Swim Against the Current: Ordinary Americans Can Make Change Happen

This is an excerpt from Jim Hightower's new book, Swim Against the Current, followed by an interview with the author.

Healthy healthcare

Who would've thought that in the moral morass of what is now called the health "industry," the flower of social responsibility could still bloom?

The industry is controlled by insurance middlemen, HMO chains, and ripoff drug makers -- all putting profits over patients. The industry's lobbyists impose public policies that leave 47 million of our fellow Americans with no health plan whatsoever, while tens of millions more hold miserly plans that provide very little balm in times of need. The industry has created such a screwed-up system that we Americans spend more each year on healthcare ($6,280 per capita) than people in any other country, yet the treatment we get ranks a pathetic 37th in the world.

But there's good news: Rising from the grass roots in every area of the country, health professionals and businesses are bringing an enterprising spirit to this dysfunctional system, reaching communities of people who've been shut out and showing the way to put the "care" back into healthcare.

Charlie Alfero is one of these people. Working with both private and public health institutions in New Mexico for nearly 30 years, he is some combination of agitator and administrator, adept at figuring out how to get quality care delivered to rural outposts that the corporatized medical system has largely abandoned. Moreover, he sees healthcare as key to reviving the economic health of those areas.

Charlie's outpost is Hidalgo County. Where? Look at the bottom left corner of a map of the "Land of Enchantment" and you'll see a boot heel. That's Hidalgo, a remote but picturesque stretch of the Old West that was once crossed by the Butterfield Stagecoach line, then the Southern Pacific railroad, and now I-10. The boot heel is a long way from any city -- Tucson is 150 miles west, El Paso 150 miles east, and Albuquerque 300 miles north.

It has been a hard-hit area. Copper companies used the place up before pulling out in the 1970s and 1980s, leaving Hidalgo mostly a ranching economy. Some 6,000 people live there, with a lot of poverty among them. The local hospital closed in 1979. The last doctor left in 1983, and the county was unable to entice another one to move in. There was an obvious need and demand for health services, but Hidalgo is hardly the sort of lucrative market that such profit-hungry chains as Hospital Corporation of America are willing to consider.

The county's leaders realized they would have to put something together for themselves. So in 1994, they asked the state rural health office to send some experts to Lordsburg, the county seat, to help guide them. One who came was Charlie Alfero. Years previously, he had attended a small college up the road in a neighboring county, and he was glad for the chance to revisit a region he loved.

Alfero had been working with the rural outreach program of the state university's medical school, and he remembered from his earlier time in the boot heel that despite economic difficulties, the people of the area shared strong egalitarian values. He felt that they might do big things. He arrived with a vision: The people there could create a health commons of their own design -- a community complex that would provide one-stop service for medical, dental and mental healthcare, with family support services and economic development built in.

Most of Hidalgo's residents have lived in the county all of their lives and have an attachment to the area and to one another. "We stick together; we help each other in times of need," said Irene Galven, now the city clerk. It was this sense of community, the residents' willingness to throw in on projects to benefit everyone, that inspired Alfero to throw in with them.