The delivery of health care used to be an individual interaction, between patient and practitioner. While medical insurance has been a positive development, providing (arguably) equity in access so that health care is not restricted to those who can afford to pay for it or otherwise dependent on practitioners willing to donate their efforts, it has been the open door through which entered the industrialization of health care delivery. (I won’t get into the mega-industrialization of health care products, from wound care to diabetes to gender identity; many people are getting rich from exploiting and perpetuating illness and distress.)
In BC, with one government-administered health care system, which would seem to level the playing field, one way by which the delivery of health care has become corporatized is through the implementation of health authorities, which are given a budget and a geographic area. It would surprise no one familiar with capitalism that the bulk of the pot of money goes to administrative costs, costs which are invented by those in a position to profit from them - the administrators. Has anyone seen an administrator eliminate his or her own position?
The next level of wasted funds is the development of duplicated services, health authorities copying programs that community-level providers have long ago implemented, and rebranding these duplicated programs as visionary ground-breaking nouvelles of the above-mentioned administrators. This is most prevalent currently in the poverty industry of providing services to those indentured to drug addiction and prostitution.
The next level of wasted expenses are the employees, hired to ramp up and roll out these visionary programs. Those hired are often attracted to the sexy new vision, needs they were not interested in servicing when it meant gritty unrecognized efforts, but now that it is sanctioned with a halo, and more importantly a salary with benefits, they come flocking.
Not least of these are the multitude of misdirected nurses, nurses who might otherwise provide some amount of care but instead are hired into programs where they spend much of their time in activities that provide no patient care whatsoever - meetings, in-services, clerical duties, charting in cumbersome electronic programs designed more to collect data for the administrators than to provide functional medical records of patient care
I do not deride nurses who provide nursing care. Rather, it is nursing as a career that is the problem, nursing, like mothering, that has been co-opted by patriarchy as a way to get women out of the way by placing them into powerless roles, roles which at the same time are inflated into images of glorious sacrifice. There is sacrifice involved, women are sacrificing themselves, but not for the causes they believe. Caring for others, whether children or patients, does not have to require sacrificing your identity or your power. By creating models of motherhood and nursing that erase a woman’s individuality, that require women to professionalize themselves with a false system of busyness training and activities (witness the rise of the nurse-administrator, and the definition of a nursing hierarchy such that nurses behind desks with Master’s degrees are more valued than clinical nurses who actually lay hands on patients), women are being seduced into a delusion of power, which instead is functioning to distract them from the reality of their removal from efficacy and trapping them in roles. (Much the same can be said of physicians and the rise of the physician-administrator, but it is a larger problem with nurses, because of their numbers and because they are more often women, being used by the system to perpetuate the system.)
If anyone doubts that many working in health care are cogs in the wheel of the industrialization of health care, consider the disproportionate pay of said workers and those they work with. If we berate corporations for the logarithmic distortion in compensation between CEOs and workers, why do we not apply the same ethic to the delivery of health care? Reduce the wages of those working in the poverty industry, providers (nurses, depending on seniority, earn more than $100,000 a year in salary and benefits) and administrators, to no more than - what is the rubric? seven times? - to seven times the welfare rate that their patients receive, and watch how many flee. Better yet, reduce wages to the same as their patients and see what happens.
All those workers who go home to their cushy west-side homes (whichever city you choose, the west side is usually the nicer, more affluent part of town), groaning about their hard day ‘in the trenches’, doing their part in implementing harm reduction, would never admit that by their efforts, they are benefiting disproportionately and merely entrenching those at the other end of the poverty industry stick. Every clean needle and condom handed out, every high-glycemic-index meal dished, every patronizing ‘there now’ bestowed, is another padlock on the door between us and them. It is saying, ‘this is all you deserve, but I deserve to make a living off of your misery and go home to comfort beyond your reach.’
Harm reduction does not serve those suffering in the poverty industry; it serves those benefiting - the employees, whether ‘front line’ (even that phrase misconstrues the reality, like the phrase ‘working in the trenches,’ implying a battle ground, but not as purported of workers allied with those suffering, but in truth workers against those suffering) or administrators, the politicians (who are declared ‘progressive’), the citizens who voted for such progress and who further congratulate themselves for their largesse by donating warm socks at Christmas time - all these, who are already well-off, benefit from the poverty industry and the industrialization of health care delivery.
And not to be overlooked is academia, with the numbers of graduate school students scavenging the alleys and drop-in centres for stories to which they can ascribe a narrative and gain a credential, a Masters or PhD, which will allow them to further their career trajectory and climb the academic ladder. Rarely do they look back, rarely does their work benefit the subjects of that narrative; at best, there is an acknowledgment, but even then, rarely that.
Further proof? Workers, not all, speak of their patients, generally women (‘clients’ is the language administrators favour, exposing the corporate model they are applying) as ‘whiny’, ‘needy’, ‘only wanting hand-outs’. They call patients attending their clinic ‘our women,’ as if possessions. They deride the high birth rate of women who are First Nations. Workers do all this without examining their bias, that the women they are working with have been culturally trained to use such strategies to get attention, to get things, to try to survive, while the workers unwittingly betray their own cultural training to belittle these women and their entrained tactics. It is patriarchy and colonialism and racism and victim-blaming. It is oppressive and bullying. It is abuse.
Along with eliminating harm reduction and distorted pay scales, we need to get privileged Caucasians out of the delivery of health care, especially to non-Caucasians, at all levels. It is long overdue, in BC, to overturn the ongoing effects of the British invasion with its imperialist imperative. Anyone who is of European descent, anyone who earns and owns more than welfare rates, anyone who perpetuates trauma and abuse by blaming those who suffer for their reduced circumstances - all these need to be removed from their positions of privilege.
Give all that money directly to the patients for whom the health care is intended. 'They’ll just spend it on drugs,' you say? If that is what you believe (such grandiose contempt!), then why are we bothering with health care for them at all? Let them die, save our money for more deserving causes - us! This is the premise of harm reduction: that patients do not want good health, that they want drugs and abuse and poverty. What if we are wrong and they want something else? What if they took that money and bought themselves decent housing and good food and safe space? What if they could afford that $8 bag of chia seeds donated to the food bank but taken home by a worker because ‘they don’t want it, they don’t even know what it is’? It is hard to know what something is when you cannot afford it.
What if we got rid of the whole poverty industry infrastructure, gave the money directly to the people, who would no longer be patients or clients, and got out of the way? What if we let them decide what they want, whatever that might be, including the possibility that they may or may not decide we have something useful to offer? What if we made our own living by means which do not depend on entrenching misery and suffering and patriarchal hierarchy?
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