Once upon a time — a couple of years ago, more or less — Becky and I were talking about the Escher-esque illogic of “healthcare.” We talked about perverse incentives in healthcare, how the goal is not health, but management of ill health. We needed a large sheet of construction paper to map out these two “worlds,” one in which a sick patient lies on a gurney at the center, another in which a healthy, happy person turns cartwheels at the center.
When we think about “cutting healthcare costs,” our starting point is more efficient coordination among hospitals, physicians, and insurance companies (and maybe patients..), reigning in pharmaceutical companies, eliminating unnecessary tests and procedures, and, maybe, programs according to which “care providers” talk about smoking, diet, and exercise with their “patients” (conversations for which care providers are not particularly well-trained and for which they have no tools).
Our thinking about healthcare starts from disease, not health. What if we planned healthcare as if we were planning for the health of the people we love?
We don’t count up from what really counts. Instead we kind of try to subtract away from the bad, the stuff we wish we didn’t have to count at all. There’s all kinds of disincentives here, all kinds of reasons for getting the math wrong.
When thinking about healthcare, we don’t, for example, typically make the connection between healthcare and infrastructure planning and community design. We don’t necessarily think about, for instance, school consolidations and what these mean for the health of children, mental health, physical health, and intellectual health: the ability to concentrate:
[A] survey looked at nearly 20,000 Danish kids between the ages of 5 and 19. It found that kids who cycled or walked to school, rather than traveling by car or public transportation, performed measurably better on tasks demanding concentration, such as solving puzzles, and that the effects lasted for up to four hours after they got to school.
Nationally, as of 2009, only 13 percent of kids in the United States walked or biked to school, down from 50 percent in 1969.
What if we planned for the health of our kids as if we were actually planning for the health of the people we love?
Likewise, our thinking about freedom from fossil fuels and climate pollution by default starts from some variation of “business as usual,” a state of ill health if there ever was one: sick democracy, polluted skies and waterways, poisoned weather. We think about how much polluting we’re projected to do and try to figure out various ways to cut this amount.
We want a planet we can live on— but our thinking starts from a place that is assumed to be inevitable, even though we wouldn’t want to live in it and maybe can’t survive it.
We’re trapped in pollution as the standard, the default mode. We’re locked into pollution, not just by our infrastructure investments but by our habits of thought.
This entrenchedness is fractal: it happens at every level.
In Parts 2 and 3, we’ll look at some of the problems that ensue from this kind of entrenchedness, at the carbon emissions level.