Hildy’s Healthcare Manifesto

If ever an issue were crying out for a different approach to finding solutions, it is the issue of American healthcare.

Post-SICKO America is feeling a combination of rage and despair and the desire to do something. While the story of events at a Texas movie theater is more dramatic than most, SICKO has clearly raised the decades-old battle cry of another movie: We are mad as hell, and we’re not going to take it anymore.

As SICKO raises this issue to a fever pitch, my greatest fear is that we will try to address America’s healthcare woes with the same problem-solving approaches that have failed in the past. I fear our Healthcare Battle will become the next War on Drugs – loud, ineffective, and causing serious unintended consequences.

So what can be effective? Our only hope is to seize the opportunity to create a truly healthy nation, in a truly healthy world. That will take a different approach – a Vision-Based approach, aimed at creating the future we do want, rather than escaping the present we do not want.

The following is the beginning of a Vision-Based approach to building a healthy place to live. I hope you will add your thoughts, to turn this into a plan that we can all turn into action.

FIRST: What would it look like if we got exactly what we want?
A Vision-Based approach anchors the planning in the future we want to create, (rather than rooting our planning in what we do not like about today). What do we Americans want for our families and our communities (and our world) when it comes to health? The answer might look something like this:

We want to live in the healthiest place possible, where all our citizens are healthy, and our communities are healthy overall. We want to live in a place that does not see health as an absence of sickness, but as a positive, energetic force – a comprehensively healthy place to live, in all aspects of the word.

THEN: What conditions would lead to our achieving that level of health? Today’s realities are the result of decisions made and actions taken in the past. And the future will be comprised of the causes and effects we are creating right now.

We therefore have the opportunity to put into place conditions that are most likely to lead to comprehensive health. What conditions would create the ripple of cause & effect that will create a comprehensively healthy place to live?

Here are some of my own thoughts:

Pre-Condition #1- Healthcare for All
One pre-condition to building a healthy nation would be a healthy level of healthcare (not a minimum level, but a HEALTHY level), provided to every living human being, regardless of ability to pay. If we can readily understand that “publicly funded education for all” is a pre-condition to building a strong country, we should have no problem understanding that “publicly funded healthcare for all” leads to strength as well. And if we can put people in rockets and send them safely to the moon and back, we can figure out how to accomplish Healthcare for All.

Pre-Condition #2 – Healthcare for My Whole Body
Universal healthcare must apply to all my body parts, and not just some of those parts. Last I looked, my teeth were part of my body, as were my gums. Last I looked, my mind was part of my body. If both my dental health and my mental health clearly affect my overall health, then one of the conditions for having a healthy nation would be that all our various body parts be healthy, and not just some of those parts.

Pre-Condition #3 – Healthcare as a Sale at the Mall
This is America, where we are used to buying what we want. Therefore, another pre-condition to building a healthy nation would be that we realize we are currently paying a lot of money to be not-so-healthy. It might be a real bargain to pay a bit more in taxes and actually be healthy! When we add up what each of us currently pays for health insurance and co-pays and uncovered expenses and medications, I will bet that raising taxes for universal healthcare will save us money AND buy us more health. That’s almost better than a Buy-One-Get-One-Free sale!

Pre-Condition #4 – Broad Community Planning for REAL Community Health
Another pre-condition to building a comprehensively healthy nation would be broad community discussion of what it means to have a “healthy community.” That would mean community planning (and implementation of those plans) for creating healthy communities, as distinct from not sick communities. What’s the difference? A diabetes prevention program does not create a healthy community. It creates a not sick community. A healthy community is one that doesn’t need a diabetes prevention program! Creating community-wide definitions of what “healthy” means, and planning to create such health in our communities, would move us closer to that goal.

Pre-Condition #4a – Broad Community Planning as a Community Role
It is important to note that while some of this type of planning is being done in communities around the country, much of it is being done by local and regional hospitals. Yes, that is both noble and necessary on their parts. But it is also both unrealistic and unfair on the part of community leaders to dump responsibility for community health planning at the feet of hospitals, as if hospitals do not already have more than enough on their plates (like, for instance, running a hospital!). Therefore, another pre-condition to building healthy places to live is that our local, regional and state governments take a more proactive role in facilitating both the discussion and the work of building those comprehensively healthy places to live. And that each of us demands that at the voting booth.

Pre-Condition #5 – Everyone at the Table
An important pre-condition to #4 is that people who are not normally involved in such discussions be engaged and present. Building healthy communities, a healthy nation, a healthy world is not a “medical professionals only” activity. And while there are few communities that are actually tackling the broader vision of a comprehensively healthy community, there are even fewer that are inviting the widest possible cross-section of the community into those discussions. (Is the arts community about health? You betcha!)

Pre-Condition #6 – Individual Responsibility
Another pre-condition to building a healthy nation would be that individuals take better care of themselves. Ironically, some of the people who scream loudest about “personal responsibility” are overweight, smoke, and/or drink too much themselves. (Did someone say “Rush Limbaugh?”) So a big pre-condition to creating a healthy nation is that we become more realistic and less judgmental about the fact that most of us are lousy at taking care of ourselves.

Pre-Condition #6a – Individual Responsibility (again)
If personal responsibility is as serious a political issue as it tends to be in this ridiculously pull-yourself-up-by-your-bootstraps nation, one pre-condition for creating a healthy nation would be the need to find what would inspire individuals to live healthy lifestyles. Just because the threat of illness and death is not enough incentive for most of us, doesn’t mean we cannot somehow be encouraged to do what is best for us. Perhaps, as has been suggested by Roger Hughes at his blog for St. Luke’s Health Initiatives, we need to structure financial incentives. Or perhaps we need to create DIS-incentives. But regardless of whether our incentives are financial, spiritual, or what-have-you, a precondition to our having a healthy nation would be that we stop judgmentally bemoaning the lack of personal responsibility, and instead find what will inspire each of us to take better care of ourselves.

Pre-Condition #7 – Government Responsibility
If we are each going to take care of ourselves, another pre-condition to building a comprehensively healthy nation would be that our government stop talking out both sides of its mouth. It is one thing for health insurance companies to penalize us for smoking. It is quite another to simultaneously use my tax dollars to subsidize the tobacco industry.

Pre-Condition #8 – Ban Drug Ads
The single step of banning advertising of pharmaceuticals could help reduce the cost of drugs immediately. That’s certainly another pre-condition to more comprehensive health.

This is just the tip of the iceberg. What other conditions would need to be in place, for our nation to be truly healthy, in all aspects of the word? Unless we consider all those conditions, and not merely pick and choose one or two, we will be destined to endure the endless task of sticking more and more fingers in the holes in the dam.

The Arguments
There are always arguments. In vision-based planning, those arguments are not considered ‘right’ or ‘wrong,’ but instead become additional cause & effect conditions to be addressed on the road to reaching our goal.

Here are a few arguments that occur to me, that are not addressed in the conditions above.

Argument: Doctors would have less freedom to practice medicine / the government would be telling them what to do
Talk to doctors. Right now, they have zero freedom. They can only perform the tests the insurance companies approve of. In many cases, they are told how many patients they will see. Just to get through the paperwork of the various insurers (payors), they must staff their offices with an army of bookkeepers and other non-medical personnel. The government would have to work really really hard to give docs LESS freedom than they have now.

But that does bring up an important condition that must change if we are to create a truly healthy nation: Doctors would need to have real honest-to-goodness freedom to practice medicine, and incentives to keep us healthy.

Argument: Eliminating drug ads would reduce Americans’ ability to make an informed choice
Let’s not even address whether the argument is spurious – that somehow advertising equals informed choice. Let’s instead ask America: Which would you prefer?

  1. Pay less for your medications, but spend time learning about the variety of drugs available or simply trust your doctor to prescribe what you need, or
  2. Pay more for your medications, but have advertising so you THINK you know more about those drugs (but really you do not).

And so perhaps another pre-condition to creating a healthy nation is that people would be truly informed, and not simply by those who want us to buy something.

Argument: It will put the healthcare industry out of business
Ok, now we’re talking. But not to worry – this would not be the first time fixing something that was hazardously broken has put people out of business. Anyone who was around for the Savings and Loan debacle in the late 1980’s knows that can happen. Prior to 1986, government action (deregulation of the Savings & Loan industry) allowed S&L’s to invest in risky ventures such as speculative real estate. The result of that government action was that many individuals and corporations made a lot of money (Recognize a pattern re: healthcare?). Then in 1986, Reagan’s tax reform act took away many of the tax incentives that had motivated those investors. What resulted was a recession, a real estate crash, the “S&L Crisis.”

In the end, the nation recovered, and all those people are now making money at something else (if God has a sense of irony, they are now making money in healthcare!) And the end result was that something that never should have been permitted and that had caused harm (the dangerous aspects of the S&L deregulation) was reversed.

Perhaps, then, another pre-condition to creating a healthy nation is that we will have to determine what to do re: the economic bumps that will be created as we make those changes.

Next Steps
Using a vision-based approach, the next step is to find all the pre-conditions to THOSE pre-conditions, to work our way backwards to figure out what we need to do NOW, to make these changes reality. It is an inclusive process, rather than a narrowly focused process, as the more inclusive the work, the less likely we are to insert the Law of Unintended Consequences into the future we are creating.

The whole process, from the rosy future we want to create, working backwards to the things we need to do today to make those happen, is all based on cause and effect. It is the cause and effect that says, “We are creating the future anyway. Let’s create the future we want!”

Now It’s Your Turn
It is my profound wish that the discussion of Healthcare in America does not devolve into problem-solving, but focuses on establishing positive conditions that would lead to our becoming a nation of strong, healthy people. If we want a better world, we cannot satisfy ourselves with just one or two of those conditions being put into place. It will take all those conditions and then some if we are to create a comprehensively healthy place to live.

That is the difference between problem-solving approaches and a vision-based approach. Problem-solving approaches choose which holes in the dam to plug. Vision-based approaches aim at the bigger question: How do we keep the town dry?

So please, add to the list of conditions we will need to put in place if we are to build healthy communities filled with healthy people. From there, it should not be hard to turn all that into a plan for making this a truly healthy nation, on a comprehensively healthy planet.

4 Responses to Hildy’s Healthcare Manifesto

  1. Hi Hildy,
    Visions of a healthy planet that come back around to our own back yard. I’m struck by how great visions keep coming back around. Think Global – Act Local comes to mind, along with all the work done under the “Healthy Communities” umbrella over the last two decades. Have we all simply lost focus?
    Well – after twenty-five or so years of health and human services I now have my view of the world in “managed care.” Someone near and dear has given me a great concept to help face the challenges of working from within – we choose to work in a crazy system…
    I love all the work you are doing. Applying the vision to help guide our future toward all of us living healthy lives in a healthy world is something to keep in our sights.
    Interestingly enough our dear Governor is launching some community conversations around the health care challenges we face. I look foward to seeing where they might lead us…


  2. Bob – Great to hear from you! I wonder what it would take to stop the Governor from talking about our challenges, and start her instead focusing on the future we have the opportunity to create? There is virtually nothing we can do about today – it will be gone before we get the second syllable out. What would it take to get her to focus on the future we have the power to create, and to see today as a stepping stone towards that? I wonder… HG

  3. Great ideas – wish I had come up with them. As a matter of fact, I have come up with them in our Healthcare Revolution. It’s a design for a community based, community driven, locally responsive, cooperative (joining providers and patients) healthcare organization whose only enemy is disease, and whose goals are developed in response to local needs. We have already started a pilot program in a small community in AZ and are a good stretch ahead of the national curve.