Maybe a couple of charts can help strengthen a speculation I keep trying to test out and explain better:
Health, education, welfare, and environmental matters have so many affinities and become so intertwined as major policy matters that it will make increasing sense for policymakers to view them as belonging together as a set, a bundle — indeed as bedrock components for an semi-independent new sector, a commons sector.
Since this has turned into another long-winded post, just skip to view the two charts — they depict the crux of my argument — if you’d rather not wend your way through my prose. The charts are what I’m testing out here. Do they work?
INTRODUCTORY REMARKS (AGAIN)
As I’ve said before, our policymakers have has long treated health, education, welfare, and the environment as matters that fall to our public and private sectors, or that civil-society sectors should attend to. That has been the case for decades. Yet by now, as a result of growing size and complexity, none of these matters fits comfortably in either the public or private sector, and they are way too big and burdensome to leave up to civil-society.
Furthermore, health, education, welfare, and environmental matters are not primarily about maximizing power and/or profit, which is what the government’s public sector and the economy’s private sector are primarily about. Good health, education, welfare, and environmental conditions may be essential for furthering national power and economic productivity, but they are primarily about something else. And the more enormous and complex they become as policy problems, the more important it is to discern and heed that something else.
Here’s my speculative deduction: If we view health, education, welfare, and the environment together, as a set, we can see that they are mainly about maximizing care, broadly defined: people care, life care, planet care, in a sense the care of body, mind, and soul. Viewed as such — as an enormously complex interrelated set of matters that our existing sectors are no longer suited to handling — they look like the most potent candidates for a prospective “fourth sector” — probably a “commons sector” — for our society, as well as for other advanced societies on the verge of evolving from triform into quadriform systems.
HOW HEALTHCARE POLICY MATTERS LOOK TODAY
A couple weeks ago, wondering about the above, I happened across a Wall Street Journal article by Bobby Jindal, plus an editorial and a bunch of follow-up letters, about how Republicans view healthcare policy — a tidy set of articles that highlight concerns found among Democrats as well. It occurred to me that these handy articles could serve as a foil for advancing my argument more quickly and easily than by going through the huge folders and hundreds of articles I’ve been saving for such a task.
These GOP-friendly articles raise a broad range of issues, more than I’m truly interested in right now: The lack of competition in our healthcare system. Its domination by a few large powerful companies. The limited choices and high costs facing consumers. The regulatory impediments to competition. The need for litigation and tax-code reforms. The power of unions intent on preserving employer plans. Et cetera. With much of all this framed in terms of individual vs. collective responsibility, and public- vs. private-sector roles. And with some ideas raised about expanding the roles of collectives, hybrid organizations, and network designs more generally. Plus laments that gridlock and stalemate now characterize our healthcare system. Not to mention more specialized points that arose in these write-ups.
Quite an array of concerns. Quite a muddle too. (And I left a lot out, too.)
What mainly catches my eye, however, is a set of policy principles that were raised, centered around the following: Whether healthcare should be recognized as a right. Whether to accept pre-existing conditions. Whether and how to support primary care, as well as offer preventive services and protect against severe risks that could become terribly costly. Whether and how to allow individuals to chose their plans and services, select tailored options, and at times make changes to them. How to keep all this affordable. Plus how to improve network designs across the system The Republican voices represented by this small set of writings were generally in favor of these policy principles, to varying degrees. Assuming most Democrats and Independents may agree, here’s what these principles look like in a chart — see Figure 1 below:
Now, take another look at that column of policy principles in Figure 1.
Doesn’t it also reflect principles we often see raised about education
policy? As well as about welfare policy? Plus, with language tweaks,
about policy principles for assuring the quality of the environment we
HOW HEALTHCARE AND RELATED POLICY MATTERS MAY LOOK TOMORROW
I’d say the principles in column one do apply not only to healthcare, but also to the policy analyses and dialogues occurring around education, welfare, and environmental matters. And I’m sure I can locate plenty of documents in my computer holdings to substantiate that. Indeed, comparable dialogues and narratives appear to exist in all four areas (health, etc.). Yet, so far, to my knowledge, no analyses exist that have looked across all four areas, assessing whether there are underlying similarities and interlinkages that could help guide policymaking. Isn’t it time to start doing so?
If so, then Figure 1 can be expanded to look like Figure 2 below. All the policy principles in the far left column reach across all four policy domains. Notice, however, that for this post I have presumptuously changed the title. Figure 1 is about a time, the past hundred years of so, today in particular, when policy dialogue is centered around public versus private options (or alternatives). Figure 2 jumps ahead to a future when “commons options” presumably take hold as well, especially for these four matters.
My questions for you as readers are mainly about the two charts: Do they help advance my argument? What else might/should be added to expand the rows, even the column headings? Have you come across depictions or proposals elsewhere that advise viewing, and treating, such matters conjointly?
So far, people have not cottoned to these ideas about putting health, education, welfare, and environmental matters in a distinct sector. Yet people have no problem nowadays thinking that agriculture and industry, not to mention agribusiness, belong together in the economy’s private sector — it’s standard, customary, to do so. Yet, I’d guess — and someday I should try to verify — that there was a time, centuries ago, when agriculture and industry were not viewed as belonging together in the same sector, say because of function, class, or other reasons. But cognitive frames about such matters can change immensely over time.
More to the point, it was only decades ago that health, education, and welfare were indeed bundled under a single U.S. government entity — first with the creation of the Federal Security Agency (FSA) in 1939 by President Roosevelt; then with the FSA’s successor, the Department of Health, Education, and Welfare (HEW), established in 1953 by President Eisenhower. Someday I hope to research the rationales for putting them together like that, since the underlying rationales (“service” being one of them) may apply to justifying the future creation of a new sector as argued here.
Today, partly because HEW became so enormous as a bureaucracy and budget item, a reorganization in 1979 under President Carter led to its components being distributed among new departments: the Department of Health and Human Services (HSS), and the Department of Education ED). Then the Social Security Administration (SSA) was separated out as an independent agency in 1994 under President Clinton.
Today, no one says that health, education, and welfare, not to mention environmental matters, should be recombined under a single government department. That would make no sense. But if my analysis is correct, it will make increasing sense to see them all move into a next/new/fourth sector — hopefully, a pro-commons sector. Today’s MediCare might thus be superseded by, say, a “MediCommons”. Government and business (i.e., the public and private sectors, not to mention civil-society actors) would still have important roles to play; but they would no longer be in charge of overall sector governance after these matters are separated out.
Seen thusly, the emergence of a distinct new sector for health, education, welfare, and the environment would spell an advance in complexity — evolution from a triform to a quadriform society — that would simultaneously bring an improvement in systemic simplicity. Getting their will require combined efforts from myriad civil-society, state, and market actors, undoubtedly across many decades, perhaps driven along by the rise of pro-commons movements. The struggle to construct a quadriformist future has barely begun.
Meanwhile, what do you think of those two charts? Do they help? Enough to make them worth further development?