October 29, 2009

Peak Oil and Health Care Reform

Filed under: Health Racket Bailout, Peak Oil — Russell Bangs @ 3:47 am


Political junkies, policy wonks, and the mainstream media, as well as a few people who actually care about the results, have been capitvated by this year’s health care reform show.
The sorry story can be summed up as follows. After having campaigned on Change and the promise of real health care reform, Obama and the Democratic leadership instead sought to hijack the concept of reform and use it for the benefit of the insurance and drug rackets by herding together a conscript market of forced consumers through an individual mandate. The money for all this would supposedly come from government subsidies, to the point that the bill’s real purpose is clearly another racket bailout, via the mechanism of junk mandated “insurance” which won’t really expand coverage or cut down on costs, but will expand racket balance sheets.
The only real reform solution, single-payer Medicare for All, was politically achievable but ideologically odious to Obama. Instead the administration played a bait-and-switch game with the public option. This was meant to divert progressives away from single-payer long enough for that idea to die completely.
As soon as this was accomplished the whole political and media crew then tried to backpedal from the public option as well. They alternately tried to gut it with triggers or neuter the concept through exchanges or co-ops or just disparage it completely.
Only fierce opposition from the grassroots and the blogosphere kept the concept in play at all, to the point that now something called a “public option” is looking likely to appear in the final bill.
But this too is going to be a phony PO. It’s just been gutted in other ways – participation pool, rate negotiation, breadth of subsidies, and so on.
In the end, reform was always a scam. We know by now that this corporatist system will never reform anything. Every major step it takes will be in exactly the wrong direction, the path of propping up zombie structures and looting the people for the benefit of those structures.
But what if we did get a real public health plan or single payer? Even real reform like this would still face an even greater looming crisis, Peak Oil.
The last 150 years of medical advance have been coincident with the fossil fuel platform. Has this advance been caused by cheap, plentiful oil?
Oil is used in antibiotics, antihistamines, psychiatric medications, medicated skin creams, many other drugs, vitamins; tubing, catheters, syringes; operating tables and other infrastructure; all sorts of hi-tech machines; it is the lifeblood of the electrical generation and transportation systems upon which modern medicine depends – everything from global transportation of medical products to ambulance runs.
“Oil allows for complexity”. It allows for ever greater specialization, more procedures quantitatively and qualitatively. The esoterica of medical technology and treatment which allows for top-of-the-line care for the rich is unthinkable without that oil platform. The system has become ever more resource intensive.
This is related to the ecological costs of the oil-based “growth” model for health care. There’s the upstream costs: Extraction, manufacturing; transportation of the raw materials. The downstream costs include how drugs contaminate groundwater and drinking water, and how the incineration of plastic medical waste pollutes the air.
These and many other externalities of the system sicken people and add to health costs. So in a feedback loop the system adds to its own burden.
This leads to the broader ethics of the system. Modern medical ethics are rather myopic, almost completely focused on the patient at hand, with zero focus on the environmental and energy aspects of the system which in turn have bad effects on general health. A reformed, holistic medical ethics would take the big picture into account. We need not just the microethic but the macroethic.
This was never so clear as it is today as we undergo the interlinked economic and Peak Oil crises. By now everyone’s aware of the eroding health care prospects of the non-rich.
What’s happening today: People are postponing elective surgery; waiting for preventable problems to become acute and then rushing to the emergency room; if they can afford “insurance” at all, getting the lowest-cost, highest-deductible and co-pay, most restricted coverage plan, and then getting care based on the lowest-cost treatment; hospitals and medical schools face wage cuts/freezes, job cuts, grant money drying up; local and public health systems are on the verge of shutting down completely (just like public legal services).
This is all under the momentary circumstances of relatively depressed oil prices.
I’ve written a lot on how the exponential debt/growth system cannot be restored beyond perhaps a temporary zombification of a year or two. Here I’ll discuss the implications of this for health care.
Even as we ooze into depression, oil prices are already back up in the $80 range based on nothing but the animal spirits of the phony rally. If there is a temporary zombie “recovery”, oil prices will surge once more the moment consumption actually increases. (Meanwhile we’ll hit classical Peak Oil within five years.)
Growth cannot really resume. The debt unwinding (personal, business, government) has only just begun, and cannot be completed.   
This will place a hard ceiling over the recovery and only accelerate the debt deflation cycle, leading to more wage and benefit cuts and job loss, and subsequent inability to afford health care. At the same moment, oil-based medical costs will also be rising.
Just like pretty much everything else in America, the health care system is based and completely dependent upon growth. It requires an ever-growing pie, and all its structures and processes are built on this. Americans have been spending twice as much on health care as any other industrialized country, 16% of GDP and rising, all under conditions of a “growing” pie (growth based on debt).
The medical culture is based on speed and heroic levels of care (for those who can afford these), without concern for cost or consumption levels. It’s all based on exponential growth. The investment model (high-tech, high-impact, high quantity) and the funding model (grants and endowments for medical schools as well as ever-rising tuition, supported by a corporatist debt structure) assume infinite growth. The government tax base is shrinking at a frightening rate, so there’s less and less public funding available for anything. Yet the leadership, public and private, still envisions (and budgets) everything based on growth.
Today the key to EVERY socioeconomic and political dynamic is that everything we have was developed under conditions of a growing pie, and now the pie will be shrinking.
(And don’t forget the boomer “retirement”. Here too, their health care presupposed a growing economy. Many of them also had retirement investment nest eggs. But now the economy’s shrinking, and we can imagine how well those investments are going to hold up.) 
Because of this, coupled with the existing curve of rising health costs, these costs as a proportion of the shrinking economy are going to skyrocket. At the same time as the zombie middle class must face up to the fact of its own economic liquidation and impoverishment, it will face health costs which are absolutely insurmountable.
This is all calculated to enslave us in everything but the physical chains.
(So think of that every time you see a politician, corporate thug, media cadre, or right winger making light of the situation and trying to block reform. He’s laughing at us as he shovels more dirt onto the grave of our dreams, a grave he personally dug for us.
And remember that when you consider how Obama and his Dems betrayed and destroyed reform.)
So we are now passing the Peak. What will we be seeing post-Peak, during energy descent? Prices of oil and electricity will rise steadily. More acutely, there will be spot shortages and blackouts. These will come with increasing frequency. They’ll affect the non-rich first, and as long as possible the rich will monopolize all energy for themselves (first through rationing by ability to pay, then by rationing through violence and tyranny).
There will be fewer hospitals, which will exacerbate transportation difficulties (already laboring under high fuel prices and perhaps shortages). Health professionals will be less able to profitably and energetically specialize, but will be driven back toward generalization. This effect will be multiplied as the medical education system unwinds, starved of its financial wherewithal.
If health insurance companies still exist, they’ll find it harder and harder to profitably invest an ever-smaller bag of loot from a diminishing customer pool, as fewer and fewer people can afford insurance. (I write that in the expectation that there’s no way government will be able to enforce this vile “mandate” even if they do legislate it. According to the proposals being batted around, whatever they do isn’t going to kick in until 2013. Very courageous on the part of Obama and the senators up for re-election before then. But 2013 is pretty much the outer bound for depletion from existing oil fields to be outrun by demand, as the effect of all the projects cancelled on account of this past year’s credit crunch comes home to roost. Thanks to all that oil which won’t be flowing, by 2013 the real Peak Oil effect will be in full force. The Depression will really set in at that point.)
(And so Peak Oil provides a clue to this politically insane mandate concept. The insurers know that the system is blowing up. They’re going to be the first big victims of Walmart-style consumer cannibalism, as their own racketeering has destroyed their customer base. The mandate really is intended to be a bailout, to counteract those shrinking pools. So it’s not just an aggressive roundup, but a defensive bailout measure as well.)
The health insurance bailout mandate is an example of the broader resource fascist agenda. Health commentator Dan Bednarz comments that “Most Americans tell pollsters they believe health care is a human right, not a privilege awarded those with higher income.” But Bednarz correctly foresees that under shrinking pie conditions the rich will seek to claim health care and every other resource through the simple expedient of might makes right. They’ll try to prop up the existing high-end dominated system, making the people pay for it even as access is limited to the rich.
You’ll get to break your back and receive no care for it, so that they can still get nose-jobs and botox.
Bednarz starkly lays out our choices: If we continue with the status quo we’ll increasingly have a two-tiered “Ferrari and jalopy” system until even this has to collapse. (And I doubt even the jalopy will run for long.)
Or we can muster the political will to truly change the system.
Mainstream medicine has the understandable bias that medicine – expensive, high-maintenance, high-tech – is not only the most important but the only thing. This is all it’s ever known under conditions of exponential growth driven by cheap oil.
But soon, for ever growing numbers of people, food, shelter, physical safety, and basic medicine will be paramount. (I add with hope, maintaining (or restoring) a sense of community.)
A restored public interest health care system would have as its first priority providing crisis care to the impoverished masses. It’s not a stretch to say it’ll have to be reconstituted along the lines of relief organizations like Doctors Without Borders. (Indeed, DWB may in fact find its services needed in America before long. We already could have used them after Katrina.)
This may be looking ahead five years or so. How to get there from here? How can we look at today’s debate and see any possibility of a coherent path from here to the outcome we need to reach?
The only obvious principle is that there’s no inconsistency between anticipating tomorrow’s financial collapse and seeking deficit spending today for a real public option or single-payer. We know that the dollar is doomed. So does everybody else. That’s why the powers that be are running up bills for bailouts, wars, weapons, tax cuts for the rich. They know they’ll never have to pay for any of it. The direct cost of this capital theft and the opportunity cost are incalculable.
So if the people could seize control of this process, we could stop binging on all that worthless, antisocial, criminal dross. We could instead use the remaining power of the dollar, what social wealth we still have, to rebuild the safety net and ease the energy transition. (The health care and energy bills should be interconnected, and should have same broad goal.)
A revolutionized health care system, focusing on the needs of the real citizens and not the luxuries of antisocial parasites, would be the centerpiece of such a safe transition.
Even if you doubt Peak Oil’s dire promises, you could look at real health reform as another stimulus. A healthier populace, less work days lost, a more productive and creative work force, reduced health care expenditure, more disposable income…it’s as Keynesian as it gets.
So either way, political or fundamental, the political revolution or the social, all the signposts, all the paths trodden by prior and present wisdom, point to this reform goal. All we have to do is fight.


  1. Again, a well written piece, but do you really think that oil can’t be replaced, and even improved upon by alternative energies, such as cold fusion, radiant energy panels, hydrinos (from Black Light Power), solar, tidal etc?

    I respect your research and writing, but disagree with the doom-laden conclusion. You remind me in tone a little of Lyndon Larouche, and in apocalyptic fervor somewhat of Mike Ruppert. I hope you’re all wrong. I think this thing is still worth fighting for, and believe the answers lie outside the left-right pantomime of politics. We really shouldn’t be taking those showmen seriously any more. The entire process is a charade. Treat it with the disdain it deserves. All appeals to it are a waste of time, including further analysis of it.

    It’s up to us “ordinary” folk now. Our task is to rally around some common, apolitical objective, such as clean energy, organize, and make our mighty presence felt. I have a strong suspicion you’ll not be moved by my plea, but that doesn’t stop me from making it. I’ve started batting an idea around on Edwardo’s blog (disaster porn — great name!) under his latest post (“Thwarted again!”). If you’re interested, please join the discussion.

    Comment by Toby — November 2, 2009 @ 11:39 am

  2. I’m all for rallying around an objective. The trouble with alternative energy is that even where some technological transformation might be possible on paper, it’s beyond (my) belief that the politics will ever allow the kind of economic and fossil fuel investment needed for the buildout.

    And I thought that was true even before the crash and the oil Peak last July, and the subsequent credit crunch.

    But I will check out Edwardo’s post and your blog as well.

    Comment by Russ — November 2, 2009 @ 4:45 pm

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