Healthcare Attributes In Open Skills Commons (Free Market)

This post serves as a sort of "mental exercise" to give the reader an idea how a city or local community might consider management of skills sets possibilities, both at a collective level, and at the level of the individual. Above, I added free market in parenthesis so as to designate the purpose a completely open skills commons would actually serve. In the same way one looks at private property as "placeholders" in free markets, one would also look at knowledge use and other skills sets as placeholders in a local open skills commons. Each individual holds portfolios of skills sets, and has the right to ownership of time use for most aspects of one's learning processes, which other individuals and groups deem worthy of  matching their own time sets for. Each matched component can be utilized in specific, recorded time measurement as primary attributes for a combination of ongoing community history and monetary validation.

First, a consideration of the working perimeters: what is population size? The smaller the population, the more of a generalist each economic participant can become if so desired, in terms of building a knowledge and skills base that can also be supplemented (frequently in "just in time" spontaneous or immediately needed terms) as needed from global and digital sourcing. 500? 5,000? While these numbers don't seem significant for divisions of community economic activity in present day terms, with open skills commons, they make a tremendous difference in the ways local activities might actually play out through economic integration. For instance: The smaller the community, the more individuals will want to seek out aspects of healthcare they will - over time - feel capable of supplementing in basic forms. No,  not everyone is well suited for healthcare provider roles in a limited sense, but we all participate in some aspect of life which relates to numerous aspects of health not readily represented through institutional forms.

While some might think that locally provisioned environments would fall short of (supposedly) available skills set options in normal (institutional) healthcare settings, in some respects the reality could be quite the opposite, in short order. That really matters when a patient grows weary of having to travel two hours from home every time a new problem arises. Specifically, many of the more service oriented aspects of healthcare, i.e. those which take more time to carry out (except the better paying surgeries) have been limited in institutional settings, in both public and private respects. In one very important instance, mental health has played a declining role in terms of reimbursement both on the part of public and private sources, whether government funded or insurance, with unfortunate results. Catherine Rampell's recent Economix article may be behind a paywall, ("U.S. Healthcare Spending is Exploding, But Not For Mental Health ") however the Economics Roundtable provides this quote:"

Mental health spending has remained roughly l percent of the economy since 1986. While total health spending has climbed from about 10 percent of gross domestic product in 1986 to nearly 17% in 2009.  

Started this post yesterday...today I had better luck! (Never can tell about NYT) and so here's the links for Rampell's accompanying magazine article and the Economix link here. A hat tip is also in order for Grace Fischer who provided me with some links that may also be helpful for the reader. Thanks, Grace! (Now I've got lots more reading to do...)

The financial constraints necessary with Obamacare also mean that mainstream, preventative and alternative forms of healthcare are forced to deemphasize human skills time, and the last two areas especially rely on skills sets (meaning they will remain limited in institutions). Even though there are positive cost offsets from personal time interaction that matter for  today's workplace, expense budgets often have to consider front end concerns rather than long term benefits.

Healthcare tends to emphasize medications in that they are more "economic" in that regard. In some instances, a pain pill quite literally becomes the substitute for the massage which no one has financial "clearance" to provide to the patient (multiple settings provide examples here), or - more ominously, the antidepressant pill becomes the substitute for the fact that institutions often don't have the additional funding to pay for what people need the most - a concerned individual who is just there to listen to what we have been through. Although fortunately, one major exception exists: the evening news reminds us that mental health professionals are called in whenever tragedy strikes.

Locally organized skills commons are capable of bringing the personal factor back in wherever institutions are forced to remove it, and in the larger sense that also applies to important and ongoing research that institutions don't have room for. Much more to be considered on that last angle, coming soon to this blog site. However there is one more area I need to mention before I run out of time for this post: institutional bed capacity is decreasing in ways that look good on paper for lowered costs, but might not actually be "good" in terms of what communities need and thus need to consider for societal coordination.

Two examples - Rampell cites the Health Affairs article, which mentions how "shortages of inpatient hospital beds in some areas may have helped slow spending growth for inpatient services as well." Then there's a more anecdotal example: a "certain county" with plenty of local wealth only had room for 14 hospital beds, for individuals coming out of surgery who needed a period of intense therapy before returning home. People often don't know that such vital services may be in short supply in their own communities, until they unexpectedly need them. Whenever a community would come together to appraise potential needs, these are just some of the factors they would want to consider, which often are not represented in their institutions the ways people presently believe them to actually exist.