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.