Swim Against the Current: Ordinary Americans Can Make Change Happen

By Jim Hightower, AlterNet. Posted March 7, 2008.

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.

It was not a simple project. For nearly four years, Charlie made the 600-mile round-trip commute each week from his home in Albuquerque to Lordsburg to work with eager locals to establish Hidalgo Medical Services (HMS), get it on its feet financially and get it moving -- one small step at a time.

• On July 1, 1995, HMS opened its doors in one wing of the old hospital, offering health services two days a week. Four doctors from Silver City (55 miles from Lordsburg) rotated to the clinic, each doing one day every two weeks.
• In the fall of 1996, HMS was able to add a full-time nurse practitioner, meaning that Hidalgo County had daily medical service for the first time in 13 years.
• In the spring of 1997, HMS's proposal for rural outreach was funded by two small but crucial federal programs, the Community Health Center and the Office of Rural Health Policy, thus allowing the clinic to expand its services and hire a full-time family physician.
• In 1998, for the first time in county history, dentistry was made available on a part-time basis. Also, with the clinic becoming a viable enterprise (it now occupied about 60 percent of the old hospital), Charlie Alfero left Albuquerque to become the CEO of HMS.

From the start, Charlie understood that the key to success would be building broad support -- enthusiasm, even -- throughout the county and gaining the trust of all involved. In addition to board members, who could bring a bit of clout to the cause (hometown bankers, lawyers, local officials and certain retired professionals), he enlisted some of the clinic's patients to serve (today, 100 percent of the board members are patients). He preached the democratic ethic that the larger community had to be invested in HMS, literally making it theirs and recognizing that "each person's success helps strengthen the whole."

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Jim Hightower is a national radio commentator, writer, public speaker, and author of the new book, "Swim Against the Current: Even a Dead Fish Can Go With the Flow." (Wiley, March 2008) He publishes the monthly "Hightower Lowdown," co-edited by Phillip Frazer.

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