Trade-offs and Truth

I haven’t been writing much, on the blog or on FB, for awhile in part because I felt like I couldn’t do any of that and also do my POCA Tech job. During the Candidacy site visit in the spring, one of the site visitors quietly let me know that any blogging I did could affect POCA Tech’s relationship with ACAOM, so I feel like I’ve been wearing a muzzle ever since. Anyway, I can’t stand it anymore. Muzzle’s off. I’m also off Facebook, so if you want to find me, unmuzzled, here on the POCA site is where I am. I’m going to try to blog regularly from here on out.

Some themes have been coming up lately about risk and sustainability, about clinics finding the right staff and POCA Tech finding the right students, about “pessimism and cynicism and whether there really are enough qualified candidates to do this work” — that’s a quote from a private message that a frustrated clinic owner sent me, wondering if his standards were just too high. Also, the question of whether or not community acupuncture clinics should make jobs at all if they can’t offer benefits like health insurance.

At this point, after almost 15 years working on this project in one way or another, here’s what I think: capitalism is brutal and requires all of us to make very hard choices. Nobody can tell anybody else how they should live in capitalism. There are so many painful trade-offs and if there’s one thing you learn by working in a community clinic, it’s that people are really really different and they need different things.

It’s incredibly difficult, in capitalism, to do any kind of project that’s focused on collective good as opposed to individual good. The odds are against community acupuncture in any form. Anyone who creates, let alone maintains, a CA clinic has pulled off something pretty subversive.

POCA as a whole, however, is even more subversive and countercultural than an individual clinic. Because this is capitalism, creating POCA required some very specific sacrifices, some hard trade offs. More about that in a minute.

When the original steering committee wrote the guidelines for POCA membership, we were very clear that the odds in this culture are against community acupuncture in any form, and we wanted to support CA in any form that we could (we originally tried to include hybrids). That’s what the Locate A Clinic guidelines are all about.The structure of what kind of clinics POCA could include, and support by its existence, has always been as broad as possible (given that we were clear we couldn’t support ANY sliding scale, or ANY hours structure, because that inevitably leads to “community acupuncture clinics” with sliding scales of $80 to $500, held regularly on alternate Tuesdays from 1:20 to 2:03 pm in months that end in “r’.).

Beyond the guidelines, people have lively conversations about the very real trade-offs of living in capitalism.

These have been going on for years, and often, I’ve stayed out of them. However, I feel like now I have to get back in — because of the school.

Here’s something I couldn’t say with my muzzle on: there are many, many of us who graduated from acupuncture school and immediately had the sickening feeling that we had been lied to about our prospects for making a living. We realized we had been operating on the basis of falsehoods, both of commission and maybe more importantly, omission. A lot of people had simply allowed us to believe a lot of optimistic things, along the lines of allowing poor kids to believe they could grow up to be famous actors or famous football players so the system can’t be that bad, right? 

Comrades, I can’t play that particular game. If you want a Director of POCA Tech who is going to lie by omission, both to students and to the co-op, you are going to have to find somebody else to do that.

Recently I learned that a student at POCA Tech was upset to learn that WCA doesn’t offer its workers health insurance. We’ve tried to figure out how to do that for years, and we’ve just never been able to afford it. Our CPA told us that WCA employees would probably get a better deal on the individual market, where some of them would qualify for discounts, than anything we could buy collectively. Anyway, the reason that I was concerned about this student being upset is that the implication was that they had been deceived. So I feel like it’s time for some full disclosure about trade-offs.

I haven’t had health insurance since about 2000 because I couldn’t afford it. I still can’t afford it. I don’t blame the community acupuncture model for that — the blame for unaffordable healthcare is squarely on the shoulders of capitalism itself.

However, I might have been able to afford health insurance, and WCA might have been able to also, if we had made some different choices. And those choices would involve there being no CAN, no POCA, and especially, no POCA Tech. If you believe in alternate realities, somewhere there’s one in which I had the good sense to keep my mouth shut about what’s important to me, and all the energy that could have gone into movement building/infrastructure building instead went into my personal financial security. In that reality I never hired anybody, never wrote any articles and never started any organizations — but I’ve got fantastic health insurance.

I’m not saying this to guilt anybody or because I want points (it’s a little late for that). I’m saying it because I think people deserve the truth about where our infrastructure came from and what kinds of sacrifices it required. Sometimes I think people look around the POCAverse and see a co-op with some nice benefits, a membership organization that works better than other membership organizations, and wow, a school — so they assume all these structures were built by conventional means, which is to say there was extra time, money and energy to build them, after people got certain needs met. Not instead of.  Which leads to them assuming that there is more money in community acupuncture than there actually is.

I did get my needs met, but not by a lot of people’s standards. See above: capitalism is brutal, people need different things. I needed to build things more than I needed health insurance.

If you have benefited in any way from POCA — gone to a POCAfest, taken an online CEU, gotten anything out of POCA at all or CAN before it — you benefited from mine and Skip’s and WCA’s willingness to create and live with (by many people’s standards) low wage jobs with no health insurance. That’s not because you took advantage of us, it’s because capitalism is brutal.

Before all of this, back when I worked a low wage public health acupuncture job, one thing I found frustrating was that the experience I got there didn’t really allow me to leave and go anywhere else except another public health job (which didn’t really exist). If somebody works for a community acupuncture clinic, though, they can always leave and start their own clinic if they don’t like the working conditions. They’ll be able to directly use whatever they’ve learned as an employee to become an owner. And of course there’s POCA, where the formula is readily available. It’s pretty egalitarian that way. If you want to create jobs, create jobs; if you want to work for somebody else, do; if you want to be a solo punk, do that. You just have to live with whatever trade-offs there are in each of those scenarios.  Nobody’s stopping anybody from choosing any of them; for that matter nobody’s stopping anybody from taking what they learn from POCA and using it however the hell they want.

But if you want somebody to tell you that there are no painful trade offs, you shouldn’t hang around here. I’m going to hang around here because above all, I need a place where I don’t have to lie. That’s a major reason I built what I built. Infrastructure for the community acupuncture movement is not really affordable or even sensible, under capitalism; I’ve always been in it for the freedom to tell the truth.

Capitalism isn’t going to get any less brutal in the near future — in fact, the opposite is likely. I’m a big fan of people being very honest with themselves about what it is they really want and need, that’s what I’m trying to do now, and that’s what I recommend. If you’re having misgivings about community acupuncture and/or POCA supporting you in having the lifestyle, particularly the security, that you need, you should feel fine about leaving this behind and finding something else to do. If you stick around, though, you should probably ask yourself what price you’re personally willing to pay.

More on this topic coming soon.

Author: lisafer

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  1. ANYONE who has benefited from a CA treatment owes a debt of gratitude to Lisa and Skip for leading the charge.
    To go from an idea to one clinic, is a success story in and of it’s self. To spread the movement and grow to over 200 clinics, is just a phenomenal accomplishment.
    The road to where we are now, (and it is not the end by far)has not been an easy one.
    It has, however, been driven by inspired leadership, hard work, integrity, honesty, belief in the mission, and the efforts of many worker bees.
    All those involved in POCA, and POCA Tech by extension, believe that the collective is a way to benefit all, no matter what their status may be.
    No one did it for recognition. No one did it for praise. No one did it to say “look what I did”.
    POCA Tech has not been funded by excess money. It has raised funds by the generosity of thousands who believe in the cause. No Alumni have written big checks to see their names on a building.
    There are no chairs endowed by millionaires that allow the staff to not have second (or 3rd)jobs just to get by.

    I humbly ask that all punklings please read/re-read the following links.

    I then ask you to remember what/why you were attracted to at POCA Tech. Why/what did you want when you decided to come here? There were no flashy brochures. No salesman. No pretty campus tours. And now you are questioning the manner in which it is provided?

    The next time you see Lisa or Skip, be sure to thank them. I am sure they earned it!

  2. The student’s reaction to the health insurance issue is interesting. Is it part of an assumption that many people make about small business success versus the realities of cash flow, actual profits, and expenses?

    Seems like the truth of most small business, even beyond this profession, is that they are challenging to run, bring little profit–especially if you bother to hire other people–and take A LOT of work day-to-day. It’s very easy to walk into an established clinic or school and assume things work a certain way but not until you build a clinic, sustain it–or a school for that matter–do you really GET that. And almost ALL acupuncture practices are going to be a small businesses, whether a person does CA or boutique.

    Sounds like good stuff to talk about in whatever the practice management portion of POCA Tech will be–which will likely be infinitely more useful than the class at my school was!

  3. Thank you for writing this! I work for a nonprofit that pays for most of my health insurance but i also get paid $11.10 an hour and if I switch positions ill go back down to the starting wage. There are always trade offs.

  4. Thank you, Lisa, for putting clarity out there! This is a favorite nugget for me: “Sometimes I think people look around the POCAverse and see a co-op with some nice benefits, a membership organization that works better than other membership organizations, and wow, a school — so they assume all these structures were built by conventional means, which is to say there was extra time, money and energy to build them, after people got certain needs met. Not instead of. Which leads to them assuming that there is more money in community acupuncture than there actually is.”

    How do we honestly say this aloud – and without resentment (or whatever base, unkind, unhelpful emotion I am trying to fight moment-by-moment sometimes)? And, yes, I look at all the other small businesses and am like “how do they pay rent? how do they make payroll?” Capitalism is grinding us all down. Yet, with CA, I see the difference it makes in people’s lives EVERY DAY, and that makes up for so much in this mean world and gives me so much hope!