Asserting our right to change the system

Just because the health industry has a stranglehold on our medical system doesn’t mean we have to pretend to like it

About 10 years ago, I joined a group of neighbors fighting to protect farmland from development in our rural part of Massachusetts, an area that has escaped much of the development Boston has enjoyed. There are still large tracts of land free of structures, and much of it is still farmed.

With the resurgence of the local-food movement, the fertile soil here is helping to keep farming a viable option for land use. One such tract straddles the towns of Hatfield and Northampton, and a big-box store had shown interest in building there.

When my Hatfield group formed, Northampton had already had several town meetings to consider what restrictions to place on the size and look of the big-box store. Its citizens had considered whether to require a pitched roof, for instance, to make the building look less enormous, or to demand that certain colors be used on the building. They thought they should try to limit the overall size of the structure - a big store, but perhaps not a megastore.

There are a lot of misconceptions about stores like Walmart and Lowe's. Their size and popularity give the appearance that they will bring jobs and taxes to a town, but this is actually an illusion.

These stores tend to pay low wages and give part-time work, so they employ younger people rather than heads of households and their employees often come from other towns. They undersell smaller stores, which can't compete with the lower prices and sometimes go out of business.

These stores might ask for tax breaks, yet they require infrastructure changes such as wider roads and traffic lights, which the town rather than the business pays for.

Finally, they have the effect of lowering property values of the houses in the area, and that loss of value is not something they compensate anyone for.

These are all things that are not addressed by a pitched roof or exterior paint color. So when our little Hatfield group came to what was considered a final planning meeting in Northampton, we came to present the idea of not letting the big-box store in at all.

Northampton already had, about 2 miles from this proposed site, a Walmart and several supermarkets. Within a 5-mile radius were Lowe's, Home Depot, Barnes and Noble, and Target, as well as a Whole Foods and a Pier One. These structures line the largest roads of Hadley and Northampton, roads that are long and straight and look confusingly similar at certain intersections.

Hatfield had written a master plan a few years before, and in it there are explicit land-use descriptions and explicit instructions on encouraging downtown-centered development and preservation of open space for farming, wildlife and recreation.

We used this master plan to strengthen our case and, because the largest part of the land was in Hatfield, we were able to keep the big-box store out. Now, a smaller, local lumberyard has been built at the site, and much of the open land remains field, which is used for haying.

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When decisions are being made that involve everyone, it is important to have the broadest perspective possible. So it is with town development, and so it is with healthcare.

We are wrangling right now with who can afford access to what health-insurance plan, as if an insurance plan, like yet another big-box business, is what anyone wants or needs.

Just because big-box stores are big and powerful doesn't mean we need to let them take over our communities. And just because the health insurance industry has a stranglehold on our medical system doesn't mean we have to pretend to like it.

Asking ourselves how much we want to pay for health insurance is like asking what we want our big-box store to look like. It's fine if that is really what we want, but maybe we need to be asking ourselves something entirely different.

Do we only want well-controlled diabetes, or do we want the healthy food and walkable communities that would lower obesity rates and thereby prevent and control diabetes?

Access to breast cancer treatment is important, but shouldn't we also be assuring protection from carcinogens known to cause breast cancer?

As we watch the bitter haranguing over the insurance exchange rollouts, food stamps are being cut; obesity is rising, and so are carbon emissions. These are all serious health issues, yet no amount of health insurance is going to address them.

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There has been a lot of press, finally, about how much more we spend on medical care in this country than other countries do and how much poorer our outcomes are.

We will start approaching the lower price other countries pay for medical care if we follow their leads: countries like Britain, Canada, and Sweden all provide universal access to medical care, but they also commit significantly more funds than we do for the resources that people need to live healthy, productive lives - resources like family leave for new parents, subsidies for healthy food, and bicycle lanes on roads.

Where other countries spend twice as much on social services as they do on medical care, our numbers are reversed: we spend twice as much on medical care as social services. The correlation between social spending and health can be seen at OECD.org.

Vermont is at least taking the first step toward seeing the big picture. Having a single-payer medical system will get rid of health insurance and places medical spending in the hands of the entity - the state - that is responsible for infrastructure and policy.

And it aligns the interests of government with the interests of we, the people - that is, to keep medical costs down not by denying people care, but by keeping people healthy.

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