Should the Military and Hospitals Celebrate Their Economic Contributions?

Do you recall the debates in communities across the United States in those rare periods when the US Congress has considered limiting our military expenses and moving toward a peacetime economy?

Typically, Congress creates a commission to recommend closure of certain military bases. Then, when a community hears that a nearby base is slated for closure, reports of that base’s contributions to the local economy hit the editorial pages. Local members of Congress begin battling to keep “their” bases open, and the money flowing.

Eventually, fear of short-term economic losses trumps the original intent. The potential benefits of public investment in a peacetime economy are lost. Fear and reaction prevail. Old paradigm military spending continues, regardless of what actions will most serve the common good.

The Wages of Disease Care

I was reminded of this pattern of behavior when I saw an April 2008 report from the American Hospital Association (AHA). The report did not highlight cures or positive movement on one or more health indices. Rather the AHA’s monthly TrendWatch ran under this title: “Analysis Celebrates the Economic Contribution of Hospitals to Communities.” The report’s bulleted highlights are that, in 2006, hospitals:

Employed over five million people.
Directly or indirectly supported one of every ten jobs in the US.
Remained a stable source of employment, even during times of economic stress.
Supported nearly $1.9 trillion of economic activity.

Clearly, this is a significant impact. But like a huge military budget, I am not sure that this is anything about which the AHA should be boasting. Exorbitant military expenditure is testament to our inability to rise above our grasping natures and resolve problems through diplomatic means. Soaring hospital expenses evidence our failure to create health and a mature relationship to our natural processes.

I read in the AHA release not as prideful accomplishment, but as economic addiction. Given the United States’ embarrassing health outcomes relative to other nations, why did the hospital industry report these data as celebration, instead of as shame and failure?

War as Medicine’s Guiding Metaphor

A significant part of the answer is that medicine in the United States remains, fundamentally, a military endeavor with aggrandizement, not health, the logical, dominant pursuit.

That war is the guiding metaphor for how our tertiary care system focuses medical resources has been a criticism long leveled by public health advocates and health-oriented, integrative practitioners. The US medical system’s resources are organized to “attack microbes,” to “battle diseases” and to fight a “war on cancer” and other conditions. We seek to “arm” a practitioner and add to his or her weapons. Our research, medical and policy leaders prefer to develop exotic strategies to repel, contain or destroy “external pernicious influences.” We nuke the enemy.

From the council of (largely) tertiary care generals who run hospitals and Medicare payment panels, we find, at best, a marginal focus on health. Pursuits such as “aiding and abetting the healing powers of nature” and “removing obstacles to cure” are given a poets’ wages. We spend little money or attention on strengthening the host, whether through education, self-care, lifestyle change, and health-creating environmental and public health strategies. All out-patient strategies - whether mind-body, nutrition, psychosocial, public health or integrative - remain grossly under-funded, based on the evidence.

Succinct Definition of Health Reform

I have never heard a more succinct description of the goals of true healthcare reform than that offered me last year by Robert Duggan, the co-founder of the Traditional Acupuncture Institute. Duggan had attended the Urban Zen gathering in New York City where he found a common theme. The goal of healthcare reform that presenters shared, says Duggan, “is to get people out of the sick care system.”

Such a recommendation is to the American Hospital Association what base closure is to the military. It’s a strike at the jugular. But now the AHA’s “celebration” becomes a counter-strike. The “economic contributions” become weapons for sowing fear of change and maintaining business as usual, for protecting the status quo. Getting people out of the sick care system is a frontal assault on the AHA’s brag-sheet.

The AHA’s report asserts that the economic benefits to communities are evidence of how “the importance of hospitals to their communities extends far beyond health care.”

Sadly, the AHA’s shameless trumpeting of the wages of disease shows what a long way we are from even beginning to discuss what it will take for the importance of hospitals to begin to extend to health care – as in a health-oriented, medical economy which orients our investment around a metaphor of peace-making.

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