A Healthcare Renaissance: Could Peak Oil Inspire America To Create A National Health Service?

By Julian Darley
December 11, 2008 | Comments: 12

Almost every day brings yet more grim economic news, and every week another raft of people are added to the unemployment statistics. As they lose their jobs, many Americans from service workers to small company CEOs will soon find themselves without healthcare coverage. President-Elect Obama said today that "healthcare is part of the emergency" and pledged to reform the system. It is a fearsome task: at least since Hillary Clinton tried and failed about fifteen years ago, US politicians have been worrying about how to fix the wretched U.S. health (don't) care system, and most of the rest of the world knows that it is one of the glaring anomalies of the world's richest nation. So yes, it's been an awful problem for a long time, and it's about to get much worse as the economy contracts -- but you may be wondering what exactly healthcare has to do with peak oil.

As someone new to peak oil quickly finds out, just about everything depends on oil and gas. One of the more startling revelations being that the entire consumer food system in most countries would collapse within a week without fossil fuels. If a shortage continued for long, nothing much would get planted, even on organic farms.

But healthcare? Let's consider it for a minute, in two very different ways. At the most extreme point of use, namely hospitals, energy is the lifeblood. If the grid electricity supply fails, diesel generators have to kick in immediately. Many hospitals have a surprisingly short supply of diesel for their generators -- though some use natural gas, which may be more robust, except in an earthquake.

All material (as opposed to maternal) deliveries and all ambulances depend completely on petroleum. How many days supply do hospitals keep of all kinds of vital devices? If they are like supermarkets, sewage stations and just about every other part of the JIT (just in time) economy, it will be about 72 hours. Just three days. Why three days? Because that's how long it takes for FEMA (the Federal Emergency Management Agency) to arrive. Try telling that to New Orleans.

However alarming these scenarios are, they are short-term issues hinging on supply interruptions. They could be ameliorated by having a larger backup supply of diesel, scalpels, syringes and so forth. Oh yes, and much larger warehouses would have to built to house all of this, not to mention more complex inventory management systems. All of this can be done, but not necessarily quickly or cheaply. Any solution will require careful planning and good execution.

So much for supply interruption issues. For the moment we'll leave aside what would happen if the whole economy got really short of oil or if the Chinese stopped making (and shipping) cheap everything, and turn to a second, much more serious aspect of the question of healthcare and oil decline.

The second issue applies most starkly to America, though it could become an issue in Europe or Canada, if those places don't take account of the dangers. (I am less familiar with other parts of the world, but am very interested to find out more.)

Here's the kind of situation I fear, and one which, thanks to the global recession now unfolding, is already starting to arrive. As an example:yYou lose or leave your job, and decide that you really want to do something that will help the world and the economy become more sustainable, for whatever reason - peak oil, climate change, guilt, love of nature, wanting a decent future for your children. Say you have an expensive graduate degree that you have only just paid off, a spouse and family, and your house now has negative equity, while you are stuck with a sky-high mortgage from the halcyon Greenspan days of borrow now, for tomorrow we die.

In other words, you have got to find some kind of work that still pays pretty well. You start looking around and you realise that if you want to become a maker of good, local furniture or become a gardener or a nurse or a science teacher, you'll have to train for years and go into more debt to pay for it all. At the end of it, you won't make a fraction of what you were earning as a software engineer, lawyer or Chief Financial Officer.

Reality begins to sink in. Something has to give. You decide to rent out your house and move into a much smaller apartment with no garden (which if you want to become a master gardener is not so wonderful), stop buying that nice local wine (not so good for the local economy), and resolve to live on rice and beans. You sell your car, join the local car share and begin to experience the joys of U.S. public transport - you learn never to leave home without a book - War & Peace, for instance.

Now you have downsized everything, given up cable television, dumped your Crackberry, use the local internet cafe for getting online, and signed up for an online course to revive your university science bachelors so that you can start to teach school children about how the world was built on cheap oil (and use Newtonian calculations to avoid the rotten tomatoes thrown at you).

However, there is one thing you dare not dump or downsize: your health insurance payments. You and your family are quite healthy, but what if your little girl really needs urgent medical help or develops one of the many new childhood afflictions that are becoming so ubiquitous? I will leave out the monstrously painful details of navigating the U.S. healthcare insurance morass. The real point is that even with so-called health insurance you never really know if you are going to be covered or whether you will find yourself saddled with six figure debts for the rest of your life. It happens every day in the United States - said to be the cause of up to half of all personal bankruptcies. In a country that calls itself civilized, private health insurance should be regarded as the number one scourge of society. National Public Radio had some poignant stories recently of children with cystic fibrosis, whose families face losing their houses or being forced to divorce in order to keep their child alive - possibly to live a long and reasonably healthy life. How can this be acceptable?

I still remember from nearly forty years ago, a school friend whose sister died of cystic fibrosis when she was about ten years old. Now you can live past sixty if you can get the treatment. Who would not want this for their loved one?

This is what it boils down to: for a society to make it through peak oil and decline, to retool, to return to more local manufacturing, to move back to a somewhat more rural way of life - to relocalize - it is going to need a single-payer universal or national health care system, with some real government control, and the private health insurance companies banished to the economic history books. It will mean that you don't have to worry about how to pay for being ill or having an accident, the very time when you are probably at your weakest. The huge economic and societal benefit of this is that you can then risk turning to a new trade or profession that is rather lower paid than you had planned, because at least you won't be bankrupted by ill health or have to watch someone die because you cannot afford to help them.

Without a healthcare system which is good, quick, and free at the point of use, the transformation to a low-carbon society will get jammed up as surely as the economy is jammed up by the current credit crunch. Just in case anyone doesn't believe a decent national health care system can be done, ask a friend in Britain or Canada, or just about anywhere in Europe. It's not that it is a free-lunch healthcare system - everyone in those countries pays a little bit all the time - it's just that it is free for anyone at any time if you get into trouble. These systems are not perfect, but they are pretty good a lot of the time.

On a transatlantic trip to Britain I once collapsed from stress and exhaustion in a showing of the Russian film 'The Battleship Potemkin' of all things. I was taken to a hospital, examined carefully, looked after and eventually when I was able, I left. I was never once asked for a piece of identification or whether I had any money or a health insurance plan. No bill, no invoice, nothing to sign. I was simply helped when I needed it. Britain brought that system into being - the NHS or National Health System - in 1948, as we Brits reeled in ruins from yet another dreadful world war. My mother nursed all her working life in that system, and I benefitted from it whenever I needed it. Just imagine: doctors actually come and visit you when you are feeling ill! And they don't charge you a penny.

Building a national or universal health care system that covers everyone - rich and poor - can be done, even in a fabulously wealthy country like America. There are plenty of models, including the one just north of the 49th parallel (Canada). If Americans really mean "Yes we can" then America will get a healthcare system fit for humans, a system that will relieve the poor from the agony and fear of falling ill, a system that will favour staying fitter in the first place (with much healthier food), and a system that allows Joe the Lawyer to become Joe the Farmer without having to literally give up his or her life for it. If America can do this, it will be one of the greatest things it has ever achieved. And by freeing people from the fear of losing healthcare, it will help Americans move towards a greener, cleaner, less-oil dependent economy, and thereby help the whole world move away from oil too.

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What a muddle! Where I live in Seattle, some 90% of the electricity our hospitals consume comes from hydro power. In other parts of the country, it mostly comes from coal. Any discussion of the costs of the diesel to power emergency generators for a few days after a major earthquake--historically about once every thirty years here--is irrelevant. Oil could be a $1000 a barrel. Paying that much for one day every decade would make no measurable impact on the cost of providing health care.

Some people, I've become convinced, simply don't have any sense. Julian Darley paid nothing for her brief visit to a British hospital, therefore in her mind it has no real cost in comparison to private systems. And she had no bad experience during her brief stay for an uncomplicated illness, one that mere bed rest in a hotel would have cured. Therefore, all the miseries the British people themselves attribute to the NHS are of no importance.

And Canada? A quick Google search will reveal medical care there has serious problems. In Toronto a few years back, people were waiting months to get a CAT scan because the government had only allocated enough money to keep the machines running 8 hours a day. But if their pet needed a CAT scan, it could be run that same day on precisely the same machines. Pet care was fee-for-service, so the same clinics that by government fiat had long waiting lists for people has no waiting period for pets brought by during evening hours.

Socialized medicine also has nasty side effects. Being old, being overweight, being a smoker will deprive you of some lifesaving NHS treatments in the UK. Being disabled or having a chronic illness in Canada makes it very hard to find a physician. Canada only pays doctors so much per assigned patient, so no doctor wants to take more than a few labor-intensive patients. And Australia and New Zealand now give their health services a veto on new immigrants. Be a bit overweight or have a child with Downs and you'll find a closed door if you want to move there.

From Julian Darley's "yes we can" remark, it's easy to suspect that she voted for Obama and all I can say it, "that figures." Exit polls show that those who voted for Obama were peculiarly clueless when it comes to politics. Almost two-thirds thought Congress was still in Republican hands, something that hasn't been true since 2004. Simply guessing would have gotten that one right 50% of the time.

The O'Reilly website really should spare us this sort of political propaganda. Stick to what you know about, computers and technology, and leave politics to other websites.

Well, I'm sorry I didn't get here before that first commenter, and I wish I had more to contribute, but I really just wanted to thank you, Julian, for making that connection between the affordability of health insurance under our present system and the affordability of trying to make changes in our personal lives for the betterment of all. I have faced this challenge directly, myself, so I can speak from a place of feeling the strain. I know countless others who face the same issues. It's unworkable if your goal is change for the better. Luckily, we do have a new administration coming in, and I think we're on the right road. But yes, better health care is not just about ourselves and our immediate families; it is a major piece in the puzzle for solutions to survival of the entire ecosystem into the future.

Thanks, Julian, you are a great guy!

Peak Oil means the end of health care.

Independent studies conclude that global crude oil production will now decline from 74 million barrels per day to 60 million barrels per day by 2015. During the same time, demand will increase. Oil supplies will be even tighter for the U.S. As oil producing nations consume more and more oil domestically they will export less and less. Because demand is high in China, India, the Middle East, and other oil producing nations, once global oil production begins to decline, demand will always be higher than supply. And since the U.S. represents one fourth of global oil demand, whatever oil we conserve will be consumed elsewhere. Thus, conservation in the U.S. will not slow oil depletion rates significantly.

Alternatives will not even begin to fill the gap. And most alternatives yield electric power, but we need liquid fuels for tractors/combines, 18 wheel trucks, trains, ships, and mining equipment. The independent scientists of the Energy Watch Group conclude in a 2007 report titled: “Peak Oil Could Trigger Meltdown of Society:”

"By 2020, and even more by 2030, global oil supply will be dramatically lower. This will create a supply gap which can hardly be closed by growing contributions from other fossil, nuclear or alternative energy sources in this time frame."


With increasing costs for gasoline and diesel, along with declining taxes and declining gasoline tax revenues, states and local governments will eventually have to cut staff and curtail highway maintenance. Eventually, gasoline stations will close, and state and local highway workers won’t be able to get to work. We are facing the collapse of the highways that depend on diesel and gasoline powered trucks for bridge maintenance, culvert cleaning to avoid road washouts, snow plowing, and roadbed and surface repair. When the highways fail, so will the power grid, as highways carry the parts, large transformers, steel for pylons, and high tension cables from great distances. With the highways out, there will be no food coming from far away, and without the power grid virtually nothing modern works, including home heating, pumping of gasoline and diesel, airports, communications, and automated building systems.

This is documented in a free 48 page report that can be downloaded, website posted, distributed, and emailed: http://www.peakoilassociates.com/POAnalysis.html

I used to live in NH-USA, but moved to a sustainable place. Anyone interested in relocating to a nice, pretty, sustainable area with a good climate and good soil? Email: clifford dot wirth at yahoo dot com or give me a phone call which operates here as my old USA-NH number 603-668-4207. http://survivingpeakoil.blogspot.com/

I wanted to take a moment to thank Mike Perry for his comments, even though he takes issue with what I have written.

For the record, just under half of all US electricity is produced with coal. Almost no oil is now used to produce electricity, except in emergencies. However, during emergencies it is not the price of diesel which matters, it is the availability. Indeed I made no mention of the price, though in ordinary times, price certainly matters a lot.

Regarding my brief stay in a London hospital a couple of years ago, I valued it very highly indeed. For one thing, I had no idea what was wrong - it turned out not be life threatening, but it was very frightening at the time. Furthermore my mother gave the whole of her adult life to nursing, much of it in the UK National Health Service. I grew up on nursing stories, starting in the Second World War, through which my mother trained as a nurse, even during the blitz. Words can hardly express how highly I value those who practice health care.

I have not experienced private health care, but I have experienced national health care in France, England & Canada, and it has been kind, timely and good in every place. And free at the time I needed it. I accept that others may have had different experiences.

There are certainly problems with national health care systems, and poorer areas of a nation may well get a poorer service, but that is not always so.

CAT & MRI scans are important issue, and it is certainly easier to get a scan done quickly if you are rich. However, having worked on the first CAT scanners (invented in Britain) and made films about MRI scanners in the national health service, my research suggested that scans were available in a reasonably timely manner in most places.

One of the reasons why I wrote this piece is that politics, healthcare and technology are going to be intertwined, in part because of the unfolding changes to the energy system. These changes will require a shortening of the supply chain system (which means more domestic manufacturing) and much greater energy and scientific literacy. It will be so much easier for people to consider the long training required to change career and reskill if they don't have to worry about exorbitant health insurance payments or worse still, being denied coverage on a whim from an insurance company. The whole of society becomes a safer and calmer place when people know that healthcare is available without fear.

Regarding my voting in the United States, sadly as a non-citizen, I am not allowed for vote for anything. I can say that I hope very much that Barack Obama can inspire the American people to deliver change for the better - he certainly cannot do it on his own, even with all the kryptonite in the universe.

PS. For better or for worse, I have a Y chromosome or two lurking in my system, which puts me in the male camp of homo sapiens.

This is a timely article in that the US is now suffering the ramifications of living far beyond its means, both fiscally and energy-wise. The present healthcare system is only a few months behind Wall Street and the Big Three in facing its fiscal contradictions. The questions we need to be addressing are about how to reform the system once it begins to crack.

I'n in healthcare and have colleagues in Canada who praise their system. No one worries about going bankrupt, and the waiting lists are for elective surgery. It's not perfect but it is vastly better than what we have in America. When you get sick in Canada you go to the health system for treatment and you get it without worrying how you're going to pay for it.

Finally, speculating about who someone cast their presidential ballot for, using propagandistic terms such as "socialized", and Googling Canadian healthcare to find reinforcing off-the-wall comments are signs of an inability to deal with the argument on the page.

It is a truism that energy descent changes everything and drawing people's attention to the connection with something as essential as health care is an important public service (where are the paid "public servants" in this process?). As Julian Darley points out, this connection needs to be understood and thought through, and the necessary preparations made sooner rather than later.

And there are many examples for the US to learn from. While Canada's system may not be ideal, it is a far sight better than that in the US ( and overall less expensive on a per capita basis). Having had first hand experience with the health care systems in Canada, France and New Zealand, as well as the US, I can attest to the fact there are real, working models out here for the US to learn from.

As a practicing physician in the United States, I see a collapse of our entire health care system just around the corner. The issues of energy, economy, and the environment all weigh heavily into the complex equation that must be considered if we are to preserve ANY sort of health care for US citizens in the coming decades. We must take action as a society, with leadership from both the political and medical arenas.

I have participated in health care in the US, New Zealand, Mexico, Costa Rica, and Bolivia, and what strikes me the most is the excesses and waste of our system here in the United States, as well as our lack of ability to prioritize the most important services. For such a wealthy country, we have the ability to provide even better public and primary care services, but we must make some difficult decisions about how we really want to care for ourselves, especially at the end of life.

Finally, I worry that our ability to make those difficult decisions will be compromised in the near future as our economies tumble and as cheap energy (which fuels so much of what we use in medicine and how we practice medicine) comes to an end. We must act soon, while we still have some financial and energy resources, to work towards improving our medical system. Personally, I prefer a single payor system with Universal coverage for all Americans. If this isn't possible, perhaps tackling it at the state level (ie. California SB 840) or even at the county-wide level is more feasable.

Always a pleasure to read (or hear) you speak,Julian.

I have a hard time understanding the folks who seem to fear universal health care. Have they swallowed whole the propaganda of the insurance industry? Have they personally experienced something bad in countries which have it? Curious.

The main thing that bothers me is that any sort of plan short of universal will leave some people out: the poor, the ill (who've lost work), children, elderly. Is this what we want?

Particularly noxious is the idea of "mandatory" health insurance. What the.... Are they insane? I imagine the health insurance people laughing at us poor saps.

A new topic on Healthcare and the Economy has been started in the O'Reilly Money and Economics Forum.

Well what you don't understand is that in the U.S. things, including health care, aren't run to benefit society, they're run to benefit the tiny minority of major stock holders, HMO CEOs, and other CEOs who place themselves in the food chain of "health care provider". The whole purpose of the industry is to concentrate wealth into their hands.

Of course the single-payer systems delivers more value and better results - just look at our ranking to expenditure rating relative to other countries; it's a joke. But the Ayn Randian True Believers, like Greenspan, and the sociopaths and those hopelessly addicted to their own greed (the Republican party) won't let it happen. Reality be damned; if there's one thing that unites those under the big tent of Republican politics it's their total contempt for science, facts and reality generally, which is seen as just something else for the Roves of their party to "spin"

Single payer health care system? A long long time ago everywhere else. Of course, all those other people are either commies or stupid or sheep, as are the 65%


of non-medical professionals and 60% of medical professionals in this country that want single payer also.


Thank God for the 35% of Republicans in this country who, the chosen, who amongst all people in the world (including all those scientists whose worthless degrees and years of experience the Republican true believers see right through) understand that single payer, while the data may show works the best, stand vigilant to keep this country and its people "free" from an efficient medical system.

Peak Oil may inspire a National Health Care Service, but it will necessarily by short-lived: the National level will atrophy to a vestige. Anything that will have to be accomplished will have to be done at the local level, as it was in the days prior to coal-fired trains.

The five elements, sun (fire), wind (air), marine (water), geothermal (earth) and nuclear fusion (?ether) have yet to achieve their full potential, But for any of all of them to replace fossil fuels is still a hopeful idea.

Its a crazy situation in regards to the oil and gas having a take on everything but I think Obama will do a good job reforming the healthcare system, the question is just how good will it be?

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