Wednesday, October 18, 2017

Rights to Heal Need Not Counter Physician Authority

As if there wasn't enough political discord in Washington already, the evergreen issues of healthcare access have resisted resolutions as long as anyone can remember. I'm now halfway through "The Social Transformation of American Medicine", which explains some of the reality behind the struggle. Even before considering the arguments Paul Starr put forward, I didn't feel comfortable about proposing knowledge use that would only counter the approach by which organized medicine developed in the U.S.

Since healthcare became one sixth of the economy some years earlier, scarcely anyone believes it should demand more resource capacity than what has already transpired. What level of healthcare can our government realistically maintain, especially while more revenue is diverted to military purposes and tax relief? Could the distinct possibility of diminishing government revenue for healthcare, be behind some of these recent layoffs? Meanwhile, unpaid medical bills are on the rise as well.

Yet earlier attempts at reform, some in the guise of making healthcare more "efficient", often included organizational changes which would have reduced the ability of physicians to define their own work environments. Only consider however, that the same autonomy physicians preserved for themselves, is the same autonomy that so many individuals would like to experience for themselves. Are there ways to "bottle" or provide an institutional framing, for what physicians have managed to achieve for themselves? Instead of yet another reform attempt which would reduce physician autonomy, why not use their success as a reference point, for the delicate balance of interdependence and autonomy which we all seek in the workplace and in our personal lives.

Another problem, is that physicians - like others who offer high skill knowledge product - mostly utilize knowledge and skill in a price making context. Price making need not be problematic at a macroeconomic level, when the product in question is only a small part of marketplace structure. But now that healthcare has expanded to one sixth of the economy; the price making that takes place, especially when knowledge is utilized in a secondary or dependent market position, puts additional pressures on general equilibrium circumstance.

The fiat monetary systems which originated in the twentieth century, also contained a built in flexibility which allowed government debt to contribute to vast progress in healthcare. Now, however, political pressure is beginning to limit this flexibility. We don't know yet, the degree to which presumed limits to growth will affect the organizational capacity of healthcare in the near future. Just as healthcare practitioners felt the need to restrict supply in the Great Depression, similar rationale can arise during periods of economic stagnation, especially given the possibility that stagnation will be with us for a while. Are there means to overcome these limits, without further straining the institutional dynamics already in play?

Time arbitrage for the use of knowledge, would not be in competition with the functions of healthcare practitioners, since time preferences would reimburse skill sets instead of money. In other words, economic unit of account and exchange functions would be assigned to mutually coordinated time units, while money simultaneously reimburses time as new commodity formation. The changing "time prices" for specific skills sets, would provide useful clues for educational options in each group. Since each local group uses the time at its disposal, no debt formation takes place. Hence time units (time purchases time) become a direct component of wealth creation, which in turn allows knowledge use to assume a primary marketplace position.

Also important is that time units in this capacity can function like the price taker positions that are often found in tradable sector activity. It becomes possible for participants to do so, because - like tradable sector commodity pricing signals - the participants become aware of the potential equilibrium dimensions of time aggregates - only the process occurs locally, rather than globally. In this capacity, healthcare as time arbitrage also does not compete with traditional healthcare, since it generates new organizational patterns from knowledge use which do not require the resource capacity of general equilibrium.

Much has changed, since earlier periods when physicians found it necessary to reduce the numbers of their ranks as means to gain status. No one need question the quality product which physicians brought to the marketplace in the last century, and other groups which seek the right to heal would augment these valuable skills sets, not attempt to replace them. In the not so distant past, people from all walks of life in the U.S. could still aspire to a life of respectability and usefulness. By no means would a renewed right to heal, based on personal desire to help others, diminish the status and respectability of those who have made such tremendous sacrifices to make the most of their human capital.

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