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Dan Bednarz
Congressman John Conyers recently quipped that most healthcare reform proposals circulating in Washington are a “cacophony of crap” that evade acknowledging medical care as a human right. With Canada across the Detroit River from his impoverished congressional district he knows firsthand how the Canadian health system bests its American counterpart. It’s cheaper by half; covers everyone; citizens don’t worry about bankruptcy –they merely get treatment as needed; and the politician who brought it into existence four decades ago, Tommy Douglas, was named the most important Canadian of all time (Wayne Gretzky finished second).
Ironically, Conyers’ National Health Insurance Act (HR 676) as currently envisioned, shares a premise with those he mocks. All sides of the reform debate presuppose a return to economic growth. It follows that none confronts the possibility that our massive debt and economic woes are not temporary but the beginning of an epochal transition to a reduced level of social complexity and economic activity, which translates into a lower standard of material living that cannot support the present structure of medicine.
Indeed, most of the reformers who claim healthcare is a human right see discussions about fiscal limits as a stealth way to kill reform. And those willing only to tinker with the financing of system assume a return to economic growth will allow healthcare to continue more or less as is. With its cost at about $2 trillion in 2008 and projected to climb to $4 trillion by 2015, attempting to maintain the current system will result in, in my view, one of two unacceptable outcomes: 1) healthcare only for the wealthy or 2) a crash of the system. There is a third way still possible, and it builds on Conyers’ plan with an acknowledgement that our present “Ferrari-Jalopy” (a nod to Congressman Roscoe Bartlett for this metaphor) health system is no longer viable. We should build a Honda Civic health system for all; it’s the best realistic chance we have.
From this vantage point, the ongoing healthcare debate in Washington is anachronistic. A future oriented analysis has to include two driving forces: first, the long-term consequences of the fiscal/economic crisis and, second, the arrival of geological peak oil, which is a symptom of the Bottleneck of ecological conditions (climate change, fresh water scarcity, population pressures, dying oceans, etc.) humanity must pass through.
Most Americans do not yet appreciate how dire our debt problems have become, in part because the mainstream media avoid the issue or characterize it as a bunch of addled and angry “teabaggers.” Still, people intuitively understand that massive debt is destabilizing, although many in the center and on the left confuse our current situation with a need for deficit-financed growth. It’s one thing for a government to borrow and spend to generate new taxes, useful infrastructure and encourage new economic activity. This can –and there is argument about this- create wealth and allow the debt to be paid off. It’s quite another to “borrow” from the Social Security Trust Fund and have the Federal Reserve in essence print money to fund further deficits, especially when it goes to financial institutions that–in my view- do not create wealth but cannibalize it.
What is omitted from this economic stimulus line of reasoning is 1) you can’t cure a debt problem by taking on more and more debt and, 2) no consideration is given to the availability of natural resources, in this case the peak of light sweet crude oil extraction makes this “stimulus” strategy not just ineffective but counter-indicated. I believe we are attempting to prime (stimulate) a well that’s going dry with borrowed water (money).
Let me digress to explain the consequences of a peak in worldwide oil extraction. Peak oil “direct” argues that the out of control financial “debt machine” was toppled because as oil production hit a plateau in May 2005 this imposed a limitation that eventually inhibited growth and wealth creation. This plateau triggered the subprime meltdown, $147.00 per barrel oil, and, overall, the exposure of enormous “systemic” debt that was no longer serviceable because real growth was constrained. Peak oil “indirect” holds that whatever caused the fiscal/economic meltdown of 2007-2008 the fact of geological peak oil –now almost confirmed- interdicts any return to the old pattern of economic growth. Either way, this makes peak oil pretty important to the socioeconomic panorama, including one of our most expensive institutions, healthcare. As we see, oil is now around $70.00 during the largest economic contraction since the Great Depression on the mere expectation that a recovery might begin.
I suggest, therefore, that healthcare reform be discussed in terms of fiscal and ecological realities, not shibboleths like this recently proffered by David Brooks. “There is the liberal way in which the government takes over … and decides who gets what. And then there is the conservative way, in which cost-conscious consumers make choices in the context of a competitive marketplace.”
But who in the healthcare reform debate makes this big picture connection between debt, oil and healthcare reform? The closest discussion I’ve heard is when Bill Moyers told David Himmelstein, of Physicians for a National Health Program, a few weeks ago, “I don’t want … you to get out of here without wrestling with this very fundamental question. We’re going to have to set limits, are we not?” (Aside: As a regular viewer of his PBS show, I note that Moyers has not forthrightly addressed ecological constraints on economic growth; so this elliptical question will have to do. Moyers has, to his credit, had Kevin Phillips on his show to elucidate our fiscal plight –and Phillips acknowledges the potential of peak oil and other Bottleneck conditions to “change the game”).
Himmelstein replied:
Ten years from now, with my colleague’s inventiveness in figuring out expensive new things to do [referring to medicine’s fascination with expensive and esoteric technology] we’re going to have to come to grips with that. But right now, we could reform this health care system. Do everything that’s helpful for every American for what we’re now spending.
Himmelstein presumes homeostasis when in fact our socioeconomic foundation is rupturing. Since he’s worked tirelessly on universal healthcare and practiced and taught medicine for many years I’m virtually certain he is correct in the sense that there’s a lot of fat to trim (I have countless anecdotes from doctors and nurses about excesses and waste). But this does not obviate our dire fiscal/economic state and the arrival of peak oil, the driving forces now unfolding and shrinking his ten-year time line.
Granted, the “public option” being debated in Congress –if defined properly- might bring temporary financial and psychological relief to millions of beleaguered and desperate citizens; but even this short-term possibility is unsustainable.
This brings up the issue of logical incrementalism, or the “science of muddling through.” Many healthcare analysts, like Himmelstein, assume societal homeostasis and find it easy to conclude that we are muddling our way to universal coverage. From this perspective the public option appears a significant incremental step. Given debt and peak oil, I think the time for incrementalism is past. As I write, California and several other states have budgets severely out of balance. They are facing devil’s choices that only a few years ago –when Alan Greenspan was “The Maestro” of the economy and President Bush was marketing an “Ownership Society” featuring private investment accounts for Social Security contributions- would have seemed incomprehensible. But here we are experiencing the limits to growth.
Dan Bednarz
Imagine the American healthcare industry as the proverbial proud oak tree that refuses to bend during a windstorm. For decades the industry has been deft at fending off resolution of the Three Cs, cost, coverage and quality of care. Predictably, this political success has nurtured a lack of resilience, by which I mean the ability of an organization to absorb exogenous shocks or disturbances and return to its original state. Read the rest of this entry »
Dan Bednarz
Recently I interviewed Gail Tverberg, “Gail the Actuary,” a co-editor of The Oil Drum, who is an invaluable source of analysis and articulation of how peak oil is manifesting itself in the world economy and its financial institutions. We began with a macroeconomic perspective and then considered then consequences for healthcare. Read the rest of this entry »
Dwindling supplies of fossil fuels are transforming “business as usual” in our world. Although we still hear mainstream pundits and media tell us the economy will improve in late 2009 or early 2010, the massive contraction of economic activity throughout the world informs us otherwise. Two areas of great importance and little-considered challenges are public health and medicine. To stimulate attention and action in these areas, Bristol Community College in Fall River, MA is planning a one-day, first-of-its-kind regional conference entitled Public Health and Medicine at the End of the Oil Age: Challenges and Opportunities. It is sponsored by the college’s Institute for Sustainability and Post-carbon Education and supported by the college’s Center for Business and Industry. The director of the Institute, Nancy Lee Wood, Ph.D., says that the conference aims to bring together anyone and everyone concerned about the future of public health and medicine in this era of fossil fuel decline and fiscal/economic decline. “Public health and medical systems will experience significant challenges in the face of the impending world-wide energy crunch,” she said. “This day-long conference will address the threats to medicine and public health – threats which are beginning to affect us all.”
The conference is to take place on Tuesday, April 14, from 9 a.m. to 5:00 p.m. at the college’s main campus in Fall River in the Jackson Arts Center. The conference fee of $75 includes an all-organic lunch and refreshments, as well as the addresses and workshops. Continuing Education Units are available for nurses, social workers, and other healthcare providers. Information is on the Website at www.bristolcc.edu/postcarbon . Read the rest of this entry »
Dan Bednarz
Author’s note: This essay will be followed by a second, “How Brittle Is Healthcare?”
As societies throughout the world wobble on the edge of socioeconomic chaos, New York Times columnist Bob Herbert avers, “The economy is obviously issue No. 1.” Well, that’s the proximate problem, but what else is going on? What has made the continuing decline so massive? Why is it that “…the current economic crisis has totally scrambled the intellectual assumptions of almost every policymaker”?1
Dan Bednarz
Abstract:
Modern healthcare systems are intensive users of fossil fuel produced energy and therefore significant contributors to greenhouse gas emissions. This suggests a moral imperative to lower energy consumption for reasons of ecological sustainability. A second, and less articulated, practical reason to lowering energy consumption is that it is no longer inexpensive; rising costs, which derive from a geological peaking of worldwide oil extraction rates, are creating a strong economic incentive to reduce energy consumption. The implications of these twin driving forces -which have a common root in our reliance upon fossil fuels- for healthcare are complex and if misconstrued can lead to public policies placing them in opposition. In other words, assigning differing weights to these driving forces leads to divergent decision trees which, on the one hand, could exacerbate climate change, as in a scenario where coal is turned to as a substitute for declining supplies of oil and natural gas. On the other hand, an alternative decision tree weighting each driving force equally has healthcare setting a leadership example for energy conservation and ecological sustainability. This latter decision path, however, will –in all likelihood- introduce revisions of extant health theories and models of practice. How sweeping these changes will be is an unknown and therefore should be conceptualized with a full spectrum of scenarios that take account of the interplay between varying degrees of climate change mitigation done under varying conditions of energy constraint.
Editors note: The following article is reprinted with the authors’ kind permission from ChrisMartenson.com. It addresses with a true anecdote how energy cost influenced state and local budget deficits are impacting now on state and local public health agencies. To get an idea how these cuts specifically affect a public health agency, see the Seattle King County 2009 Public Health Budget Report. The website ChrisMartenson.com also contains the Crash Course, an excellent 20 chapter online multimedia instructional course that eloquently explains the links between what is happening with the economy, energy and the environment… and ultimately our capacity to keep public health and health care systems operating as they should − or not.
Monday, November 17, 2008, 4:02 pm, by cmartenson.
I had a most pleasant weekend off – the first in a very long time – and spent some of it pondering an unusual recent event.
We are raising turkeys, five very large, gorgeous bronze birds. Last Thursday they started making their alarm sounds meaning that something was not right. Rushing out I saw that “Skunky McGee”, our ancient resident neighborhood skunk was in their pen toodling around. He’s nearly all white and we know his habits quite well, and his appearance at 9:30 in the morning was a bit late for him to be out and about.
It took me far too many beats to realize he wasn’t toodling around looking for errant food scraps, he was chasing our turkeys in an unbalanced, tippy version of the skunk waddle. As I stared in wonder he caught one and began, well, chewing on it. You see skunks are not predators usually of anything larger than a lawn grub so he was incapable of really doing much more than begin a long process of gnawing. He started near the tail.
It was at this time the word finally popped in my head; “rabies”.
It’s at times like these that having a .22 is a must and I sent skunky McGee off to the great beyond and immediately called the local animal control officer to come and test the animal for rabies.
Imagine my shock when the town official who answered said, “We don’t have an animal control officer anymore – the budget was cut. Do you have a shovel? Maybe you could bury it.”
So here I am, in full possession of the knowledge that trillions of dollars are being lavished on a defective banking and financial services industry while my locality was unable to contend with a dangerous communicable disease.
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