Our Bodies, Their Subsidies

In “Invitation to a Dialogue: Alternative Therapies” (New York Times, May 14), Dr. James S. Gordon writes:

“Many economists believe that health care costs will continue to rise. Even more distressing, the Affordable Care Act will likely reinforce current practice, which dictates surgical and pharmacological interventions that can be expensive, inappropriate, burdened by side effects and, often, ineffective.”

Moreover, the Affordable Care Act is merely the latest in a century-long line of legislation ostensibly aimed at increasing the affordability of health care, but which by subsidy have locked in a status quo of needlessly high levels of costly treatment required in order to receive any level of health care, crowding out innovations in the lower-cost methods and self-help advocated by Dr. Gordon. As Ivan Illich observed in 1975 in Medical Nemesis:

“Awe-inspiring medical technology has combined with egalitarian rhetoric to create the impression that contemporary medicine is highly effective. Undoubtedly, during the last generation, a limited number of specific procedures have become extremely useful. But where they are not monopolized by professionals as tools of their trade, those which are applicable to widespread diseases are usually very inexpensive and require a minimum of personal skills, materials, and custodial services from hospitals. In contrast, most of today’s skyrocketing medical expenditures are destined for the kind of diagnosis and treatment whose effectiveness at best is doubtful.”

Such will be the inevitable result as long as the necessity of bailing out the capital-intensive, mass-production model of delivery of uniform service by a favored professional elite to passive recipients — the bête noire in all of Illich’s work, from health care to education to energy — is assumed necessary to guarantee a modern standard of quality. Which it is not. In the same year’s Neighborhood Power, David Morris and Karl Hess observed: “We are most dependent upon outside experts when we are ignorant — and we are probably most ignorant about our own bodies. Even our cars are more open to common-sense knowledge than our bodies.” In surveying the simpler forms of health care, Morris and Hess conclude: “Surely such service could be administered by less than fully trained M.D.’s.”

Historian David T. Beito, in summarizing his extensive research on the lodge practice which provided low-cost health care to millions of members of early twentieth century fraternal societies before the model was deliberately crowded out, notes that they “opened up rare opportunities for many working-class Americans to compare and experiment and empowered them with the necessary economic clout to break free from the confining view that health care was merely a generic good.”

The ephemeralization of twenty-first century technology would only make a revival of lodge-style cooperative, nonprofit, red-tape-free provision of basic health care even more feasible. Just like Morris and Hess’s urban farming and solar power, as the perverse effects of the current model become too widespread to prevent its crumbling, such current overlooked successes as the Ithaca Health Alliance could spread from isolated exceptions to a burgeoning essential in a post-industrial society.

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