I will leave it to others to analyze the economic and political details and implications of this bill. I am interested in what the existence of the legislation says about how we regard health, illness and health care and how we experience them as a result. As Moshe Feldenkrais said, “If you don’t know what you are doing, you can’t do what you want.” When we fail to examine the assumptions embedded in our health care system, we end up with a system that doesn’t serve our true needs.

Why do we need privacy and confidentiality around medical information, anyway? It seems to me that there are two levels of necessity here. On the first level, we require confidentiality to protect ourselves from material disaster. Our culture reifies productivity and self-reliance. Regardless of our rhetoric to the contrary, our social policies demonstrate that we do not truly value those who cannot or do not meet our definition of productivity and autonomy: children and their caretakers, the elderly, the ill or injured. In this society, if your health insurer or employer learns that you suffer from certain real or potential health challenges, you may well lose your insurance and/or your job. Since we do not have an effective and humane social safety net, you and your family are in big trouble if you lose these sources of support.   Legislation like HIPPA is a natural outgrowth of our desire to protect ourselves from such exposure.

On a deeper level, we require privacy at certain points in any true healing process. Healing—as opposed to curing—is a fundamentally creative act, a process of gestating, then birthing, meaning from the womb of chaos. Like any creative process, healing requires a strong container to hold and nurture the new life as it develops. Our relationship with our healer is a critical component of this container, and therefore requires a certain degree of protection from outside influences. Confidentiality can assist in maintaining that protection.

For instance, if you are involved in an abusive relationship and decide that you wish to transform your situation, your healing—and perhaps your survival—may depend on your ability to grow a relationship with a counselor, minister, doctor or friend in secret for a while. Less dramatically, if you are wrestling with an illness or injury that has resisted amelioration through the channels most readily acceptable to your family, community, or culture, you will need some privacy in order to ferret out and anchor yourself in a different approach. Constant or premature exposure to the feedback of seemingly well-meaning family members, friends, neighbors or co-workers may well interfere with your process, just as exposing a newborn to too many strangers risks their health.

We need to ask ourselves if legislation like HIPPA is a good way to address either of these legitimate needs in the long run. Does it go to the root of them, or does it, like an addiction, merely distract us from our real pain and its real remedies? Does putting another expensive layer of bureaucracy between you and your health care provider facilitate the development of strong relationships that nurture healing? Or does it tend to promote yet more haste and impersonality where we crave slowness and intimacy? Could the time, energy and money individual providers and health care institutions are now spending on “compliance” with HIPPA be better used another way?

Does HIPPA do anything to address the underlying insecurity that surrounds our experience of illness and injury in this country? HIPPA does not provide anyone with better access to health insurance or health care. It does not speak to the inherent dilemma of allowing our access to health care to be controlled by private corporations that routinely protect their profits by using any means at their disposal to deny care to those who need it most desperately.

Perhaps worst of all, HIPPA mirrors and reinforces our cultural bias toward seeing illness and injury as solely individual dilemmas that should be kept private. This attitude toward illness and injury is socially constructed—there are other cultures on the planet even today that view any individual’s illness or injury as symptoms of a larger imbalance in the community, or in the relationship between the human community and the surrounding non-human world. Consequently, everyone in the community has some stake, and some role, in healing the imbalance expressed by the sick or injured individual. Can you even imagine what it would be like to be ill in such an environment? Can you imagine what it would be like to be ill or injured without the sneaking sense of shame and isolation that always tends to accompany these states in a culture that regards health (defined as productivity) as “normal” and any deviation from that norm as a mark of individual failure?

Despite the harsh rhetoric and conditioning of our materialist culture, the intuitive wisdom of our “primitive” ancestors and relations lives on in us. The incredible popularity of individuals’ published accounts of healing and of support groups for those living with all manner of health challenges attests to our deep understanding that the creative work of healing is always a collective as well as an individual process and to our ineradicable understanding that any person’s illness resonates with broader themes in our families, communities, and relationships with the non-human world.

But if we truly desire healing for our communities and for our society as a whole—not just for relatively privileged individuals—we need to attend to the relationship between what we know in our hearts and practice in our homes and what we enshrine in social policy. While political processes are inherently imperfect and no fruits of them will ever fully embody our ideals, we can ask if we are moving in the right direction or not. While I am no expert on HIPPA, I have the strong sense that this legislation is not moving us in the direction we want and need to go. Perhaps through deeper contemplation of and wider conversation about the profound issues embedded in this legislation, we can make our slow way toward something better.