Avoiding Politics: A Primer
Yes, the title is misleading.
Guess what?
You can’t avoid politics, especially when that definition of what is “political” has been ceded to people with an agenda.
Throughout my career, I have come into conflict with those who want to avoid politics, especially when it comes to leadership in healthcare for substance use issues. Many people want —understandably — to avoid the appearance of partisanship. The problem comes when the political and the partisan become conflated. I hate to break it to you, but everything is political. Even deciding to not participate in politics is political.
In Bill White’s recent blog post, The Ecology of Recovery Revisited, he shares two papers that — rightly, in my opinion — ask our system of care to pull back our focus and address not just on the individual aspects of SUD, but the all-encompassing aspects of the systems that prevent effective care for entire populations. We all know that social determinants affect the likelihood of a person finding a stable footing in recovery, and yet our systems of care remain focused on the individual.
In Minnesota, this looks like unacceptable disparities in outcomes between Native and African-American people and their white counterparts. It looks like the incredible national disparities in incarceration rates for drug offenses. It looks like disparities in access to healthcare. Much focus is placed on the nature of addiction as the equalizer among “people who would normally not mix.” But, addiction — and more importantly recovery — does not occur in a vacuum. This willful ignorance to recovery’s contextual drivers borders on the criminal.
And yet somehow, we find ourselves at a place where speaking out about the florid failures of our current healthcare policy remains off-limits. Despite having the receipts on how our system of care has failed, despite the widespread understanding that both providers and consumers are being victimized, despite the impending and inevitable collapse of this system, any naming of the problem is sometimes viewed as out-and-out politics.
For decades, what is “political” has been defined as that which might threaten the status quo. Despite the overwhelming problems driven by poor policy and ineffective organizational leadership across almost all aspects of American life, healthcare has sat on the sidelines while we have watched our system become subservient. We have watched the needs of the individuals we serve, the needs of our staff and providers, and the needs of our communities be relegated to the backseat while the needs of the businesses extracting money from these groups are prioritized.
So what do we do?
We must take advantage of the shrinking bipartisan focus on care for people with substance use disorders. This fleeting alignment remains the single area of intersection among electoral politics. We need to move faster and capitalize on the institutional weaknesses and openings to change the band of acceptable conversation around this topic. We need to be unafraid to challenge those in power when their behavior doesn’t reflect a commitment to our people.
This looks like:
Leaning on those who claim the mantle of “recovery advocate” to embrace Medicaid expansion across the country.
Ensure peers and people with personal experience are at the table for all policy conversations. And not “celebrity peers,” honest-to-goodness recovery folks who nobody recognizes. The professional recovery people who clamor for a seat at the table could benefit from giving up their seats more often.
Push policy efforts that align increases in reimbursement or establishment of valued-based contracts with embracing of true person-centered care, including harm reduction.
Establish recovery-oriented systems of care via a twenty-five percent mandated use of block grant funding supporting recovery support services.
Engage frontline staff in advocating against anything and everything that stands between them and the needs of their folks, including all of the power brokers; government, payers, large systems disinterested in change, ignorance, racism and discrimination of all flavors.
It is not combative, partisan, naive, silly, or inappropriate to do that which benefits our patients, our communities and our staff. we have been in a crisis for some time now — perhaps a change is warranted.