This is the group statement that we generated from our Health Care Community Discussion on December 31st at Working Class Acupuncture in Portland, OR to send to the Obama/Biden transition team (see www.change.gov).
First, we want to offer a huge enthusiastic thank you to the Health Policy Transition Team. We began our discussion with pretty much everyone saying that we were somewhat stunned by the fact that the government actually wanted to know what we think about health care. We were surprised to be asked, to be acknowledged, to be invited into the conversation. Simply being INCLUDED in a national discussion about health policy seemed like a very big deal to us. After spending two hours together talking about issues that matter enormously to all of us, we felt as if we had somehow participated in history.
Through the course of the discussion we discovered a remarkable unity amongst ourselves. There are a number of core points that, although they were raised by different people, resonated deeply with everyone.
The first point was that though we appreciated the questions offered as guidelines for the discussion, we needed to take our discussion beyond the parameters of the questions. Beginning with the first question of what is wrong with health care in America, we arrived pretty quickly at a consensus that the system is so broken and so unresponsive to our needs and the needs or our families, that what we really need is a complete paradigm shift. The system needs more than repairs; we think its foundations are askew.
We agreed that health care is a public need rather than an individual need, not unlike the need for roads, a postal service, or basic education. Individuals should not be as responsible as they are for figuring out how to make health care happen for themselves and their families, any more than individuals should be responsible for figuring out how to make the roads work before they can drive on them, or make the postal service work before they can mail a letter, or make the education system work before they can send their children to school. There are so many national systems that really do work; why can’t health care be another one?
We also felt strongly that the health care system in its current state is clearly NOT FOR US. It is not designed to benefit or help us. Who is it for? Who does it benefit? We suspect that the answer is big corporations, because none of us know any individuals who feel that the health care system really meets their needs. It’s bureaucratic, disempowering, overwhelming, confusing, and frustrating in more ways than we can list.
We all agreed that the profit motive for health care has got to be removed. Medicine should not be a lucrative practice. We favor salaries that are livable for health care providers, but we do not think the reward for being involved in health care should be financial. (We had two nurses and four licensed acupuncturists in our group.) Lower salaries would probably translate to a greater number of jobs. Similarly, the litigious aspect of the health system needs to be reined in; there should be no profit motive for lawyers. (We had a lawyer in our group.)
We decided together that we need to “redefine the discourse”. Even the questions you offered us as guidelines for the discussion were couched in the status quo. Prevention, for example, means more to us than just early detection of disease. Health is more than the absence of illness.
The idea of “health insurance” does not really make sense to us. As responsible adults, we have car insurance, we have home insurance, we understand how insurance works. Car insurance and home insurance work as a concept because most of us are not going to total our cars or have our roofs cave in. You get insurance with the expectation that it is unlikely that something will go so badly wrong that you will need to use it. But human bodies are not like cars or houses; all of us are definitely going to have something go wrong with us someday. All of us are going to die. You can’t base health care on a system that presumes you shouldn’t need to use it.
We agreed that we do not actually want “health insurance”. We want “health assurance”. We want to know that we will get the care we need, when we need it. We understand our own responsibility for making our lives as healthy as possible, but we want to know that there is a larger system to help us, a system that is based on the public good rather than individual profit. We do not expect to precisely fulfill every one of our individual preferences; we are prepared to compromise and adjust as long as we know that the point of the system is to take care of people. We believe that there should be an assurance of basic services for everyone.
All of us in our discussion group are either staff or patients of Working Class Acupuncture, an acupuncture clinic that treats over 400 people a week, located in a “marginal” neighborhood in Northeast Portland. We all agreed that we wished the whole health care system was more like WCA, which has a community based business model. We all feel invested in and empowered by our clinic; we feel that it represents the concerns of working class people around health care. We loved the experience of having this discussion with each other, of creating and sharing a collective vision. We all left feeling uplifted and connected to each other in a new way, so thank you again for encouraging us to participate in this process.