Monday, June 06, 2005

Unplanning Health Care

This week has been an epic one in terms of illness for me and my family. At one point we all were being treated with antibiotics and other prescriptions for a variety of ailments. Bronchitis, upper respiratory infection, conjunctivitis, stomach flu, ear infection and colds, we had them all. With four trips to the doctor and missed school and work days, it certainly been difficult. It also got me thinking: Health care is a mess even before peak energy and even more so as we drift into the inevitable decline of our energy-dependent civilization.

Not only will we live a poorer, colder, darker and hungrier existence, but we will experience it in worse health as well.

Certainly, proper sanitary practices, improved medical knowledge and the proliferation of cheap prophylactic medical measures, have gone a long way in improving life spans and reducing the death rates world wide. But advanced pharmaceutical research, high tech health care imaging and heroic medical operations (e.g. a heart-lung transplant) played an equally important role in reducing death rates for diseases and increasing average life spans. Many of these advances were made possible by cheap energy-driven prosperity and health care coverage. Some drugs, devices and utensils (think plastics here) are directly derived from oil and certain machinery dependent on an uninterrupted supply of electricity. As those resources become harder to come by, the costs and availability of these items will suffer. However health care’s greatest vulnerability is not with the procedures themselves, but with the system in which they are provided.

In most industrialized countries health care is provided in one of two general ways: funded directly by the government (e.g. Canada’s single-payer system) or via a mix of government and insurance funded mechanisms (e.g. the US health care system). Both have their advantages and disadvantages, with different forms of rationing the inevitable result. However, I am not concerned so much with the current problems in either system, but rather how health care in general will fare in an energy-driven decline.

The answer I am afraid is not well.

The US System is perhaps the more fragile of the two. Currently most individuals of working age receive coverage through their employers along with their dependents. People older than 65 and those deemed destitute enough are covered directly by the federal and state governments. The problem is, as employment patterns have shifted over the past few years, so have the number covered. As the number of well-paid jobs with benefits has waned, the number of uninsured has grown steadily to some 45 million today. These individuals along with those in the country illegally have come to rely on hospitals as a last resort while the whole system has become mired in paper work with by some estimates, one out of every ten dollars spent on administrative or clerical expenses. Costs have risen much faster than inflation over the past decade while wages have stagnated. Going into the future, the picture looks much, much worse.

Unemployment will become rampant as whole sectors become eviscerated by rising energy prices. As bad as job losses have been to date, millions still retain coverage. This will change as those sectors go belly up, whether they are the domestic auto manufacturers, travel or tourism industry or even the financial sector. With millions more joining the ranks of the uninsured, the problem will grow from being an underclass issue to a middle class issue. Pressure on the providers of last result will increase to the breaking point to provide coverage to huge numbers of people without any hope of repayment, while costs for the remaining insured skyrocketing out of control as the insurance companies and health care providers attempt to recover some of their costs on an ever shrinking pool of the uninsured. These impacts will filter back to the drug and medical industry manufacturers. Not immune to the malaise gripping the economy, manufacturers of drugs will inevitably cut back on staffing, research and even production. As transportation-driven interruption commence, the delivery of drugs from a limited number of manufacturing locations becomes increasingly problematic, resulting in periodic shortages of key medicines.

How bad it gets to ultimately, will be determined by the actions of the federal government. If they are appreciative to the growing political pressure of the legions of uninsured and nationalize key segments of the healthcare network (out of public safety considerations) to provide emergency and prophylactic treatment, the overall health picture will not dramatically change. Fewer people will likely receive those heroic lifesaving measures we have come to expect so that more people could be vaccinated from the flu or have their basic injuries patched up.

If the feds abdicate this public health care responsibility out of cost or political considerations, the foundation will have been laid for the spread of epidemic and pandemic-level diseases. Even if the government begins to provide such basic level coverage, the increasing costs and disruptions to the national economy will push the government to the financial breaking point.

Other countries are not immune to these impacts. Unless countries choose to prioritize the health of their citizens over other priorities, their overall health situation will also decline. As the economic pie continues to shrink, more priorities (transportation, education, military, civilian governments and other needs) will compete with health care for an ever-shrinking slice of their respective budgets.

Barring a revolutionary source of new energy, health care will devolve back to a much more basic level of service. This is not an entirely bad development either. Health care, like everything else will have to be provided at a local level. Just because available energy will inevitably decline, does not mean that knowledge will be lost. We won’t go back to the era of leaches or ritual sacrifices to cure ailments. But the focus will return to prompt and preventative treatment of minor ailments and injuries so they do not become major issues. Good eating and hygienic habits also will play a part, such as eating a wholesome diet, maintaining an appropriate weight as well as following common sense practices such as hand washing.

The jury is still out on the pharmaceutical industry. The manufacture of many drugs will likely be out of the reach of most local communities. As a result, it would be optimal that in a post peak-energy civilization that emerges from the wreckage of the industrial age, feature a number of pharmaceutical operations scattered around the world, manufacturing the most commonly needed drugs and distributing them regionally, with any developments or advances shared with their counterparts world wide. With an adaptation to a steady-state economic paradigm, the pharmaceutical industry would hopefully become a service to humanity instead of a profit based operation.

That’s the optimistic view anyway. If we do not successfully adapt our health care infrastructure to deal with the realities of a low-energy existence, the framework for a die-off will have been set.


Blogger Jack said...

A new post-oil paradigm is not the only new paradigm that it needed. Here's the new one for health: Virtually all chronic disease is self-induced as a result of unhealthy life-style choices, the most prominent being the daily consumption of cooked and processed food. That's right, cooked food causes cancer. Too much fat causes diabetes and heart disease. The corollary to this is that there is no cure. They will never discover a cure for cancer, heart disease, diabetes, and all the other chronic diseases because these conditions took decades to form in the body. It takes years of no longer consuming processed foods to allow the body to undo the damage.
The optimal diet is fresh fruit all day with a big salad at night; fruit supplies the calories, and lettuce and veggies supply the minerals. If we ate this way, there would be no chronic disease, no huge health care system. But, here's the dirty secret: cooked and processed foods are addictive. Even though nutritionally difficient, we strongly desire the excitotoxins in the spices, and the heavy feeling of concentrated calories in the stomach. Pizza, pasta, bread, ice cream, meat, potatoes, corn, etc., are all detrimental to health. Tough, eh?
So, when I hear or read people complain about their health, or the health care system, I shrug because it is entirely within that person's ability to be healthy. The question is: are you willing to give up your favorite foods to avoid illness? and instead, eat large amounts of fruit every day. No doctor or pharmaceutical medicine is going to provide you with health; that has to be earned, the old fashion way.
I figure that's about as likely as people voluntarily giving up their cars to save the environment. Wish it were different, but that's the way it is. There's a new paradigm, but about as many people will take note of it as will of peak oil.

6/06/2005 2:59 PM  
Blogger monkeygrinder said...

Jack, you are right.

Food is addictive. MSG is added to almost everything these days.

This is not something that makes me shrug, but at the same time, peak energy has the potential to cleanse our collective palates on any number of levels.

6/06/2005 9:49 PM  
Blogger Disease Index said...

You keep a nice blog. I just started one myself, about Diseases. If you know of anyone who'd benefit from Diseases information, then please refer them to my Diseases information site. I'll return the favor.

Let's put an end to the suffering.
Find A Cure For Any Disease!

10/04/2005 3:31 PM  
Blogger Disease Index said...

You keep a very nice blog. I'm new to the whole blog thingy, but I enjoy reading through other people's blogs.
Let's end the suffering of all Diseases
Find A Cure For Any Disease:

10/04/2005 7:24 PM  
Anonymous Blue Cross of California said...

Great blog I hope we can work to build a better health care system. Health insurance is a major aspect to many.

12/02/2005 11:12 AM  

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