Tag Archives: advocacy 101

For Those Who Have Ears to Hear

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My day job took me to DC. I’m on the 12th floor of a hotel, looking out over the city, which had a snowstorm. Overnight, it looked like the little pellets inside a snow globe, and in the lamplight as I watched the snow fly, it was beautiful.

I stood looking out my hotel room window, and thought, “There are two men out there who have done the same, only with acquisition on their minds. They don’t see a strange mix of buildings and beauty; they see something they feel they own.”

Tuesday, the meetings I attended talked about how to talk to the legislators regarding rural health policy (think the sexy topics of Medicare and Medicaid) which we will do today. I am at the National Rural Health Association’s annual Policy Institute, since you ask.

Tuesday, several men in suits told us which words to avoid, which words to focus on. What no one discussed much was, how do you talk to people who work for someone who considers us serfs? Who looks out over the city and doesn’t think, “how can I make this place better,” but “how much can I enrich myself from this place?”

Maybe we didn’t discuss it because there is no way to get into that mindset and come out whole.

There was one interesting group discussion. Someone pointed out that “rural health” can be framed as a national security issue. If we can’t make them feel compassion for the loss of places where women can go to have babies, perhaps we can shock them with the potential loss of their own safety and security? We supply the food, the raw materials that become power (as in electricity, don’t stretch that into a metaphor, k thanks?). We supply the soldiers that fight wars and “keep” peace. Rural is vital to the proper functioning of the United States.

Mmhmm. Today is the day we go talk to the elected men (and some women) in suits, who work for the men in suits looking out their windows at what they believe they own. Those elected ones, they must be in some confusion at the moment. One hopes. It depends on why decided to occupy an office in the capital in first place. Did they believe they could make the world a better place, or that they could better their worlds? That they could do both with integrity and good results?

Moral high ground is slippery, and sometimes it walks through dark valleys. Good luck, elected officials. You’re going to need it.

But so are we, the grass roots non-profits and other care providers who find ourselves suddenly framing arguments without using certain words, and shining bright lights on how lucrative we are to their agenda. We’re being drawn into their kind of fight, and it would be naïve to believe that we can refuse to do that with any good results for the people counting on us to get them care.

I am praying to hold onto some integrity, intelligence, and a sense of humor today. Humility may come in handy, too. When people speak different dialects, you need to speak theirs to get things done. It’s called code switching, changing your accent and vocabulary to make communication more clear. It doesn’t usually have a moral component.

Except this time. Here we go.

Meanwhile, in DC…..

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mental-exhaustionEvery year I go to DC to advocate on behalf of rural Virginia inside rural America. We converge from all 50 states and a couple of charted territories, spending a day catching up on the annual stats in health and economics, then charging The Hill to talk to the reps and senators for our individual states.

I’ve done this about eight years now, and this year sucked. Most don’t, but this time around the mood in DC and the mood at the National Rural Health Association match each other: big smiles in front of shattered glass plates.

We’re in trouble, and we know it. Insurance premiums in rural places are 150-300 percent higher than in urban areas. Insurers are refusing to enter some rural markets as a second company because the competitiveness makes the money they’d earn so low, it’s not worth it to them. And the Affordable Care Act, the thing we were all told we had to champion as though our lives depended on it, is about to go bye-bye.

There were some very honest moments this time around. A Senator told this group of beleaguered altruists that everyone involved knew the ACA rolled out with “terrible flaws” but that this was “anathema” to say in DC. You could feel the room struggling not to cheer, because we’d defended that dog’s breakfast up one side and down the other, lacking a better alternative. Not that we want its repeal to be accomplished before a replacement is in effect. Baby, bathwater. Let’s not walk backwards just because we walked too far too fast the first time out of the gate.

But we’re also struggling with the exhaustion of the staffers on The Hill, those sweet little 20-somethings who are, in the words of one we talked to, “the interns on which the back of this government is balanced.” They are tired. They are exquisitely, mind-numblingly tired.

We were supposed to ask them not to repeal the ACA. We wound up asking what they were hearing about what could replace it. Their eyes just about rolled back in their heads. Some smiled, some growled, a few talked in such bland cliches (robust, rolling out new ideas, a healthy America is good for all of us) I started counting them. He got to 10 before he quit.

But there was also a little spark in each encounter this year. When we walked into the offices of our Congressmen and women, they almost to a human commented on the power of rural to change things. Some sighed, some celebrated, but nobody was discounting us as that voiceless group that doesn’t vote out there in the sticks.

My takeaway point from this year’s NRHA conference is in two parts: 1) We’re screwed. 2) We don’t have the luxury of despair. As one friend says, “no matter how far down you are in rural, you can always find a well and climb in.”

And as we have pointed out to one another, over and over again during this conference, rural power has never been stronger. We elected a president. We proved that the Electoral College is necessary as a protection for rural voices. We reminded people to listen to us. (You should see the parade of Senators eager to address this convention this year; some of them have no idea who we are and one spent ten minutes explaining Medicaid to a room full of rural health experts. Oops.)

So if we’re screwed, we will have to unscrew ourselves. We elected a president on the power of our beliefs and knowledge. Now we have to get our healthcare positioned to really look after us, the voices that didn’t used to get heard.

It’s a little convoluted, but it’s not all bad. People may be tired, but they’re listening.