many Americans will still lack affordable primary care.  Meanwhile, primary care is the only medical service that’s been proven to improve the health of the population, and the only service proven to reduce the cost of health care.  (How’s that for a win-win?)  So if insuring all Americans is prohibitively expensive, and delivering primary care to all Americans is not only absurdly cheap in comparison, but what actually improves their health, why not just bypass insurance altogether and go straight to providing primary care for all Americans? 

Again, this makes so much more sense than these bloated systems that require so much administrative cost and loose sight of the ultimate goal to provide care. 

I’ve been thinking about the acupuncture profession’s big push to pass HR646.

Something about it seems mis-directed and yet AAAOM has  plans to spend 120,000 dollars that the to promote it.  Larry blogged about this a while back, citing the huge amount of bureaucratic spending/waste that has resulted from “covered” chiropractic claims.  

It seems as acupuncture as a profession is trying to convince the public that an ancient Chinese practice of sticking small needlesin the skin should be something they think of as good for their health, like taking vitamins, or exercising, or brushing their teeth. But the way they are working to accomplish this is like approaching the AMA toget AETNA to confer with FoxxNEWS, to convince top Washington insiders, to getthe president and congress, to sign off on a bill that will offer coverage to afew million Americans that would give some of the public the opportunity toafford having someone stick small needles in their skin. 

Wouldn’t it be easier for us to just lower our prices? 

And to open up so many affordable clinics that everyone who starts thinking about acupuncture as something useful can actually find someone to perform this treatment?  

Author: crismonteiro

I've always thought that I would live to be 100 years old and now that I have an actual idea of what it might be like to inhabit this body for a century I want to be damn sure that Community Acupuncture is around to help me through my days and in the end, on my way. In the meantime, I am passionate about getting shit done, and also having fun.

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  1. i guess this is spreading

    doctors are so unhappy at work that they are starting to re-invent their work situations as well. just read this excellent interview in The Sun Magazine with Pamela Wible, MD practicing in Eugene, OR. the link only gives you a partial interview, (i subscribe to the print magazine), but it’s enough to get the point across. You CAcupunks in Eugene should hook up with this lady, she sounds pretty cool.


  2. I’m going to have to get that book, Cris.

    The McKnight quote, “Health is the unintended side effect of citizens acting powerfully in association” kind of blew my mind.  I’m going to be chewing on that one for awhile; also loving Illich’s idea of “cultural iatrogenesis.” 

    I liked that Sun article too, Tatyana, thanks for the link.  

  3. I’ve been working my way through Dr. Fine’s book as well,

    on Cris’ recommendation.  I like very much how he’s persistent in his redirection of what the meaning of health is/may be, within a historical and social context.  And also from the point of view of a care-giver.

    It won’t do Dr. Fine or the book much justice, as it is a well of information, but I’d like to quote towards the end of chp. 7:

    “Our understanding of health can take one of two paths.  If relationship is no longer essential to human life, then the concept of health shrinks in meaning and denotes the functional efficiency of our body parts.  This understanding of health is unarguably gaining ground.  We increasingly address the health of the knee to ski, the health of the brain to concentrate for school and job success, the health of the emotions to preserve mood in the face of a world that seems to exist to provoke anxiety.

    But if relationship is indeed essential to the human life we want to lead, then we will have to change the culture, resuscitate the conditions under which relationship is possible and redirect our energies toward relationship and community.”

    Community Acupuncture is many things all at once; a business model, a call to acupuncture’s more simple past, a challenge to the faltering acu-establishment’s moral center, a means toward gainful employment… 

    That through the vision and work of patients, individual clinics, WCA & CAN, CA seems to be playing a part in holding long-dormant conversations about Community and Humanity a la ‘The Nature Of Health’, is reason enough for me to be an aspirer for changes ahead.