Open-Source Healthcare
By Kevin Carson / blog.p2pfoundation.net

The healthcare industry is a textbook example of what Ivan Illich (in Tools for Conviviality) called a “radical monopoly.” The central function of the government’s “safety” and “consumer protection” regulations, in most cases, is either to exclude competing providers of a good or service from the market, to circumscribe the areas of competition between them, or to set a floor on the capitalization required for doing business and thus impose a mandatory minimum overhead. The overall effect, as Paul Goodman put it in People or Personnel, is to create a 300% or 400% markup in the cost of doing anything, and render us all dependent on institutional providers with bureaucratic cultures and high overhead costs. By mandating centralized, high-tech, and skill-intensive ways of doing things, the state makes it harder for ordinary people to translate their own skills and knowledge into use-value. Tollgates are erected between effort and consumption, so that it becomes harder to meet our subsistence needs through our own direct labor or through barter with other small producers outside the wage system. As a result, “decent poverty becomes impossible.”

For example, schooling becomes something you can only get from somebody with a degree from a teacher’s college, according to a state-prescribed curriculum. According to Illich in Deschooling Society, the first thing students learn at school is to confuse process with substance, and to view almost every form of consumption good imaginable as something properly provided by a professionalized institution. Self-treatment, self-education, etc., are things that only dangerously irresponsible people do. Back in the 1920s and 1930s, public school Home Ec curricula threw their weight behind the creation of mass consumer society, teaching students that home-baked bread, home-canned vegetables, and home-sewn clothing (in fact, pretty much homemade anything) was old-fashioned and grounds for suspicion by right-thinking people.

In the field of housing, around a third of which was still self-built in the U.S. as late as the 1940s, self-building is virtually illegal thanks to local housing codes set by licensed contractors and their lobbyists. This despite the fact that the available technology for self-building (modular houses, “cob” building, etc.) is far more user-friendly than it was sixty years ago.

And in healthcare, state intervention artificially skews the model of service toward the most expensive kind of treatment. For example, the patent system encourages an R&D effort focused mainly on tweaking existing drugs just enough to claim that they’re “new,” and justify getting a new patent on them (the so-called “me too” drugs). Most medical research is carried out in prestigious med schools, clinics and research hospitals whose boards of directors are also senior managers or directors of drug companies. And the average GP’s knowledge of new drugs comes from the Pfizer or Merck rep who drops by now and then.

The professional licensing cartels outlaw one of the most potent weapons against monopoly: product substitution. Right-wing libertarians are fond of using “food insurance” to illustrate the effect of third-party payment: if there were such a thing as grocery insurance, with low deductibles and a flat premium, people would be buying a lot more filet mignon and a lot less hamburger. The problem is that we’ve got a medical licensing system that criminalizes the sale of hamburger and mandates the sale of filet mignon. While healthcare consumers fall into many tiers of income, the state mandates only one tier of service regardless of ability to pay.

Much of what an MD does doesn’t actually require an MD’s level of training. Unfortunately, no matter how simple or straightforward the specific procedure you need done, you have to pay for an MD’s level of training. The medical, dental and other lobbies make sure that legislation is in place prohibiting advance practice nurses or dental hygienists from performing even the most basic services without the “supervision” of an MD or DD.

In an open-source healthcare system, someone might go to vocational school for accreditation as the equivalent of a Chinese “barefoot doctor.” He could set fractures and deal with other basic traumas, and diagnose the more obvious infectious diseases. He might listen to your cough, do a sputum culture and maybe a chest x-ray, and give you a round of zithro for your pneumonia. But you can’t purchase such services by themselves without paying the full cost of a college and med school education plus residency.

The government having made some aspects of treatment artificially lucrative with its patent system and licensing cartel, the standards of practice naturally gravitate toward where the money is. The newly patented “me too” drugs crowd out drugs that are almost (if not entirely) as good, so that the cost of medicine is many times higher than necessary. The licensing cartel requires diagnosis and treatment by someone with an MD’s level of training, when something much less might be all that’s needed.

Result: radical monopoly. The state-sponsored crowding-out makes other, cheaper (and often more appropriate) forms of treatment less usable, and renders cheaper (but adequate) treatments artificially scarce.

I’m very big on the idea of reviving the mutuals or sick-benefit societies that working people organized for themselves, back in the days before the state and the capitalist insurance companies conspired to destroy them. One small-scale attempt at doing this sort of thing is the Ithaca Health Fund, created by the same people involved in Ithaca Hours.

But such things alone are not enough. The problem with such systems is they handle only the financing end of things, while delivery of service is still under the control of the same old institutional culture. Any real solution will have to involve cooperative control over the provision of healthcare itself, as well.

Imagine, for example, a cooperative clinic at the neighborhood level. It might be staffed mainly with nurse-practitioners or the sort of “barefoot doctors” mentioned above. They could treat most traumas and ordinary infectious diseases themselves, with several neighborhood clinics together having an MD on retainer (under the old “lodge practice” which the medical associations stamped out in the early 20th century) for more serious referrals. They could rely entirely on generic drugs, at least when they were virtually as good as the patented “me too” stuff; possibly with the option to buy more expensive, non-covered stuff with your own money.

Their standard of practice would focus much more heavily on preventive medicine, nutrition, etc., which would be cheap for members of the cooperative who didn’t have to pay the cost of an expensive office visit to an MD for such service. Their service model might look much more like something designed by, say, Dr. Andrew Weil. One of the terms of membership at standard rates might be signing a waiver of most expensive, legally-driven CYA testing. For members of such a cooperative, the cost of medical treatment in real dollars might be as low as it was several decades ago. No doubt many upper middle class people might prefer a healthcare plan with more frills, catastrophic care, etc. But for the 40 million or so who are presently uninsured, it’d be a pretty damned good deal.

0.0 ·
0
What's Next
Trending Today
This Polish Ad Will Give You The Feels, For Reals
3 min · 14,088 views today · This is an ad for Allegro, a Polish company similar to eBay, and it's heartwarmingly lovely.
6 Toxic Relationship Habits Most People Think Are Normal
Mark Manson · 12,882 views today · There’s no class in high school on how to not be a shitty boyfriend or girlfriend. Sure, they teach us the biology of sex, the legality of marriage, and maybe read a few...
Time-Lapse Satellite Images Give a Startling Snapshot of Past 30 Years on Earth
2 min · 12,276 views today · Working with satellite images from NASA and the US Geological Survey, Google has created a searchable snapshot of the past 3 decades on Earth, creating startling time-lapses of...
Dr. Maya Angelou: Love Liberates
5 min · 5,455 views today · Words to live by from Dr. Maya Angelou. Love each other.
Ten Ways We Misunderstand Children
Jan Hunt · 5,126 views today · 1. We expect children to be able to do things before they are ready. We ask an infant to keep quiet. We ask a 2-year-old to sit still. We ask a 3-year-old to clean his room...
The Myth of Positivity: Why Your Pain Holds a Mighty Purpose
umair haque · 2,075 views today · Of all the great myths of contemporary life, one of the most toxic is positivity. It says: there are negative and positive emotions, and only the positive ones are worth...
The Problem with Hating Our Enemies
Charles Eisenstein · 1,953 views today · He who fights too long against dragons becomes a dragon himself; and if thou gaze too long into the abyss, the abyss will gaze into thee. —Nietzsche
15 Easy Things You Can Do to Help When You Feel Like Shit
Maritsa Patrinos · 1,181 views today · You don’t have to tackle it all at once.
John Lennon's "Imagine," Made Into a Comic Strip
John Lennon. Art by Pablo Stanley · 1,103 views today · This is easily the best comic strip ever made.  Pabl
The Lid Is off, The Truth Is Coming Out
Charles Eisenstein · 1,056 views today · It is getting harder to keep a secret these days. The collective shadow of our society, once safely relegated to the dark basement of the unmentionable, is now exposed to...
Today I Rise: This Beautiful Short Film Is Like a Love Poem For Your Heart and Soul
4 min · 1,022 views today · "The world is missing what I am ready to give: My Wisdom, My Sweetness, My Love and My hunger for Peace." "Where are you? Where are you, little girl with broken wings but full...
Have You Heard of The Great Forgetting? It Happened 10,000 Years Ago & Completely Affects Your Life
Daniel Quinn · 964 views today · (Excerpted from the book, The Story of B) With every audience and every individual, I have to begin by making them see that the cultural self-awareness we inherit from our...
Sleaford Mods on Brexit Britain
4 min · 894 views today · In early 2014 the Guardian hailed duo Sleaford Mods as ‘the most uncompromising British protest music made in years’. Here, we go backstage at a Sleaford Mods gig in their...
How to Expose Trump's Dastardly Bait-And-Switch
Robert Borosage · 818 views today · Trump is not an economic populist, he’s just playing one on TV.
The White Man in That Photo
Riccardo Gazzaniga · 538 views today · Sometimes photographs deceive. Take this one, for example. It represents John Carlos and Tommie Smith’s rebellious gesture the day they won medals for the 200 meters at the...
A Hauntingly Beautiful Short Film About Life and Death
5 min · 461 views today · The Life of Death is a touching handdrawn animation about the day Death fell in love with Life.
Why You Should Stop Apologizing for Doing All That You Can
Kelly Hayes · 436 views today · I’ve noticed lately that a lot of allies and accomplices I talk to about NoDAPL and other struggles will name what they are trying to contribute to the cause, and then promptly...
The Top 100 Documentaries We Can Use to Change the World
Films For Action · 388 views today · A more beautiful, just and sustainable world is possible. Take this library and use it to inspire global change!
Black on Black Crime Isn't a Myth
Donyae Coles · 350 views today · Let’s talk about Black on Black crime. Maybe you’ve heard about it on the news, specifically likely in regards to Black people murdered by other Black people. Perhaps you’ve...
Schooling the World (2010)
66 min · 319 views today · If you wanted to change an ancient culture in a generation, how would you do it? You would change the way it educates its children. The U.S. Government knew this in the 19th...
Load More
Like us on Facebook?
Open-Source Healthcare