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Recovering backpacker, Cornwallite at heart, political enthusiast, catalyst, writer, husband, father, community volunteer, unabashedly proud Canadian. Every hyperlink connects to something related directly or thematically to that which is highlighted.

Wednesday 19 September 2012

Consumer Based Health

I've always been fascinated by the way we view our relationships with service providers. In my blissfully ignorant youth, when people referred to "their" real estate agent or "their" trainer, I assumed they had to be exceptionally wealthy to afford a retinue of specialized retainers like that.  Of course, we don't actually own our consultants and contractors.  Implying we do is simply a way of denoting status, the modern equivalent of long fingernails; we don't have to do the work, we have people for that.    It's not a notion that has ever sat comfortably with me.  Now that I'm actively out there consuming specialized services, I make a point of not propertizing (a neologism for you) those providers. I use a real estate agent; he's not mine. I see a physiotherapist - I don't own her.

It's this last that got me thinking about how we view health care.  I was in for physiotherapy today and got to talking with the kinesiologist treating me  about how the brain adapts to pain.  A funny little thing, this: we pattern things like posture and physical response to the programming our noggins have created to adapt to injury, even after the original source of pain is gone. If you spend long periods hunching over a computer terminal and find yourself hunching the rest of the time, too, it's that behavioural patterning at play.  Left unabated, it can change the curvature of your spine and cause all sorts of spin-off problems.

The kinesiologist and I also talked about the sorts of exercises and activities people can do to reset these posture programs over time - a key part of the injury recovery process. The challenge is, one visit a week to "your" physiotherapist isn't going to do that. Significant changes in behaviour come from regular, consistent practice - something you can only pay someone to do to you regularly enough to have long-term impact if you are rich as thieves.  For the rest of us, we have to internalize our own care through exercise regimens, etc.

A big challenge this kinesiologist faces is getting this message through to her clients.  If they don't make the time to do their exercises at home, they will not get better.  She can give an initial push and serve as a stop-gap, but a full return to health involves active patient participation.  The problem is, everyone is too busy with work, kids or the commute and far too stressed out to worry about their own health. Besides, they can pay someone to do that (like their physiotherapist) or pay for a product like ibuprofen to fill the gap.  That's how we solve problems in our society - by buying the solutions.

How often do we view our family doctor as just another service provider, like our accountant or our real estate agent?  Have we hired them to make sure we stay in good working order, like a car mechanic?  The capitalist theory suggests that if there's sufficient demand, supply will emerge to match; we are specializing our skills to an increasing degree to be competitive and besides, we define success as having the ability to pay others to do the stuff we don't want to.   When was the last time you made your own furniture?  Do you grow your own produce?  Heck, do you even know where those things come from?  The further up the food chain we are, the more stuff we can have and the less general work we need to do.

This, naturally, got me thinking about Mitt Romney. We've all seen or read the quote:

"All right, there are 47 percent who are with him, who are dependent upon government, who believe that they are victims, who believe the government has a responsibility to care for them, who believe that they are entitled to health care, to food, to housing, to you-name-it."

Romney is a pro-free market capitalist who is a big fan of consumer culture. In his mind, everyone should have the responsibility to work hard and by hook or crook, find profitability. When they do, they'll be able to pay for more stuff and expand the economy.  They'll also be able to afford not to do things, like serve in the military.

Whatever the Romneys of the world try to tell themselves, we are working hard.  At the lower end of the economic spectrum there are countless folk holding down two or more jobs, trying to make ends meet and save up for their kids' education. In the middle you have folk busting their butts to garner recognition and earn the next raise or promotion. Even at the top you have executives putting in 12 hours a day to keep their operations afloat. Heck, I even see homeless beggars in position starting at the crack of dawn.  It's a very scant percentage of people who can afford not to work at all.

We work hard at what we do - we expect others to work hard at what they do. But what happens when those interests collide? What about when the service we are paying for is the maintenance of our own personal health?

Healthcare is a huge industry. Everything from pills to acupuncture and even health promotion services like spin or yoga classes generate a lot of revenue. Public health services are also a multi-billion dollar industry. In fact, public health care cost the Ontario taxpayer $49 billion in 2011.  But are we getting better?  Whether we thinks we're victims or players, how healthy is our reliance on outsourcing health - and, like bad posture, is this pattern-forming behaviour?

We live in a consumer/producer based society. Every aspect of our life, even parenting, has been affixed with a dollar value and is offered on the market by someone as a for-profit service.  Maybe you think this is a good thing.  Me, I make a point of getting in my exercises so I can heal myself.  for me, independence isn't about holding ownership over the labour of others; it's about gaining the ability to be master of my own fate.

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