...In other words, even though I advocate for a right to heal on the part of all citizens, and for fully thought out responses to fragility in healthcare systems, I generally do so in value in use terms and not from a position of anger or any desire to disrupt today's value in exchange systems. Consequently I wish to apologize for the frustration I vented in two recent posts in that regard, which stemmed partially from being reminded that patients can't always receive adequate nutrition in hospital settings when they are in fact having a difficult time eating on their own. To be sure, when a hospital runs short on nutritional supplements, lipids and other forms of intravenous assistance, that is just one more reason for a patient to remain in home environments as long as possible, when they can at least try to continue eating something which is personally prepared for them.
This post also serves to highlight an older physician who made me aware - early on in my economic studies - of the degree to which our healthcare system was in fact fragile, long before Obama ever took office. I remember the day and the setting well, for it was one of the single days of the week that he - like so many doctors - was able to set aside for patients on Medicare, Medicaid, low income veterans and others on disability. There were so many that it always meant a very full schedule in the attempt to serve them all. It was clear that those patients meant a lot to him. Certainly he mattered to them as well, for people who were waiting that day in the hall brought little gifts and baked goods, some of which were already sitting on his desk.
He basically told me, "Don't ever take healthcare as you see it now, for granted. There are many kinds of potential disruptions which could mean that Medicare and Medicaid might not even be available at some point in the near future." I know that plenty of people would disagree with his words, and the point here is by no means to dissuade anyone. What I want to do is simply provide some real options for alternate organization, structure and service product framing, just in case his words should come to pass. In other words, many of the posts I write also serve as little "open as needed" boxes in the case of emergency. What's more these suggestions tend to be along the lines of value in use, or helping people find more meaningful ways to help themselves, than would be possible in ad hoc circumstances.
More importantly, it's not just this so-called "marginal" aspect of healthcare for older populations or lower income individuals that many physicians can't really afford to take on. Hardly any one would go to medical school now without "crunching the numbers" on the kind of work that actually pays. Even so, specialists have much more leeway in this regard for Medicare reimbursements, than the general practitioners who have to limit their time with Medicare patients to less than ten minutes.
Just the same, the places where such pay may actually be lucrative (here in the U.S.) are already experiencing some overcrowding. Thus the specialist may find himself or herself limited to options which may not in fact cover both education plus ongoing business overhead costs. The result today is fewer individuals who are inclined to go into traditional healthcare, in spite of their desire to do so - at a time when physicians continue to be needed in many places of the world without the resources to pay for their expensive educations or consequent expected overhead. Plus, with political circumstances such as those that exist in the U.S., it's not hard to see where today's efforts to maintain current healthcare structures could readily backfire.
How to think about this scenario? For one thing, the possibility of doctors ending up driving taxi cabs is always real in fragile economies of all kinds. For the rest of this post, I want to focus on those who - if they in fact had means to do so - might reach out to one another across nations to help create value in use settings for healing. By so doing, much valuable knowledge could be preserved for future generations, even when nations lose the ability to use that knowledge through optimal value in exchange. Already, physicians who struggle to practice in places economically unstable, sometime find themselves either endangered or their services in a highly compromised position. The more of us who are prepared to heal when the need arises, the less a danger this may in fact remain.
Helping people help themselves in value in use scenarios, means doing so with the understanding that equal time measure be a part of the process. This allows coordination of knowledge and skills sets, free markets in group arbitrage, and just in time knowledge use across local service settings rather than transport to larger population centers. Plus, knowledge coordination by digital means is inexpensive, whereas transport can be expensive indeed. People can elect to gain knowledge skills based on the needs they observe, along with their desire to provide what they feel to actually be of use or gain. This in turn allows for more experiential aspects of healthcare product than are currently possible.
Plus, those who would be taught to heal in informal settings would do so in the understanding that they pose no threat to the customer base for the kinds of services that physicians provide to higher income individuals, who in fact are able to support their education and subsequent overhead. Just the same, these voluntary circumstances are far preferable to the two tier healthcare system that might otherwise result over time with Medicare, if in fact it could be preserved.
Who might wish to participate in such settings? Certainly there are physicians who are retired and yet still have plenty of energy for what could be a very hopeful endeavor. Potential for coordination of activities exists along a wide spectrum, which is not always included in normal healthcare scenarios. Others who might utilize a physician's approach to training would include doctors who have left practice for financial, family related, social or political reasons, or possibly due to licensing issues. Other possibilities include physicians working in non profit settings who would see this as a way to make greater use of healing in a larger sense.
As for those who might be considered for training, clearly first on the list would be people who don't have the money or resources to go to medical school, or may otherwise have been rejected. In some countries that are short on physicians, young people with clear potential in medical skills have also been encouraged and trained at a young age, in recent years. And then there are the physicians who are frustrated - of course - that they can only take so many Medicare patients in the course of a week, who might see a day or two of training for others as a more useful alternative for the long run. These are just some of the possibilities in the ultimate sense of a physicians' skills, but opportunities for healthcare knowledge preservation go well beyond the basic set suggested here.
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