Health care is more than medical insurance, right?

Once upon a time, four years ago or so, I went to a heartfelt but less than rigorous lay-led church service on insurance. Andrew Fischer spoke on how the function of insurance, to sustain people and families after a crisis-level loss of property, health, or life, used to be provided by churches, as the most substantial local institution of care, and how providing this care to members in turn strengthened churches and communities. Then around 200 years ago, private, regional, market economy insurance started to be provided for the tragedies of domestic life, evolving out of the insurance developed around a growing mercantile system of trade. Andrew focused on what was lost in that transition, trusting that the story of what was gained, in spreading risk, clear contractual relationships, portability, etc. had been adequately told in the popular business press.

By moving the function of insurance out of the local community, he said, the personal relationship of care among neighbors was weakened. By relying on businesses instead of parishioners to help us after the loss of a job, the death of a spouse, or the destruction of a home by fire, flood, or crime, we marginalized the church, pushed it out of the necessary core of a family's existence. By ending the practice of helping our neighbors in their times of need with our own time, energy, and money, we created a vacuum of care that left many people spiritually hollow, without outlet to help others through personal connection, atomized among neighbors who rarely become friends.

It was interesting, not exactly convincing, thought provoking, and nostalgic. The idea of tracking and measuring the losses involved in shifting key societal needs from the world of social capital to the world of financial capital matches other trends in my idea environment, that about the price of pollution and climate change, of hidden costs in the rich world's industrial food system, of separating health care from medical care.

With the spiraling costs of health insurance regularly in the news, I wonder about how to capture the benefits of community-centered care without losing the fantastic gains of industrial scientific medicine.

I occasionally avoid medical care, not that I or my immediate family have needed substantial medical interventions in the past few years (barring my partner's pregnancy and the birth of our child, which required in the end only minimal medical intervention), not because it is expensive to me but because I understand it to be expensive to the medical system. The science fiction reading part of my mind thinks about how to create for myself a minimal medical cost life. Certainly regular exercise is involved. Probably identifying the riskiest behaviors in my daily patterns, like driving. A low calorie diet, but one that brings me joy. Finding happiness and low stress habits among my friends and family. Hoping to luck out genetically to avoid having big, expensive diseases, like cancer, alzheimer's, or diabetes. Accepting home hospice care by loving friends and family, even at the cost of potential years of life.

I think of a health care system, one that includes medical insurance and access to the fruits of excellent medical care but goes beyond it to support me in leading a healthy life. I want integrated care that encourages and enforces lifestyle choices that help me be healthier, happier, and less dependent on medical intervention, that cares about me in good times and bad, and that I can care for in return. A church community, at least the mythically friendly and supportive one that Andrew sketched, sounds like a good candidate to host such a system. Caring for the whole person, knowing the people around me and letting them know me and my life, a community that relates to my spiritual, intellectual, familial, social, and personal dimensions and recognizes that they are wrapped up in one another. I believe such a holistic care system, though it has very definite flaws, could be enormously more efficient in health per dollar of medical care than the crisis mitigation business model we seem to have now.

Yesterday's run destination: Montana Ave.

Yesterday's menu:
breakfast: eggs and toast
lunch: leftover chili with lime and cilantro
dinner: shrimp fried rice