This May, I’ll be going to Philadelphia to make a
presentation on my travels to Germany and Mexico as an Eisenhower Fellow last
year. It was an amazing experience that continues to influence my work here.
One of the best things about being a Fellow is the
relationships that come from it. I’ve
had the privilege to speak with people who are studying remarkable subjects
like the impact of data on medical decision-making, the future of the Internet
of Things, and circular agriculture, to name just a few.
One of the people I’ve exchanged ideas with is Heide
Castañeda, an anthropologist who has done extensive work in both of the
countries I visited. In the course of
our conversation, she posited that the work that Casa and other community
clinics do is actually contributing negatively to the national issues around
access to care. The crux of her argument
is that these clinics relieve pressure from politicians and policy makers who
might otherwise be forced to deal with these issues in a systematic way (you
can read Dr. Castañeda’s complete take on the subject here).
I think she makes a compelling argument, but I’ve come to
the conclusion that the absence of Casa and other Safety Net providers would
not result in better policies or laws.
We, the people who lawmakers represent, are simply too disengaged. I’m repelled by a lot of what happens in the
Missouri General Assembly, not the least of which is the blocking of Medicaid expansion.
But ultimately it’s not that body’s fault: it’s ours.
As long as we remain on the sidelines because we are not
poor, not black or brown, not uninsured, nor a host of other factors that
affect people without privilege, the folks in Jefferson City and elsewhere will
continue to act with impunity. Change
won’t come from them. It’s up to us to
create the change we want.
