Health care in a post-modern world

In late modern times, health spending is spiralling out of control as poor health, sustenance and lifestyle practices, and an unlimited health care culture conspire to blow health budgets out of the water in ways that are unsustainable for health care users, providers, and patient and third party funders (private or public).

The users are kept in increasingly expensive and chronically poor health for ever longer periods of their lives.  The providers are gradually drowned in increasingly complex and constantly multiplying intractable health issues in ever younger patients.  The funders have to keep plundering ever large slabs of the GNP to somehow keep up with not just health infrastructure growth, but a continually exploding and ever more expensive armamentarium of new equipment, drugs and treatment regimes. 

And all of this takes place in the context of an increasingly frantic battle against drug resistance and an exponentially increasing requirement to medically and surgically intervene ever more diversely in the lives of increasingly health vulnerable and compromised populations, who will not or cannot do even the basics to save themselves through regular exercise, a planned and rationed diet and avoidence of long term stress.

This happens in the context of a society that orients itself around super-productive machinery and output excess, rather than the basic needs of its human operators and customers. It does this to such an extreme, that amongst other things, it health disables whole populations and then creates a super massive medical industry to take care of the mess, but which itself cannot help but go into dysfunctional hyperdrive, like every other industry with which it co-habits.

Eventually the unsustainable system will become so overloaded and stressed out that it will be forced to change either by rationing itself to a smaller clientel, or forcing a change in mass health habits, or some combination of the two.

In a rational and resource constrained world that wants to maintain a universal system of health care, lifestyle and health habit management will be the obvious choice, but it will necessarily involve some tough backstops to what it provides and to whom. 


Mrs Chen, you came to me with a variety of symptoms including high blood pressure and cholesterol readings and a body fat index that indicates you are at least thirty kilograms overweight. Your muscle tone and cardio-vascular responses are poor, indicating lack of exercise. Your knee joints are starting to show signs of undue wear owing to the excess weight they are carrying. Your kidney functions are working but not travelling well. There are some signs of possible early onset type 2 diabetes. Your life attitude index indicates mild depression and low self esteem. The food intake monitoring that you did with the assistance of your neighbour, John Witherspoon, shows you are eating for comfort rather than for nutrition.

My assessment is that if you do not change your attitude and personal habits, your health will be severely and possibly irreversibly compromised within five years. That gives you a category 2 self harm profile. Fortunately you do not smoke which means you are not a category 1.

Being a category 2, I am authorised in the first instance to prescribe anti cholesterol and blood pressure drugs for up to three months. You can only continue to access these drugs and any others you may need if you start a weight reduction and fitness programme within the next two weeks. Continued drug supply will be dependent on dropping and keeping off those thirty kilograms.

I am concerned that your local Health Watch Committee has not been able to do more to help you prevent getting into this situation. The declaration of an official category 2 self harmer within their jurisdiction is going to focus the collective mind to co-operate in solving your health and life threatening condition. I shouldn't have to remind you Mrs Chen, that their funding depends on consistent delivery of health outcomes in their area.  They are responsible for you, as much as you are accountable to them. 

I would like to see you and your HWC convener, Jan Kopechne, in three months time, to review your progress and entitlement to further scripts.

I know this sounds tough Mrs Chen, but your life is now very much in your hands. In the event that you maintain your self harm profile, the only further treatment we are going to be able to offer you is palliative care.

Good Day.......