A Mennonite family we know had to take one of their children to the hospital recently. He had stepped on a wire (barefoot, I assume, since that is how Mennonites spend the warm months), and his foot had become badly infected. A week later I asked how he was doing, and was told that the doctors still hadn’t figured out what was causing the infection. My heart sank at that; last year we spent three days at the hospital with newborn Peter and incurred $13,000 in costs, only to hear that they were unable to figure out what was wrong with him but that whatever it was he seemed to be over it. The Mennonite boy is home now, after twelve days in the hospital; they never figured out what was wrong, but he is doing better now. I have no idea what that episode will cost the family, which on principle does not carry insurance.
If anyone ever develops an agrarian economics, it will be either Wendell Berry or someone who builds on the important foundational work he continues to do. His latest essay on Faustian economics is now available to read at the Harper’s website, and I recommend it highly. One thing he mentions is how in today’s predatory economy the so-called free market is only free for some:
Some of us would-be humans have thought too that we should not be free at anybody else’s expense. And yet in the phrase “free market,” the word “free” has come to mean unlimited economic power for some, with the necessary consequence of economic powerlessness for others.
Several years ago, after I had spoken at a meeting, two earnest and obviously troubled young veterinarians approached me with a question: How could they practice veterinary medicine without serious economic damage to the farmers who were their clients? Underlying their question was the fact that for a long time veterinary help for a sheep or a pig has been likely to cost more than the animal is worth.
And even if the cost is less, it may be a matter of throwing good money after bad, preserving an animal which will never thrive. In his writings on raising meat animals, Gene Logsdon suggests the most prudent course is usually not to intervene at all. He mentions a rancher who simply put his animals out to pasture in the spring and rounded them up in the fall, figuring that any that were lost over the summer were being culled by nature.
I had to answer that, in my opinion, so long as their practice relied heavily on selling patented drugs, they had no choice, since the market for medicinal drugs was entirely controlled by the drug companies, whereas most farmers had no control at all over the market for agricultural products.
My questioners were asking in effect if a predatory economy can have a beneficent result. The answer too often is No. And that is because there is an absolute discontinuity between the economy of the seller of medicines and the economy of the buyer, as there is in the health industry as a whole. The drug industry is interested in the survival of patients, we have to suppose, because surviving patients will continue to consume drugs.
I would only disagree with the final sentence. I do not think that the drug industry is interested at all in the survival of its patients; if it could find a way to make good money from drugs that killed people or animals, it would do that as well. What the medical industry is interested in is convincing potential customers that the work done by its products and procedures is vital, whatever that happens to be. During our three days in the hospital with Peter there was never a single question raised, by us or the practitioners, about whether a particular procedure was needed. In fact, one particular procedure was clearly not needed, as a nurse happened to say when the doctor who ordered it was out of the room; but it was performed anyway, and charged for afterwards.
Berry contrasts this with an example of what he calls community economics:
Now let us consider a contrary example. Recently, at another meeting, I talked for some time with an elderly, and some would say an old-fashioned, farmer from Nebraska. Unable to farm any longer himself, he had rented his land to a younger farmer on the basis of what he called “crop share” instead of a price paid or owed in advance. Thus, as the old farmer said of his renter, “If he has a good year, I have a good year. If he has a bad year, I have a bad one.”
This is what I would call community economics. It is a sharing of fate. It assures an economic continuity and a common interest between the two partners to the trade. This is as far as possible from the economy in which the young veterinarians were caught, in which the powerful are limitlessly “free” to trade, to the disadvantage, and ultimately the ruin, of the powerless.
In our own situation, the members of the medical establishment were the powerful and we were the powerless. Can we imagine an alternative scenario where both of us shared a common interest and a common fate? Say, paying for treatments of conditions identified (if the patient elects to take them), but not for the identification process itself?