Thursday, August 25, 2016

Reciprocal Altruism and the Fundamental Assumptions of Market Based Thinking

Another interesting article from Bloomberg has come out that deserves a read. It's from Megan McArdle and it delves into the dichotomy of having no problem with ordinary commodities, or services, being provided to us via a market system (with the usual provider rewards --profit-- understood to be a logical component), but then getting upset when socially important ones (subjectively determined of course) are made to submit to the same market forces. And she certainly has a point. If you play within a market system, trying to isolate singular sectors within it to which completely different rules should apply is going to cause problems.

Which brings us to the quandary of health care as a nexus of services and products. This one is particularly unique in that it is wrapped quite tightly within a host of extremely specialized skill sets.

All choices are a combination of tradeoffs though, right? To some degree we are willing to accept new difficulties if taking a certain choice provides some countervailing benefit. And however you might define what "socially important" might be, we have, over time, agreed that there can be things that fall into that, sometime ambiguous, category. That being said, though, doesn't change the fact that there are still limits to how much you can bend underlying market rules no matter how well intentioned you motives might be.

The thing is, however, technological change has this amazing tendency to make former assumptions quite questionable. Foremost, in this case, being the idea that all skill lies within the sole purview of human practitioners.

In the past this was quite understandable. It could take years of training, and apprenticeship, to acquire a particular skill set, There was also the fact that geographic location might not have developed it at all, or not to the same degree as another; so it was also natural that different regions would gravitate to doing particular sets of things other regions either couldn't do, or simply couldn't to the same degree of quality.

The advent of repeatable print technology eased this situation to some degree as the mobility of books began to make knowledge more universally available. But then came electricity, which could not only transmit knowledge wider, and faster, but which could store the full complexity of conditionalized process, with all of the contingency branching any process might require, and then express the material manifestation of the desired output. Whereupon that store, or what we now know as software, can be placed, at the click of an icon, anywhere in the world where the machines to use it have already been delivered (which, with modern transportation, is also a much more easily accomplished task).

It is in this new environment where one has to ask themselves why skill as a commodity makes any sense at all any more. To ask whether we ought to be considering that a new organizational model is not only possible, but quite likely essential.

Not everything has been rendered to "software" yet, but that is not to say it won't be. Then again, not everything should be rendered to "software." The same thing goes for specialization. I don't think it is likely we could ever get rid of it, but why would we even want to? People specialize for the same reason that human taste is so variable. Saying that, though, doesn't mean we can't de emphasize it within the context of how we organize ourselves. If we were to take direct responsibility for both our community's productive infrastructure, as well as the productive decisions of same, we could work a balance between automation and specialization. We could eliminate monetary exchange for the inducement of skill reproduction and switch to cooperative production, and maintenance, for the creation of materia basics, and then make whatever end use items desired ourselves, and we would be able to because we would have an equity share of the basics.

This is possible. It wouldn't be easy, by any means, to implement, but it is possible. And given the extremes of where Capitalism is taking us now, it is absolutely mandatory that we try.

Health Care Is a Business, Not a Right