Wellness; Illness; The politics of Scarcity----a true story

(The following story is in memory of Mark Stolpman, a young hospital planner some 30 years ago who introduced me to Ivan Illich. Thanks, Mark.

I told the story recently about out patient surgery, and the revolution that I witnessed in Minneapolis some thirty years ago as one innovative administrator disregarded the spreadsheets and focused on the mission of health--care, and not the mission of sickness care.

The reflection on that last point---wellness vs. sickness was the result of a study group among the administrative team. Our young intern at that time was Mark Stolpman, who I believe was a grad student from a univesity in DC and was reading the works of Ivan Illich. One of his first books was called "Medical Nemisis." The date of this story is 1976. Seems like just yesterday for me.

The thesis of the book was that we have become as a society obsessed with "illness" care and not "health" care. We are treated as patients only when the problem has resulted in an illness and can be treated with some surgery or pharmacy, and not earlier when it would have been more productive. The true healer is one who treats the patient far earlier, and far more inexpensively.

Well----this was a hospital. With doctors who made their living treating sickness. And paid very well for it. Imagine their enthusiasm on hearing that some adminstrators were reading such revolutionary books filled with such threatening ideas.

Mark Stolpman, after reading and sharing the book "Medical Nemisis" with us, made a recommendation that we as a hospital begin a "wellness program." It would be the first in the state. You can imagine the reception of the doctors. They moved in executive committee to have Mark fired. Sound familiar?

The head adminstrator intervened. He said that wellness would be no threat and that if the medical staff would have some patience with the idea, it would prove otherwise in short order. Again he was proved right. Soon all the hospitals began wellness programs. They became the hot "in" health program. Our hospital became a leader in "wellness" as well as "outpatient surgery."

Growing out of the wellness movement, were such things as the running craze, 5k fun runs, fitness centers, HMO care, and much, much more. Yes, before 1977 folks were active but they never were "totally buff" like they are today. Just kidding.

At the very center of this idea is the idea of SCARCITY vs. Plenty. The traditional notion of health care was that sickness care was expensive and scarce, and it had to be fought over. Ivan Illich goes over in his book that this is focusing on the wrong thing---focusing on the hole and not the donut. By focusing on the wellness and plenty of life and enabling the patient of all ages to begin a program of healthy living, one could transform the very nature of life to a higher level.

So---when you think HMO care or running or the fitness craze...Think of the father of these, who was Ivan Illich.

Oh, by the way----he also wrote a book called "DeSchooling." I bet you can guess what that is about. More on that later.