Access to Choice

Kai Jones left a comment in my recent post on the US health care debate being informed by different positions on the socially-appropriate degree of persistence attached to luck, and that had a pointer to his post on the subject.

Kai's post contains:
where we (as individuals) decide that this problem is best left in individual hands and to individual judgement about individual solutions, which also imposes some costs on everyone, just different costs.

At which point my brain emits a sort of distraught grinding noise.

Individuals can't solve very many, or very large, problems; humans solve problems by co-operating in groups.

If you want to start solving medical problems as individuals, well. Consider that staple of modern medical care, the sterile disposable plastic syringe. Off the top of my head, and certainly incompletely, that involves:

• a needle, which means mining, refining, and smelting of ores; some source of process heat for the refining; instrumentation to allow precise alloying; precise fine extrusion; polishing (which gets done with abrasives from somewhere); sharpening (different abrasives); attaching to a standard size of connector that will fit the syringe, which means plastics for the connector and some sort of adhesive that will stick polished stainless steel to the plastics
• a plastic barrel and plunger, which means two different kinds of plastics (the plunger has to have that gasket part at the bottom), which in turn means fossil hydrocarbon extraction, the science of geology, deep drilling (tungsten carbide, betonite drill mud, high-tensile bolts and steel to build the drill string, internal combustion or steam engines to drive the drill...), plastics refining (huge swathes of the science of chemistry, large refineries and attendant physical plants (high pressure-pipe in many sizes, valves, stuff that won't catch fire or melt or react with the hot chemical soup being piped through it), instrumentation necessary to quality control, see also "laser mass spectrometry as a driver for industrial production capabilities"), precise moulding and extrusion technologies to make the actual plastic parts, the germ theory of disease (so you know what sterile is), and some means of sealed packaging for the sterile parts after you've filled them
• some ability to produce -- more process chemistry, biochemistry, statistics, and medicine, so you have some idea what substances produce which theraputic results -- whatever is in the syringe, whether MMR vacine or lidocaine freezing, make it sterile without ruining its effectiveness, and get it into the syringe which you then pack and ship
• which means transportation infrastructure; road or rail and the necessary communications technology to run the transport network and pass order from those as would like some disposable syrninges full of MMR vacine to those as makes them

That takes, right there, millions of people. Most of whom probably don't think of themselves as being involved in anything to do with providing medical care; the truck driver with a load of syringes, scrubs, and blood pressure cuffs may not know what's in the truck, after all, and the roughnecks on an oil well aren't generally thinking about what people do with the stuff.

There isn't any possibility of an individual decision or an individual solution becuase the choices that exist for an individual are a function of how the productive activity of millions of people is organized. The argument is about the form of organization that will be used to provide the scope of choice which applies to providing medical care, not meaningfully about individual anything because it can't be done that way. It takes a huge co-operating group to do it at all.

Individuals have choices, and should have choices, provided to them by the form of organization that arranges for the co-operating in groups.

Indvidual people should be able to say "I hurt, and want care", and they should have the cost/benefit of the possible solutions explained to them, and this should all be organized to be efficient in its use of resources, but the only way the question of what those choices are can be left in individual hands is if we're all individually chewing on willow bark by our individual selves in the howling wilderness.

It's a question of whether or not various corporate organizations get to keep extracting their billions of dollars. It's not, cannot be, never was, not even in the gods-be-feathered neolithic, a question of individual solutions.

The purpose of a system is what that system does; if the results differ from what the people responsible for the system say it ought to do, they're either incompetent or lying about what they truly intend the system to do.