Swim Against the Current: Ordinary Americans Can Make Change Happen
March 07, 2008Activism
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.
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."
Alfero took public involvement a step further by bringing ordinary residents inside to serve as a direct, integral and very effective part of the health delivery system itself. They were enlisted to be promatoras de salud (promoters of health). These community outreach workers, trained in the management of such chronic diseases as diabetes (a huge problem in this region), literally spread the reach of HMS, traveling out to smaller settlements and isolated ranches, and bringing medical help, information, news, connection and ... well, care. "I think I've always been a promatora," declared Elva Quimby, a 50-ish former cosmetologist. "I just thrive on helping people."
Step by step, service was expanded, gaining the attention and the support of health professionals and funders outside of the boot heel. A little more capital was raised, another nurse or physician arrived, and before long HMS had become not only a strong medical center but also the largest economic engine in the county. Alfero contended that if the strongest local asset is a health clinic, go with it! Why try to get some out-of-state conglomerate to reopen the copper smelter when you've got a clean, community-supported enterprise creating jobs, generating small business growth and making people healthier?
A dozen years after opening its doors, HMS has become the health commons it was envisioned to be. On its tenth anniversary, it opened the doors of its new 22,000-square-foot clinic in Lordsburg, a modern, full-service facility with nine exam rooms, lab and x-ray rooms, a dental clinic with six chairs, and offices to deal with mental health problems, substance abuse and family support needs. It has a staff numbering more than 140, operating on a budget of more than $10 million a year.
In addition to Lordsburg, HMS now has clinics in six other communities in two counties, including one in Silver City, where it originally had to go to find doctors who were willing to come to Hidalgo twice a week.
"I didn't deliver healthcare," Alfero noted. "I'm not even a doctor. I just gave people an idea, pointed them in a direction and they built this themselves. People who rely on external forces to determine their future are going to find a bad future. The people in this area are showing what healthcare can be if we invest in people, not in the layers of intermediaries looking to make money off a top-heavy system. Our country needs more clinics like this."
Interview with Jim Hightower
AlterNet: What made you decide to write this particular book -- one that relates the stories of everyday people around the country, versus all of your other books?
Jim Hightower: The inspiration came from the people themselves, people that I had come across in my travels, and I found that unlike what you find in the New York Times or on the nightly news, there is a very progressive spirit in the countryside, enormous progressive activism ... not merely in politics but also in business, the food economy, healthcare, religion, numerous different ways.
These people's stories were very uplifting, yet not being told. And then at one point I got an email from a lady a couple years ago, and said, "I have a decent job and I do it well, but I'm constantly thinking that I'm wasting my time. I want to begin doing something useful to contribute to changing things, at least become a cog that's on the right vehicle."
I think a lot of people feel like that. A lot of young people are starting off their careers but are thinking, "Is this all there is? To go to Wall Street or to get into a corporate cubicle, is this my future? Or are there other ways to do this?" And there are people like this email writer who are saying, "I've been at this for some time, I'm doing well, but I'd like to be doing better -- in the sense of doing something that's more meaningful to me."
This was your way of providing people the inspiration to do that.
Exactly. If these people in the book can do it, we all can. These are not Rockefellers, and they're not Einsteins. They're not people who just got lucky. They're folks who just said, "I think I can do it a different way, and that's going to be better for me, and I'm going to try and do it." As we are clear about in the book, it's not an easy thing to do. There are all sorts of potholes on this alternative road. But it can be done, and these stories will, I believe, inspire people to give their own lives a bit of a different direction.
By the way, to give people a helping hand with that, not only do we tell the stories, but at the end of each of the three sections, we provide an extensive list of contacts of not only the people that we write about but others that we think could help in that particular area.
Another thing that's different about this book is that you wrote it with your long-time co-agitator, Susan DeMarco. How did you come to the decision to write it together?
Well, Susan has worked on every book that I've put out, going back to Hard Tomatoes, Hard Times in the early 1970s when we were working together for the project. I've always acknowledged her participation, but it was long overdue for her to have her name right up-front. The second reason is that she framed this book, came up with the notion of how it could be organized, how it could be presented, which really is her genius. It's written in my voice, but she knows many of these people herself, she came up with the people that we covered, and she has the ability to pull these things together in a way that's more compelling than my usual sort of ranting style. (laughs) So we've been co-conspirators for a long time, and we decided to do this one together.
Much to our amazement, we were able to pull it off without doing any serious bodily harm. It's hard to write with someone else. To tell you a quick anecdote about our writing styles, I'm an early morning person and she's a very late-night person. I would go off in the morning to a coffee shop somewhere and write up a section, then bring it home. As I went to bed, I'd leave that on the kitchen table, and she would take it with her nasty red pencil (laughing) and thoroughly x it and put all sorts of lines around it and stuff. Then I'd get up in the morning and there'd be this little ugly nest of editing, which then I'd go to a coffee shop and put all her edits into a good form. That's how we did it, so it really was a collaborative effort.
What kind of effect is the grass-roots activism that you talk about in the book having on the campaign season so far?
I think that in this political season in which "change" has become the buzzword, it's interesting to realize that that cry for change and the activism attempt to implement that change has not come just full-blown out of the Obama campaign from nowhere; rather, this has been building for a long time out in the countryside. People voted for change in 2006, and the Democrats in the Congress disappointed everybody ... so this time they're shouting it even louder than before. Finally, I think the message is coming through.
The "change" and the success that Obama is having with his campaign is somewhat attributable to the efforts of those that have gone before. I think of Wellstone Action -- Paul Wellstone and his wife Sheila, for example, their great vision and leadership have inspired a lot of people, and Wellstone Action. the organization that came out of his last campaign, has done phenomenal work in training campaign managers and candidates to be in the position to sustain a movement like Obama is now carrying forward.
We had in the last election, I think it's four new members of Congress who came out of the Wellstone training sessions. Tim Walz, for example, or Keith Ellison up in Minneapolis, the first Muslim elected to Congress, was actually a Wellstone trainer.
A movement has a history -- it doesn't just erupt all of a sudden out of the blue. Many of the political stories that we write about in the book are people who hae been leading the way, providing context, energy, leadership, the ideas that can lead to the kind of campaign that Obama's running.
Your tour isn't set up in a typical way, either. Can you talk about that a little?
We're making an effort for the tour itself to reflect the spirit of the book. Thus instead of going to bookstores, we're trying to have book events around the country that benefit good progressive organizations, radio stations, independent newspapers and media, good candidates. Already in March and April, we've scheduled about 40 different cities, and you can find a point on the compass and pretty much I'll be going in that direction.
We kick off at the beginning of March in Philadelphia and New York, and then throughout the Northeast; heading then down south through Florida and coming back across the upper Midwest, through the Rocky Mountain states, not only in Denver and Boulder but also through Idaho; then up to the Pacific Northwest, down through California and back across the Southwest to Texas. Pretty much everywhere.
What do you want folks to take away from the book?
I hope that people will come out of the book with a sense of possibility, with a sense of excitement -- that there is another way. You can buck the system, you can defy conventional wisdom and you can define your own success -- not just in monetary terms as the corporate structure wants you to -- but you can reach for something bigger and more satisfying in your life and have a good shot of achieving it and, in the process, make it a better world.
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."
Alfero took public involvement a step further by bringing ordinary residents inside to serve as a direct, integral and very effective part of the health delivery system itself. They were enlisted to be promatoras de salud (promoters of health). These community outreach workers, trained in the management of such chronic diseases as diabetes (a huge problem in this region), literally spread the reach of HMS, traveling out to smaller settlements and isolated ranches, and bringing medical help, information, news, connection and ... well, care. "I think I've always been a promatora," declared Elva Quimby, a 50-ish former cosmetologist. "I just thrive on helping people."
Step by step, service was expanded, gaining the attention and the support of health professionals and funders outside of the boot heel. A little more capital was raised, another nurse or physician arrived, and before long HMS had become not only a strong medical center but also the largest economic engine in the county. Alfero contended that if the strongest local asset is a health clinic, go with it! Why try to get some out-of-state conglomerate to reopen the copper smelter when you've got a clean, community-supported enterprise creating jobs, generating small business growth and making people healthier?
A dozen years after opening its doors, HMS has become the health commons it was envisioned to be. On its tenth anniversary, it opened the doors of its new 22,000-square-foot clinic in Lordsburg, a modern, full-service facility with nine exam rooms, lab and x-ray rooms, a dental clinic with six chairs, and offices to deal with mental health problems, substance abuse and family support needs. It has a staff numbering more than 140, operating on a budget of more than $10 million a year.
In addition to Lordsburg, HMS now has clinics in six other communities in two counties, including one in Silver City, where it originally had to go to find doctors who were willing to come to Hidalgo twice a week.
"I didn't deliver healthcare," Alfero noted. "I'm not even a doctor. I just gave people an idea, pointed them in a direction and they built this themselves. People who rely on external forces to determine their future are going to find a bad future. The people in this area are showing what healthcare can be if we invest in people, not in the layers of intermediaries looking to make money off a top-heavy system. Our country needs more clinics like this."
Interview with Jim Hightower
AlterNet: What made you decide to write this particular book -- one that relates the stories of everyday people around the country, versus all of your other books?
Jim Hightower: The inspiration came from the people themselves, people that I had come across in my travels, and I found that unlike what you find in the New York Times or on the nightly news, there is a very progressive spirit in the countryside, enormous progressive activism ... not merely in politics but also in business, the food economy, healthcare, religion, numerous different ways.
These people's stories were very uplifting, yet not being told. And then at one point I got an email from a lady a couple years ago, and said, "I have a decent job and I do it well, but I'm constantly thinking that I'm wasting my time. I want to begin doing something useful to contribute to changing things, at least become a cog that's on the right vehicle."
I think a lot of people feel like that. A lot of young people are starting off their careers but are thinking, "Is this all there is? To go to Wall Street or to get into a corporate cubicle, is this my future? Or are there other ways to do this?" And there are people like this email writer who are saying, "I've been at this for some time, I'm doing well, but I'd like to be doing better -- in the sense of doing something that's more meaningful to me."
This was your way of providing people the inspiration to do that.
Exactly. If these people in the book can do it, we all can. These are not Rockefellers, and they're not Einsteins. They're not people who just got lucky. They're folks who just said, "I think I can do it a different way, and that's going to be better for me, and I'm going to try and do it." As we are clear about in the book, it's not an easy thing to do. There are all sorts of potholes on this alternative road. But it can be done, and these stories will, I believe, inspire people to give their own lives a bit of a different direction.
By the way, to give people a helping hand with that, not only do we tell the stories, but at the end of each of the three sections, we provide an extensive list of contacts of not only the people that we write about but others that we think could help in that particular area.
Another thing that's different about this book is that you wrote it with your long-time co-agitator, Susan DeMarco. How did you come to the decision to write it together?
Well, Susan has worked on every book that I've put out, going back to Hard Tomatoes, Hard Times in the early 1970s when we were working together for the project. I've always acknowledged her participation, but it was long overdue for her to have her name right up-front. The second reason is that she framed this book, came up with the notion of how it could be organized, how it could be presented, which really is her genius. It's written in my voice, but she knows many of these people herself, she came up with the people that we covered, and she has the ability to pull these things together in a way that's more compelling than my usual sort of ranting style. (laughs) So we've been co-conspirators for a long time, and we decided to do this one together.
Much to our amazement, we were able to pull it off without doing any serious bodily harm. It's hard to write with someone else. To tell you a quick anecdote about our writing styles, I'm an early morning person and she's a very late-night person. I would go off in the morning to a coffee shop somewhere and write up a section, then bring it home. As I went to bed, I'd leave that on the kitchen table, and she would take it with her nasty red pencil (laughing) and thoroughly x it and put all sorts of lines around it and stuff. Then I'd get up in the morning and there'd be this little ugly nest of editing, which then I'd go to a coffee shop and put all her edits into a good form. That's how we did it, so it really was a collaborative effort.
What kind of effect is the grass-roots activism that you talk about in the book having on the campaign season so far?
I think that in this political season in which "change" has become the buzzword, it's interesting to realize that that cry for change and the activism attempt to implement that change has not come just full-blown out of the Obama campaign from nowhere; rather, this has been building for a long time out in the countryside. People voted for change in 2006, and the Democrats in the Congress disappointed everybody ... so this time they're shouting it even louder than before. Finally, I think the message is coming through.
The "change" and the success that Obama is having with his campaign is somewhat attributable to the efforts of those that have gone before. I think of Wellstone Action -- Paul Wellstone and his wife Sheila, for example, their great vision and leadership have inspired a lot of people, and Wellstone Action. the organization that came out of his last campaign, has done phenomenal work in training campaign managers and candidates to be in the position to sustain a movement like Obama is now carrying forward.
We had in the last election, I think it's four new members of Congress who came out of the Wellstone training sessions. Tim Walz, for example, or Keith Ellison up in Minneapolis, the first Muslim elected to Congress, was actually a Wellstone trainer.
A movement has a history -- it doesn't just erupt all of a sudden out of the blue. Many of the political stories that we write about in the book are people who hae been leading the way, providing context, energy, leadership, the ideas that can lead to the kind of campaign that Obama's running.
Your tour isn't set up in a typical way, either. Can you talk about that a little?
We're making an effort for the tour itself to reflect the spirit of the book. Thus instead of going to bookstores, we're trying to have book events around the country that benefit good progressive organizations, radio stations, independent newspapers and media, good candidates. Already in March and April, we've scheduled about 40 different cities, and you can find a point on the compass and pretty much I'll be going in that direction.
We kick off at the beginning of March in Philadelphia and New York, and then throughout the Northeast; heading then down south through Florida and coming back across the upper Midwest, through the Rocky Mountain states, not only in Denver and Boulder but also through Idaho; then up to the Pacific Northwest, down through California and back across the Southwest to Texas. Pretty much everywhere.
What do you want folks to take away from the book?
I hope that people will come out of the book with a sense of possibility, with a sense of excitement -- that there is another way. You can buck the system, you can defy conventional wisdom and you can define your own success -- not just in monetary terms as the corporate structure wants you to -- but you can reach for something bigger and more satisfying in your life and have a good shot of achieving it and, in the process, make it a better world.
