Post-Politics, Post-Scarcity, and Growth Solutions for Health Care
The debate between transhumanist socialists and libertarians continues, with Jamais Cascio weighing in on those who take an apolitical or anti-political stance:
You have my express permission to kick the next person -- especially someone advocating the embrace of radical forms of technological advancement -- who tells you that they wish nothing more than to get rid of, move beyond, or otherwise avoid "politics." Kick them hard, and repeatedly. They have adopted a profoundly ignorant and self-serving position, one that betrays at best a lack of understanding of human nature and society, and at worst a malicious desire to preemptively shut down any opposition to their goals.
I consistently try, whenever the subject of politics comes up, to move the conversation elsewhere. Moreover, in the spirit of full disclosure, I must admit that I have often pined for a post-political world. Seeing as I don't think I have a malicious desire to shut down any opposition to my goals, I am left to conclude that the severe kicking I have coming stems from being profoundly ignorant and not understanding society.
Politics is good, Jamais explains:
Politics is part of a healthy society -- it's what happens when you have a group of people with differential goals and a persistent relationship. It's not about partisanship, it's about power. And while even small groups have politics (think: supporting or opposing decisions, differing levels of power to achieve goals, deciding how to use limited resources), the more people involved, the more complex the politics. Factions, parties, ideologies and the like are simply ways of organizing politics in a complex social space -- they're symptoms of politics, not causes.
Well, hang on, there. I'm really okay with all of that. What I find imminently avoidable is not that set of relationships or even the various processes we put in place to manage those relationships. It's the prevalent discourse surrounding those processes. Political discourse tends towards hysteria and mean-spiritedness, neither of which I have any use for.
Moreover, most of it is pointless. As Michael Anissimov puts it:
I have substantial political knowledge, and frequently follow politics, but I speak about my (socially liberal, economically moderate) political views much more frequently offline than online. Why? Because politics is a huge niche occupied by millions of people. Anyone can do it. Pick a side and start shouting slogans.
Right. And once the slogan-shouting begins, you can pretty much forget about any serious discussions on any other topics. Although you could probably get some good religious shouting matches going, too, if you wanted to add some variety.
Contra Jamais, I doubt many of those who eschew "politics" are seeking utter isolation or looking for a world in which the only viewpoint is theirs. Again, it is the increasingly absolutist nature of current political discourse that I personally find offputting. Why must the "persistent relationship" between parties with differential goals be a toxic one? Why must virtually all communication between the different parties be hostile denunciations and condemnation?
Jamais makes a good point that technology and politics are not alternatives to each other. But whereas the former seems to open up endless possibilities, the latter (or rather the prevalent discourse surrounding the latter) works to reduce everything to a binary choice between that which belongs to the Good People and that which is of the Other.
In the comment thread to the post linked above, Jamais writes:
Every politician makes noises about wanting to end politics as usual, and very very few of them ever actually try to do anything about it.
As things are set up now, to try to do so is political suicide. Just as technophiles need a greater appreciation of the value (and inevitability) of politics, politicians need more choices -- a better appreciation of technology might open some up for them.
For example, as the current health care debate rages, I keep wondering why little (if any) time is spent discussing disruptive changes that could massively increase the amount of health care available while massively decreasing the costs of care. Clayton Christensen of the Harvard Business School argues that retail clinics are precisely one such disruptive innovation:
Retail clinics are basic health clinics staffed by nurses and located inside pharmacies and stores such as Wal-Mart, CVS and Walgreens. There are about 1,000 such sites in 37 states, according to a September 2008 article in the journal Health Affairs. Nurses deliver routine medical care for common ailments like a sore throat or ear infection. A typical visit costs one-third less than an urgent care clinic visit and three-quarters less than a visit to an emergency department, according to another article in Health Affairs that analyzed the costs to the insurance carrier.
Ninety percent of retail clinic visits are for 10 common complaints that constitute 18% of all visits to primary care doctors and 12% of visits to emergency rooms.
Retail clinics are a good start, but they're just a start.
The ailments treated at retail clinics all have a simple and unambiguous treatment strategy. If the answer to a particular medical problem is known and will not vary from doctor to doctor, then the best possible strategy -- if we want to maximize both the total amount of care and available and the quality of that care -- is to get doctors out of the loop on those problems. This frees doctors to spend time on issues where decisions really need to be made.
I liken the treatment of these defined problems to a solved games such as checkers and tic-tac-toe. Just as a human being can't beat a computer which has been programmed with complete knowledge of these games, a doctor can't add value to the treatment of one of these (highly limited and very well defined) problems. The challenge is to greatly increase the number of "solved" medical problems, and the way to do that is through automation. Increasingly sophisticated computer technology can guide technicians (or even patients) through tests to reveal the appropriate course of treatment for increasingly complex problems.
I would guess that fewer than 20% of the problems that doctors routinely encounter account for 80% (or more) of the time they spend with patients, and that many of these would be good candidates for automating. Offloading 80% of the tasks doctors currently perform would be the equivalent of having five times as many doctors on hand to apply their expertise to the treatment and prevention of illness. The total amount of medical care available would increase geometrically. And, since the vast majority of this care would be automated, the total cost of care would plummet.
Essentially, we're talking about applying Moore's Law to medical care. Increase the amount of care available by an order of magnitude or two, decrease the cost by the same margins, and what is the right model for providing universal health care?
I don't know.
The problem is, neither does anybody else. And our leaders, far from considering these possibilities, have entrenched positions that assume scarcity as a permanent feature of the world, rather than a problem that we should only have to deal with for a few more decades. Unfortunately, how long we will have to wait until we reach an era of virtually unlimited medical care is pretty much in their hands. The longer it takes them to see the possibilities, the longer they will continue to waste all of our time with politics as usual.

Comments
Roadblocks to the type of progress you describe here, are becoming more detailed than "politics as usual". A closer look is available, and intimidating.
Posted by: Harvey | August 9, 2009 08:08 PM
Scarcity is the condition that most effectively permits the broadest possible societal control mechanism. In your medical example, consider the AMA's decades-long resistence to creation/accreditation of new medical schools (or even expanding existing facilities). More generally, any alternative method/mechanism that reduces the potential for control of some aspect of a given society will always be resisted by those most empowered by the existing structure. Since politics is the mechanism we use to consider and enact change, I suggest that the more vehement the political process becomes the greater the change a society is willing to consider. If true, singularitarians want political vitriol and excess, the better to encourage the change process along.
Posted by: Will Brown | August 10, 2009 12:39 PM
Driving to work this morning I caught an NPR segment on the health care debate that compared the current political climate with what prevailed back in 1986.
Reagan had run for office promising to lower marginal tax rates. Politically, he needed that victory. Democrats controlled the House, Republicans controlled the Senate.
Reagan and his advisors looked at this political landscape, and knew they need broad bipartisan support to get tax reform passed. They wrote and presented a bill to the House that lowered marginal tax rates (which the Republicans wanted) and closed loop-holes that allowed some rich people to escape with very little taxation (which the Democrats liked).
It passed the House because the Republicans were onboard, the Democrats were onboard, and because the special interests were so divided - each advocating that their loophole shouldn't be closed - that they got no traction.
Once it passed the Democrat controlled house, the Republicans in the Senate felt compelled to pass it too - though they weren't in love with the loss of the loopholes - to support their Republican President.
It was a remarkable moment politically. A moment - the NPR commentators agreed - that is almost unimaginable under the current political climate. And yet, this sort of miracle is precisely what is needed in the health care debate.
Perhaps we should stop talking about moving past politics - something I don't think is desirable. Post-politics is post-democracy.
But bringing a greater civility to politics is always a good thing.
Posted by: Stephen Gordon | August 11, 2009 08:59 AM
Even though this is not exactly a part of the specific online discussion on health care Phil is referencing, this interview with Dean Kamen, inventor of the Segway and a number of important medical devices, fits in perfectly.
Here, he takes politicians and commentators to the woodshed for failing to recognize that accelerating technology has already made the current debate obsolete. He also gives readers some excellent historical perspective on how health care has radically changed in the last 150 years throughout the interview:
"Diabetes alone, if you include all of the long-term, insidious consequences of a lifetime of diabetes, is responsible for about 30 percent of the federal reimbursement for healthcare. Taking care of the diabetic every day is a small piece of it. But what if tomorrow we could wipe out diabetes, suddenly everybody takes a pill and it cures the people that have it, and it inoculates the other people so they'll never have it? Forgetting what a great life that would give people and their families, you take care of 30 percent of what now we project as this insurmountable problem of healthcare, which they project is going to kill us.
Well, it would kill us if we look at the 30-year actuarial data based on our 19th century confidence in technology. But I'm sure in 1920 if you asked actuaries to say what percentage of our GDP are we going to spend taking care of people with polio, they'd say: "They get polio, it goes to their lungs, they sit in iron lung machines, they could live a whole lifetime with three people watching over them. We can't support them all."
But what did it cost to deal with everybody with polio? Oh, $2 apiece. We gave them the Salk vaccine. But in the 1920s Salk wasn't around yet."
The point he makes about diabetes and polio can be expanded to include all diseases. Consider how much work is involved in saving and maintaining the lives of those who suffer from serious chronic diseases. What will happen to health care spending projections once we can fully CURE these diseases???
My point? Technological advance is at the core of the future of health care...and it isn't being discussed as it should be.
http://www.popularmechanics.com/science/health_medicine/4327012.html
Posted by: Sally Morem | August 11, 2009 09:11 AM
SG- I heard that segment too. They forgot to mention the other thing that is generally always true- all politicians like to cut taxes. And, in general, none want to be the guy opposing tax cuts. But in those glory days of the late 80's we had this thing called Gramm-Rudman- (which died in 1990- never to be heard from again)
At the kitchen table level where most useful and the most powerful politcal discussion occur- technological advance as the future of health care doesn't get much attention for two reasons.
First- when the test confirms everyone's worst feat, that Dad (or any other family member) has cancer - it would be rude to point out that well in another few years, that type of cancer will probably be cured because of all the advances. He's sitting here, sick and scared,now.
Second- the conversation is focused on the practical logistics of dealing with things as they are now. And dealing with cancer today is expensive for most families - break the bank, lose your job, sell the house, omg expensive for many. How is it helpful now for Dad that sometime in the future it's possible that no one will have to endure what he's going through?
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