Saturday, September 5, 2009
Tuesday, August 18, 2009
I was up until 3 a.m. recently, slightly melancholy after a spur-of-the-moment, lovely picnic in the park with friends. I'd come home a little tipsy, very tired, pondering my life, my age, our culture and the ways of the world. I plucked up the courage to finish one of the best books I've read in a long time (The Elegance of the Hedgehog) -- a book I've been reluctant to commit to because in some ways, it hits too close to home, and I was approaching its final chapters with a low sense of dread. The writing was too good to offer an easy out, and true to form, author Muriel Barbery’s ending left me spinning and stunned. I found myself sobbing at nearly 3 a.m., about my family, about ten years of loss, about doors that close and the unrelenting force of circumstance. How can I fundamentally transform a world in which power is decreed by class and status, when I have little of either? When will this 20 year task, of healing myself deeply enough so that I can help heal the world, find its cynosure? And how do I ensure the weaving of a bright tapestry after more than a decade of trauma? Exhausted, I lay there wondering just how much tenacity I can continue to muster amidst my struggles with fate, my profound sensitivity, and a world of systems I don’t believe in.
Here’s the deal: l love this planet. I love life with a fierceness and tenderness I can’t easily explain. I am not afraid to die. But sometimes, I am deathly afraid of the world we have created. On a fairly regular basis, everything inside of me rises up against the things we take as commonplace…supermarkets, corporate personhood, adulterated food and dollar stores to name a few; this last being particularly disturbing when you follow the trail of exquisite beauty and ecological complexity of a rainforest to plastic bins of throw-away goods for a throw-away culture – one in which we know all too well how to throw away each other. (And honestly, I think these things are connected). Supermarkets are just as frightening -- though not as frightening as the fact the most Americans don’t realize this -- that aisle after aisle of all of our major grocery stores are filled with toxic chemicals and fake food. In American culture, it is a great and cloudy distance from the soil and the farm to healthy, nourished cells and clarity of mind. Our addiction to technology has dulled our senses to the healing power of nature’s bounty and the fantastic toxicity of the systems we have created to manipulate, produce and procure its proxy. This fact can be said for more than our food.
A modern era that cut us off from heart and old wisdom has led us to a postmodern world in which speed, complexity and an increasing sense of universal malaise is the norm – and we don’t know how to navigate back to the vitality of the moist earth, hard ground, seed and acorn where once we lay dreaming. We are a simultaneous juggernaut and mad dash toward massive planetary destruction. And setting this unnerving fact aside for just a moment, we have built a world of systems and ways of being that are oppressive rather than liberating. The result? Widespread apathy, anomie and a low, reverberating global hum of desperation. It is not surprising that anyone, anywhere, feels helpless. For to change the world, we must change ourselves, and to change ourselves, we must change our systems, and to change our systems, we must muster the kind of courage on a collective level that we’ve never managed to do as a species, let alone a people or a country.
It is a daunting proposition to think of, or to believe in and fight for, a global paradigm shift in human consciousness; but it is precisely what is required of us, if we are to survive and create sustainable systems in the process. And the beauty of it, implausible as it may seem, is that it is just such a shift that is going to liberate us. Coming to an understanding that we are, in the end, all in this together, that whether it makes sense yet or not, we are part of a collective psyche in which what each of us does affects one another, is a shocking prospect. No, I do not believe those with the most protected class and status have any corner on happiness. And our culture of mind-numbing entertainment will not save us. Nor will our desperate obsession with youth and beauty, as if our collective grasp toward its fertile hopefulness will not mean that life has passed us by while we turned our backs on an authentic existence. We cannot be happy when we oppress one another. We cannot reach the fulcrum of what every sane human being seeks: a deep sense of fulfillment, love and peace (a sense of the oft inexpressible, infinite divine and our perfect part in that infinity) – we cannot reach this, until we realize that each and every one of us needs the chance to know it. Or, at the very least, needs the option to live a meaningful, safe, productive, and secure existence, content in our traditions and beliefs and content enough with them to not encroach upon the differences in one another’s. But amidst this relativity there is a deep need to nurture our sense of connectivity and universality. Whether we agree on the existence of god, or paths to the divine, we must all be able to agree that the path to the divine (or to a sustainable future) is not one of massive planetary degradation and a world of social injustice. No amount of power, wealth, status symbols, antidepressants or zanax can save us from the truth of this. And our global sense of malaise will only deepen as we destroy this planet, and each other, as rapidly as we can in our stubborn attempts to hide behind our carefully crafted illusions – including capitalism, consumerism and the dogma inherent in all the monotheistic religions.
What we need is a global transformation – a global evolution of our species – something beyond anything we’ve yet seen. Yet any true kind of transformation will first require brutal honesty; a hard look in the individual and aggregate mirror, so that we more fully face where we’ve been, who we’ve become, and what it means for our survival and our happiness. Our obsession with science, reason and fundamentalist religion has cut us off from a deep sense of heart, soul and connectedness to a thread that links each of us to each other and all of us to this vital, vulnerable planet. I know that we are beautiful. I know that each of us, in our own ways, is amazing. We are capable of deep humanity, of joy, of moments of grace – yet the ways we are living, individually and collectively, are insane. I don’t believe that our species is actually crazy, but I do believe we are deeply lost. We find ourselves hopelessly entrenched in systems that keep us perpetuating nightmares around the world, and we insist on maintaining an existence of massive global injustice, all with a sense of entitlement. Worse still, there is a deep symbiosis between the systems we’ve created, and the way these systems shape us. We are slaves, most of us, expert at towing the line. Our survival in this society, in our world, depends on it. And in the process, we learn with great skill how to oppress one another, and how to betray ourselves, sometimes so deeply that it can take lifetimes to find our way back home again.
Well, I am here to say that I don’t believe in what we have created, but neither do I believe that what we face is impossible. Absolutely daunting, yes. But I fundamentally believe that we are meant to do better than this. I believe, with every ounce of my being, that we ARE better than this. And, that although our lives are but a brief, bright spark, we are meant to learn how to evolve, WHILE WE ARE HERE. We are meant to make this world a better place for ourselves, and for each other. This is our clarion call. This is our task. We have a task to consciousness, a task to understand our collective psychological and ecological connectedness and interdependence. And, we have a task toward goodness. I know, I know in my heart that we are starved for this; we are deeply starved for the truth of a more connected, creative, liberating, passionate and soulful existence. We have grace in our hearts and grace in our fingertips. It is a matter of having the courage to face the loss of taking so long to discover it, of facing the loss of the darkness we collectively perpetuate. There is no one way to the divine. But the divine is calling us to the task of rising above who and what we have been, to co-create a world that we know, truly know, in our hearts makes sense.
Monday, August 3, 2009
Disease is big business in the US. Our national failure to distinguish health care and medical care has us trapped in fallacious arguments -- with talking heads in the media across the country espousing on their ideas for "health" reform, such as the push for universal care -- which is simply to increase access to medical care -- without ever truly understanding the full scale or depth of the problems. The following are some of the most critical problems in our health care system:
A medical system and medical monopoly on care that prevents options -- and thinking -- outside of allopathic medicine.
A fee-for-service reimbursement system that allows physicians to over-prescibe services for profit purposes. This reimbursement system has persisted despite common sense, but was spawned, in part, by physician groups' fighting for autonomy after the introduction of the third party payer system.
A mixed market that prevents the development of a more democratic socialist type of universal care while also preventing the "laws" of capitalism from working. Consumers are unable to play their normal role in a capitalist system in US health care, partly because the AMA forbids publication of the relative value units (RVUs -- the costs attached to its codes) from being made public knowledge. We are thus unable to competitively shop for services, which would normally force those providing them to lower prices and/or become more efficient. The private market in health care has long enjoyed its status of being free from the dictates of consumer- oriented capitalism -- and it is foreseeable that we could change the reimbursement system while still preventing consumers from being able to influence price.
Our national obsession with pharmaceuticals. This is perhaps one of the most ghastly aspects of our current paradigm -- the susceptibility of the American public to believing that a pill can be a panacea -- or that drugs cure -- when quite often they are highly toxic, far more dangerous than natural health options, and far less efficacious when it comes to restoring health. DRUGS MANAGE SYMPTOMS of underlying imbalance in systems. Yet the power, money and influence the drug companies have gained since we repealed the law prohibiting them from advertising on TV has allowed these companies to spend the kind of money needed to convince the American public that they need more and more drugs. Meanwhile, we are polluting water tables across the country -- due to major over-medication of millions of people who would, in many cases, find real relief from methods that treat whole systems and underlying problems.
An underfunded and corrupt FDA. The FDA, an organization designed to protect the American public, is largely funded by drug companies. Its hands are tied due to funding issues, it is understaffed and overworked, and it is squarely entrenched in the allopathic mindset. It is by no means a neutral organization -- and at present, it is incapable of living up to its duties.
Moral hazard. Moral hazard occurs when patients take too little accountability for their own health, and/or they overuse health insurance due to a lack of knowledge about costs and a lack of responsibility for paying them. (MDs commit moral hazard as well, when they over -- prescribe due to greed or malpractice fears). Patient moral hazard is in part due to the allopathic paradigm that has convinced people they have no valid intuitive knowledge of their own bodies -- a paradigm that has shifted accountability, responsibility, and the power to heal -- into the hands of MDs. This psychological paradigm runs deep -- and secured itself in our history in the late 1800's, when the AMA systematically set out to destroy and discredit the homeopathic industry. Since then, the American people have largely distanced themselves from natural healing and an understanding of their own bodies -- instead choosing to believe that the "doctor knows best" -- when very, very often, this is NOT the case!
A profit-based, allopathic-obsessed system that actively prevents the adoption of low-cost efficacious healing modalities -- to the point of sending innocent people to jail and turning our backs on methods that work because they are not highly profitable and not instigated by those in the orthodoxy.
This last point is one of the most critical, and ties back to the first. Ultimately, whether the American public or Congress knows it or not, we are facing a clash of paradigms. I have worked for many years in the alternative/integrative health industry (which we now refer to as "natural medicine" or "natural health"), and witnessed many incredible things. I call it the "underground railroad" of health care in the US. Across the country providers and patients are working together to restore vital health, often after patients have been told there are no answers or they have no hope. There are tens of thousands of American citizens who know otherwise.
Yet, colleagues like my friend Dr. Nicholas Gonzalez in NYC nearly go to jail, lose their licenses, lose their reputations, and rack up millions in legal fees defending themselves -- all too often because they had the gall to "go off the deep end," and turn their backs on the orthodoxy of conventional medicine. Despite his sterling credentials, Dr. Gonzalez nearly lost everything because he discovered and began to offer an alternative cancer treatment. And, after years of fighting for his freedom and ability to practice, the NIH turned around and gave him a $2 million grant to test his treatment on patients! This is because he is one of the few people in the country seeing success in treating pancreatic cancer.
I have many stories similar to that of Dr. Gonzalez. But let me say this: I am as critical of the natural health field as I am of conventional medicine. Both sides of this fence have their strengths and weaknesses, their successes and failures, their places of integrity and places of greed, dishonesty, and a willful refusal to work toward a higher, common good. Natural medicine holds INCREDIBLE promise -- but the field itself is a terrible mess -- and despite the good number of people who are working for change -- it is characterized by a complete inability to come together to actually change our system.
All of this scratches the surface of what we face, and how and why we got here. When we fail to understand the psychology behind health care -- and how much this psychology has been shaped, even deliberately, by the self-interests of big industry, then we fail to grasp the problem to the degree that provides the power to generate real change.
There are practical, entrenched systemic issues to deal with at hand. And then there are our illusions -- and our need to create a new dialogue, one that allows us to break free of our narrow understanding of health and healing, to see the full range of tools and options we have at our disposal, and to discover how we might best make use of them to create a healthy health care system.
Tuesday, July 28, 2009
I love our President. I still think he is the best thing that's happened to this country in a long time. He is just one man - and no, he is not capable of transforming a toxic political system, a broken health care system or a wobbling economy overnight - so be patient folks. Nevertheless, he is largely on the wrong track with health care reform.
So, how do we slow down a juggernaut that is blinded by the primacy of allopathic medicine and over-fueled by politics and special interests -- an underinformed, ill-advised race to piecemeal, corporate-defined care?
Make no mistake - this is not a transformation of our system. It is a desperate, if valiantly motivated lunge to try to increase access to the most expensive and often least efficacious paradigm of care. And, since medicine is the most expensive option, all these desperate attempts to figure out how to reduce costs become a bandaid on a gaping wound.
It is not only our health care system that needs healing. It is congress too, and our entire political process. Politics is inevitably toxic when self-interested parties continually have the greatest access to forming the policies that affect the entire country.
Nothing will change overnight. But we need our Senators, Congressmen and women, our President and those he has tasked to understand health care's problems to rise above the toxicity that politics has become. To take a stand and say no to corporate special interests. We also need our congressmen and women to stop being mired in a political game of constant power plays -- overly worried about raising money, re-election, and their own constituents -- at the expense of the future of the country at large. The American public is tired of partisanship, ideology and ill-begotten, pork-ridden, poorly designed policy. Between partisanship and lobbyists, our policies are falling far short of what they need to be. Who will be brave enough to change the way things are done? We all deserve better - even those on the hill who are mired in "just the way things are". It is up to each of you - to each of us - to change the world in which we live, and we can't change it if we can't change how decisions are made in our political system. This fact is evidenced in your actions around health care reform.
So first, successful health care reform requires overcoming the fallacy of believing that health is medicine. It requires that the American public, Congress and the Obama administration fully understand that by design, medicine is a system that intervenes after we are already sick. It is a system that primarily manages symptoms of underlying illness.
Health care reform requires that we decide as a society whether we want health care that includes medicine as part of the pie or as the whole pie. It then means that we decide whether health care is a right or a luxury, and if it IS a right, then to WHAT do we have a right? This means deciding what and how we ration - and what each of us is responsible for on our own.
Health care reform means that we, as a country, understand that every sector, every stakeholder has played a role in making our system sick, and that every one of us is accountable for creating a functioning and affordable system. This means overcoming the huge lack of integrity on the part of drug companies and the FDA. It means putting the American Medical Association in its place and it means that conventional physicians must accept the fact that they no longer control "what" care is or "who" is allowed to provide it - so if they aren't willing to open their minds about what health entails and requires then they better get used to a shrinking customer base.
Health care reform also means that the American public must be honest with itself that our predominant culture, habits and food production are not conducive to health. There is much to change on this front. Suffice it to say - we have too long been disconnected to the truth of WHAT health is, what it requires, and what it asks of each of us. We want a panacea in a pill and we are making ourselves and our planet sick because of it! Drugs are not health, and it is not up to the doctor to make us well. We are full participants in wellness and illness - whether by any action on our part or not - and learning to accept this fact and navigate it is a liberating and empowering process. The more we learn about ourselves and the interconnectedness of our spirits, hearts and bodies, the more power we have to define ourselves and decide how to be in the world, whether we are well or ill.
Health is integrity, honesty, heart, spirit, passion, love, and treating ourselves and each other well. Health is a socially just society in which we make sure we provide ample opportunity to all to live decent and meaningful lives. Health is getting over being so consumptive, and it is learning how to preserve and live with this planet, rather than destroy it. Until we do these things, we will continue to impinge upon our ability to FEEL healthy, because whether we are conscious of it or not, we are all a part of a larger, collective psyche, and what we do here MATTERS, both physically and energetically.
But bringing this back to health care reform, we must ask ourselves this simple question:
WHAT is health care?
At its foundation, it is the system we create to provide CARE for one another, to restore our ability to be well, to feel good, and to contribute to our society. While this definition is ubiquitous when it comes to actually conceiving a new system, it is a much-needed reminder of why we co-created health care in the first place. We want and need to be well, and we can't always do that on our own! So, we need to know -- what is our purpose? What can we agree upon? What are the best tools we have at our disposal now, and how do we take those and recreate a system that is genuinely about health? Because medicine is useful, but it is unaffordable at the same time that it is not enough.
We need to simultaneously dream bigger (and understand there is a world outside of the drugs and surgery paradigm) while better understanding the nature - and real failures -- of the current system. And then we need to build a bridge between the parts of our system that work now and a vision of a brighter, less costly, more efficacious system that just makes sense - because it is ABOUT your health.
Challenge #1: Distinguishing medical care from health care, getting through to Congress, and reigning in the lobbyists.
"One by one and all together"
Thursday, July 23, 2009
I heartily applaud your efforts on health care reform, and in particular the change you are bringing to government simply in the quality and integrity of your person. We are so fortunate to have you in this office, and I pray that this country has the collective intelligence to understand the depth of complexity and difficulty in the challenges you face. I am writing because I am certain that I can provide valuable assistance to you in your health care reform strategy, despite the fact that it is well underway. There is a way to simultaneously and sustainably decrease costs and transform our system. The problem is, although you are surrounded by some of the best experts in the country, nearly everyone is failing to diagnose the true problem! And until we do, all efforts at truly changing our toxic system will fail. So, I’ll keep this brief and hope that it reaches your hands:
Proper Diagnosis of the Problem
Medicine is NOT health. The American public has failed to distinguish between health and medicine. We call it “health care”, but in the US, we have MEDICAL care. Medicine is by far the most expensive, and often the most invasive treatment modality. Medicine is a paradigm that works backwards from disease to health, intervening most often when people are already very sick. The medical model is critical for acute care and emergencies (and we should have access to this as a right), and useful for diagnostics, technology, and some chronic diseases, yet profoundly limited when it comes to understanding what is causing so much illness and disease, or what “health” means in a society and entails in a human being. The medical system is not about health, Mr. President; it has largely evolved into a system of expensively managing illness. Our system’s history is one of the rise of a vast industry – and the assumption of primacy and efficacy – of medicine. This primacy has combined with a host of factors to blind us to the dangers of assuming that allopathy should continue to be the first and primary method of intervention (despite clear evidence of its limitations and poor outcomes), when other methods of intervention could be used to decrease costs while vastly improving health outcomes. Your plan is working to increase access to a broken, unaffordable, and misdirected system.
Costs of a Medical Monopoly
The AMA has a statutory monopoly on physician billing codes. This is likely the largest monopoly in the history of US health care, yet it is so institutionally and systematically entrenched that few people know that it exists, much less understand the full depth of its consequences. It has been calculated to cost the federal government upwards of $50 billion dollars per year. Suffice it to say: the AMA has undue control of the definition, costs and delivery of health care in the US. It is a private trade organization with the power to continue to define WHAT health care is, by refusing to write codes for several million licensed, qualified health practitioners. The “agreement” used to procure the use of CPT codes, (which has subsequently and indirectly been legislated) forces the US health care system to rely primarily on physicians for the 80% of non-acute care needs in the US. This forces insurance companies to rely first and foremost on the most expensive practitioners and methods of treatment, which drives up premiums, and forces many employers who cannot afford it to drop health insurance as a benefit. It prevents US firms from competing overseas, and forces the US public to pay out of pocket for thousands of treatment modalities that have provided minor to major relief to millions of people at a fraction of the cost of medical care. Most importantly, there are more than 3 million licensed practitioners offering qualified care in the US who lack codes to adequately describe the care they provide. These include nurses, chiropractors, acupuncturists, mental and behavioral health therapists, nutritionists, midwives, and natural health MDs, DOs, naturopaths, and others. There are only 567,000 MDs in the US, and fewer than 250,000 of those belong to the AMA. Yet, while there are more than 8,800 codes to describe the services of conventional physicians, there are approximately 100 codes for everyone else. The “code monopoly” stands at the center of US health care and is a primary obstacle to both decreasing costs and transforming our system.
Transforming our system means first understanding the difference between health and medicine, then understanding the tremendous costs involved in relying primarily on allopathy, and finally investigating our options for supporting the health of the American public from a proactive rather than reactive stance. Comprehensive strategy must be developed from this basis. But first, we need to shift the national discourse on health care reform! We need to break this “wheel in the mud” cycle of arguing over costs and access and talk about access to WHAT, and how to change that “what” to better reflect health needs and treatment options based in the 21st century. In fact, shifting the discourse at this time may be the best strategy you have to combat the real challenges of cost, to reframe the debate and to provide viable, nonpartisan solutions and overcome the all-too partisan politics of your detractors.
My Credentials (briefly)
I have worked as a consultant in the field of integrative medicine, spoken in front of the Clinton Commission on Complimentary and Alternative Medicine (now NCCAM), in front of the California State Medical Board, and in front of former Oregon state senators Ben Westlund and Vicki Walker. I have assisted in strategy for individual practitioners and integrative medicine societies. I have presented at multiple conferences, worked as a patient advocate, overcome my own severe health challenges with the help of both conventional and natural medicine; met with Congressmen John Conyers, and currently have a paper circulating at several federal agencies, including the Department of Justice, regarding the AMA code monopoly. I am pursuing a PhD in Public Administration and Policy and a Masters in Public Health. I have devoted my life to system change, and I am passionate, articulate, and dedicated to intelligent diagnosis of systemic issues, as well as to the concept that transformation of systems requires a hard look at the truth of how stakeholder entrenchment can blind intelligent diagnosis and solutions. I have devoted many years to understanding how history, psychology, politics, profit and industry have collided to create a deeply toxic health care system, and have arduously sought practical, implementable solutions.
I would be happy to chat with someone in your administration and supply more information, research or references if requested. Meanwhile, I wish you well and support the efficacy of your valiant efforts at a difficult time. Aside from the practical value of your actions as President, personally, I believe your approach to governance to be a balm on the collective psyche of a nation that has too long been off track. May our efforts, consciousness and levels of integrity strive to meet yours.
Jennifer “Tangerine” Bolen
(Tangerine is my long-term nickname, due to my red hair, and the name I go by. I’ve been on Oprah, and Ms. Winfrey, Congressman Conyers and others all know me by this name).