Culture Change e-Letter #8

"Intriguing"
- Daniel Quinn

Elder care "insurance" 
Health Care Tribe

by Jan Lundberg

Picture a simple, transitional system for better caring for people's health on a community basis.  Imagine a do-it-ourselves, neighborhood/family approach.

In these stressful and uncertain times, mutual care can step in to supplement or replace reliance on huge corporations and government.  Today's institutional sector could become incapacitated, as it is increasingly bureaucratic, corrupt in places, and grossly petroleum-dependent.  The present corporate system already fails to serve many people's needs fully.

This state of affairs only worsens, as the effects of overpopulation and the aging of Baby Boomers hit harder.  Our most vulnerable citizens may be our old ones.  The elderly deserve respectful care that enables society to draw upon their enduring value to us all.

Citizens of an existing or planned community can create and sustain a system of care than can work with today's natural and institutional care capabilities÷no need to throw the baby out with the bathwater.  The prevailing social structure is what begs modification.

We can form microcommunities for the initial purpose of just agreeing to help care for one another.  One motivating factor is the increasingly toxic environment.  Another reason for taking more control over our own lives is that the so-called free market is oriented to "sell people out."  A value system that cherishes people and other species rather than profits is overdue.  One could look to other countries to see family-based care in action, but the encroaching global market's value system is starting to erode the traditional family bond almost everywhere.

Today's typical U.S. family is less and less able to cope with caring for itself and its elders.  The dissolution and scattering of families, and isolation within families, is discouraging to many, but causes others to seek a solution to the health-care crisis on a "new" level.  That level may involve a pact among relatively few people, in a band or tribe.  Forming such pacts has always been a human characteristic.  Such a level of mutual aid may be revived in a most practical way, such as in health care, given society's failure to provide it adequately.

Before going into the specifics of a health care tribe, or what can also be called a mutual care pact, let us go further into the underlying socio-economics concerning elder care:

When people are old and incapacitated, they are unable to organize their care.  So they need to organize now, in their middle age perhaps.  It is increasingly common in the U.S. that when we find ourselves aged we are preyed upon or abandoned÷children or no children.  So it is beforehand that we should protect ourselves and one another in health and sickness.

Focusing on elders deals with the deteriorating connection between generations that distinguishes (and will help extinguish?) our unsustainable society.  The older people are, the more likely they possess information or experience relevant to sustainable living.  Living in a nursing home or convalescent hospital cuts off the older generation from the rest of society including loved ones.  And when senior citizens are isolated, and cared for by impersonal professionals, more accidents and costly medical fraud occur.

Mutual care for our elders sounds simple and yet is crucial; such behavior is almost extinct in U.S. materialistic society.  If a "nuclear family" has both mom and dad out working, and the kids in school, can old grandpa stay at home alone?  At first, perhaps, but eventually, no.  However, it should be questioned whether full-time public school is automatically the best place for every young person when some could be learning from and caring for an elder at home÷and saving the family money by not warehousing grandpa in a retirement/nursing home.

Families' stress, worries and distractions are only building, and it is not primarily because of bogey men such as Saddam Hussein or, some might even say, George Bush.  Some youth blame the entire older generation for the bleak present and bleaker tomorrow; hence, the historic need for reforming tribes, one at a time.  Many youth may remain disaffected, but they would be impressed by their parents' organizing to take care of grandparents and themselves.

A tribe or band that forms around health care would actually be a limited society of mutual-aid collaborators.  Initially the tribe would exist for health care, but it could become more than that, eventually÷but we donât want to scare our dear old Mrs. W. across the street before we even get started!  

The mutual care tribe for elder health care can be implemented immediately, and may already exist even somewhere in the U.S.  The way it could start is to bring together maybe a dozen people of like mind, who pledge to cooperate and supply a significant portion of their resources now and in future for the tribeâs elder care.  This begins with a solemn vow.  Money has little to do with it, compared to the time people actually would put in to the project.  When you are sick or disabled, what would you choose: to have a person whom you know present to help you, or, just have money with no one around whom you know and trust?

The health care tribe would initially exist only for a local cluster of people; it would be unrealistic to include an absent relative or friend who is firmly attached to his or her own town far away.

Whether youâd call the kind of commitment I'm suggesting a health care tribe or something else, it could work effectively.  An example:

Old Howard is unable to work much anymore, physically or white-collar, and he isnât able to generate much money by selling stocks he doesn't own.  Letâs say he is not significantly incapacitated, and is fortunate to have his rent or property tax covered for the rest of his life.  He says to the tribe, "Well, itâs time I got some help around the house and for traveling."  Maybe his only close relatives are few and far away, assuming they might take care of him if nearby.

Mutual health care tribe to the rescue!  Old Howard would get help from the pool of people in the tribe, starting with a group consultation with itself.  Every effort would be made to get young people involved and motivated to participate and belong to this health care tribe (or another health care tribe).  The future generations must be the real purpose of any cultural self-support system.  But meanwhile, if the Howards of the world are put into nursing facilities÷often before their time÷this key segment of society cannot pass on to the young the parts of the culture that need to last.

So, once or twice a day Howard is visited by a couple of able bodied tribal members ready to assist.  Together the three of them can do something in Howardâs garden with him for his sustenance.  Perhaps an errand is run on the way home by one of the care-givers.  Maybe Howard needs a massage.  

As a wise elder, he gives of his long experience, wisdom and insight to the younger masseur or masseuse benefiting from his talking.  As Howard was once a private investigator, he could tell stories for his supper, so to speak.

In past years Howard has "paid his dues."  In addition to having  pledged his caring and support for the tribe, he contributed:  Before he became partially disabled, he was educating young people on trail walks.  He helped people with their gardens and he cared for the sick.  He thus earned his present support by the tribe.  It wasn't easy when he had to work 40 hours a week outside the tribe, but he was smart enough to avoid wasting hours of his life each week commuting and watching television.  So Howard's time was well applied for the tribe and its community, and he is repaid later in life when he most needs help.

The medical details of Howard's final days, whether lucid or befuddled, painful or easy, would depend on genetics, environment and love.  Much technological care can be very costly.  Maximizing home-based care is possible.  A health care tribe could have its own hospice service.  

One scary rule in the dominant system is that to receive government medical care funds, this can depend on one's home being sold.  So, health care, hospitalization and seniors' residence are all the more crucial to address and for citizens to improve on.  Conscientious care-givers and doctors would buy into Howard's non-institutional approach, one would hope, for their patients and for themselves as infirm seniors of the future.  One cannot count on "going fast," i.e., dying instantly in fairly good health.

Whether the tribeâs members vote Green or Republican is irrelevant, if the mutual care tribe system works.  However, once this tribe starts functioning for the common good and offering actual security (which the U.S. does not offer to most of its hard-working citizens), other tribal traits such as economic cooperation and mutual defense would kick in.  Environmental stewardship begins as well, because it is the tribe's "own back yard" instead of a matter of the tribal members' living as isolated consumers engaged in distant exploitation (to and fro, victim and victimizer).

One reason new tribes in general have been so few, and so difficult to establish and maintain, is that too much theory can be pursued at once.  Intentional communities with "alternative" goals are not easy to start or sustain in the context of materialistic, property-oriented society with its dollar-value approach to everything.  Although many ideas for tribal sustainability are valid, they cannot all be experimented with properly, nor adopted at once, during the dominant paradigmâs heyday.

It has been shown that alternative currency systems can be viable, and that co-ops are established successfully.  But a tribe may be limited to just two or three people if they try to also simultaneously add, for example, neighborhood home-schooling programs and frequent forays into the halls of government and corporations to protest some fascistic policy.  Most people are too busy working and going to school to try to do much else.  

Yet, if a health care tribe is established, one aspect of life's security (or insecurity) is handled.  The beauty of the mutual health care tribe is that people can relax and say, "I donât have to fear getting old.  I have to give a lot while I can, and try to get my whole family to give as well, as much as possible.  Then I (and my family members who participated) will in turn receive."

When a tribe or band gets going within itself, it can then make a mutual-aid pact with another tribe or band.  The possibilities are intriguing.  The concept could eventually include political realities.  Some folk might wave some flags, or wear all black or the Stars 'n Stripes.  But people helping each other is as old as the hills.  It endures, even though the consumer culture is about private property.  The authorities tell you that competition and submission are the only options.  Shall we take action for ourselves, strengthening families and reforming tribes, or, do we trust in disturbing trends put in motion by the selfish elite?

One need not be a radical to see the need for mutual protection from con artists and other thieves.  Elder abuse is rampant and growing in the U.S., and much of it has to do with taking an old, helpless person's wealth.  "He who dies with the most toys wins," applies only to he who is protected by trustworthy, ethical family or friends in his final days or years.  Much luck is needed to end up dying with one's wealth intact and bound for its intended heir(s).  In a sound marriage in conventional society, when one partner dies, the survivor may become impoverished or dispossessed, especially with possible opportunists' legalistic and illegal maneuvers.  Families afflicted with division÷a common U.S. trait÷are ripe for third parties' self-dealing participation in financial and real assets.  Considering other influences as well (e.g., the overpaved environment), severely dysfunctional and antisocial behavior within and around families is getting to be "as American as apple pie." 

The mutual-care-tribe approach is an alternative to insurance-company (mis)management of health, and without the pricey premiums.  But one could have private medical insurance individually as well, to complement perhaps a health care tribe.  Maybe a health care tribe would obtain an insurance policy.  However, we have seen that group insurance has not been the savior of many; indeed, less and less so.  Even a grandiose federal program, with money taken out of the bloated military, might fall short of individual and community needs.  Therefore, mutual care on the neighborhood/community level seems inevitable if our culture is to be turned into something sustainable (i.e., ecologically and socially healthy).

The nursing home often awaits, no matter what one might have achieved or assumed when younger.  The indignity and loneliness of an institution, where negligent mishaps and spirit-killing hopelessness cut short many lives, can be best dealt with when we deal consciously with our culture.  

The comprehensive or cultural approach is necessary in part for the simple reason that the biggest health disasters of all time are ahead, whether the source be famine from supply-interruption/depletion of petroleum, or genetic over-manipulation of foods, or nuclear nightmare.

Yet, we must start simple and local.  You might be our Howard, or wish you were.  Go ahead: live the dream, to shape the future. 
- Depaver Jan

*****

The article above was originally titled Mutual Care Tribe, written April 20, 2002, Arcata, northern California.  The name Howard is borrowed from the hero of Daniel Quinn's new book The Holy (Context Books).  Jan "Depaver" Lundberg has a petroleum-industry background and writes on sustainability for Culture Change magazine.

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