A few first thoughts. Child care and medical care have changed enormously over the years. Not all of todays' problems are not due simply to a market economy.
Re. medical care: Much has changed since 1961, when I was at my poorest, I could take myself and my children to a doctor who charged between $2 and $5 including any shots and medicine needed. Later, as a college student in Chicago, students and faculty gravitated toward a doctor with his own practice, who spent as much time as needed with each patient -- over an hour if need be. (We went expecting to wait, knowing that when our turn came, it would be worth it. And he accepted whatever insurance you might have. By then I had a bit.) Even in Atlanta in the 1970's, there were doctors who'd come out to the home with their black bags when need be. And in the early 1980's, after I moved from Atlanta into rural woods, the nurse practitioner in charge of our local clinic spent as much time as one wished. He always stayed firmly seated and relaxed, when he asked "Is there anything else you'd like to talk about?"
Of course, just reading 19th century novels reminds me that there have always been doctors who looked on their work as a sacred vocation, and doctors who simply wanted to make as much money as they could. There are perhaps more temptations now for doctors to prioritize money -- especially if their practices are in neighborhoods or cities where doctors are expected to participate in high society.
However, there are significant factors not so entangled with the market economy that have caused huge changes in medical care. The rise in lawsuits forced providers to buy increasingly expensive liability insurance. The rise in the cost of medical education leaves most graduates owing huge debt. In the 1980's insurance companies gained more and more power not just over costs, but on vital treatment decisions. Providers are now pressured by patients who've seen ads and commercials for specific medications. And somehow it became okay for providers to advertise their services -- something that professionals just did not do.
These things are entangled with the way the market works in the United States, but weren't inevitable. Perhaps inevitable, though, given the way our economy and culture have evolved over past decades, are certain current trends. One is the massive trend toward consolidating providers into larger and larger networks and "mega-hospitals," Also based on cost efficiency is the rise of "hospitalists" who take charge of patients, leaving their own doctors out of the treatment decisions.
Working within this increasingly hindering environment, there are still doctors who go even further than the extra mile to get to know their patients as persons, not cases, and who will find ways to give treatment to people who can't pay the usual charges. These outliers might increase in number if the system separated insurance from employment, so that everyone could be freer to shop for a doctor. That could at least be a step toward evening out the current power imbalances that tilt mainly toward corporations.
If you've never read Ivan Illich's works, take a look at "Medical Nemesis: The Expropriation of Health." That book, first published in 1974, may be why I never refer to medical care as "health care." They're not the same.
Not commenting here, yet at least, on child care as infrastructure. More rules tend to lead to unintended negative consequences. And I'm still a proponent of a free-learning or only slightly more structured approach to the education of children. Lots of examples of kids not learning to read till age 9 or 10 when they just hadn't been interested enough till then to learn. Thank God we don't expect kids to get a good paying job at age 11, so there's still a lot of flexibility and personalization without ruining a child's future life. (And yes, Illich is also well known for his 1971 book, "Deschooling Society."
Ooh! Thank you for recommending her. I looked at her website, love her photograph -- total contrast with the "sexy seductive pose" self-branding photo so common these days. Then when I read her theme of "doctor as gardener" I was immediately brought in. Another of my favorites, Lawrence LeSha, wrote a book with that theme, "The Mechanic and the Gardener" (1982). My favorite of his books is "Cancer as a Turning Point," which explores the psychosocial triggers of cancer and more importantly, how to use awareness of these factors to heal from cancer. Like Carl and Stephanie Simonton, LeShan was given only the patients that medical doctors had given up on for any treatment. Using these approaches, many got well and recovered completely.
> "for a particular neighborhood is working out" <-- I think you meant "isn't" here.
> "seems like a way of sneaking in the claim “childcare is good” or “childcare is important” without having to talk as explicitly about values" <-- Ahhh! (Only slightly-topically, hasn't the locus of the word "healthy" shifted to encompass "good"/"morally-right"? Like, you don't talk to someone about whether there's something wrong with their actions or tendencies; you question whether it's healthy.)
A few first thoughts. Child care and medical care have changed enormously over the years. Not all of todays' problems are not due simply to a market economy.
Re. medical care: Much has changed since 1961, when I was at my poorest, I could take myself and my children to a doctor who charged between $2 and $5 including any shots and medicine needed. Later, as a college student in Chicago, students and faculty gravitated toward a doctor with his own practice, who spent as much time as needed with each patient -- over an hour if need be. (We went expecting to wait, knowing that when our turn came, it would be worth it. And he accepted whatever insurance you might have. By then I had a bit.) Even in Atlanta in the 1970's, there were doctors who'd come out to the home with their black bags when need be. And in the early 1980's, after I moved from Atlanta into rural woods, the nurse practitioner in charge of our local clinic spent as much time as one wished. He always stayed firmly seated and relaxed, when he asked "Is there anything else you'd like to talk about?"
Of course, just reading 19th century novels reminds me that there have always been doctors who looked on their work as a sacred vocation, and doctors who simply wanted to make as much money as they could. There are perhaps more temptations now for doctors to prioritize money -- especially if their practices are in neighborhoods or cities where doctors are expected to participate in high society.
However, there are significant factors not so entangled with the market economy that have caused huge changes in medical care. The rise in lawsuits forced providers to buy increasingly expensive liability insurance. The rise in the cost of medical education leaves most graduates owing huge debt. In the 1980's insurance companies gained more and more power not just over costs, but on vital treatment decisions. Providers are now pressured by patients who've seen ads and commercials for specific medications. And somehow it became okay for providers to advertise their services -- something that professionals just did not do.
These things are entangled with the way the market works in the United States, but weren't inevitable. Perhaps inevitable, though, given the way our economy and culture have evolved over past decades, are certain current trends. One is the massive trend toward consolidating providers into larger and larger networks and "mega-hospitals," Also based on cost efficiency is the rise of "hospitalists" who take charge of patients, leaving their own doctors out of the treatment decisions.
Working within this increasingly hindering environment, there are still doctors who go even further than the extra mile to get to know their patients as persons, not cases, and who will find ways to give treatment to people who can't pay the usual charges. These outliers might increase in number if the system separated insurance from employment, so that everyone could be freer to shop for a doctor. That could at least be a step toward evening out the current power imbalances that tilt mainly toward corporations.
If you've never read Ivan Illich's works, take a look at "Medical Nemesis: The Expropriation of Health." That book, first published in 1974, may be why I never refer to medical care as "health care." They're not the same.
Not commenting here, yet at least, on child care as infrastructure. More rules tend to lead to unintended negative consequences. And I'm still a proponent of a free-learning or only slightly more structured approach to the education of children. Lots of examples of kids not learning to read till age 9 or 10 when they just hadn't been interested enough till then to learn. Thank God we don't expect kids to get a good paying job at age 11, so there's still a lot of flexibility and personalization without ruining a child's future life. (And yes, Illich is also well known for his 1971 book, "Deschooling Society."
I've really loved Victoria Sweet's books on medicine.
Ooh! Thank you for recommending her. I looked at her website, love her photograph -- total contrast with the "sexy seductive pose" self-branding photo so common these days. Then when I read her theme of "doctor as gardener" I was immediately brought in. Another of my favorites, Lawrence LeSha, wrote a book with that theme, "The Mechanic and the Gardener" (1982). My favorite of his books is "Cancer as a Turning Point," which explores the psychosocial triggers of cancer and more importantly, how to use awareness of these factors to heal from cancer. Like Carl and Stephanie Simonton, LeShan was given only the patients that medical doctors had given up on for any treatment. Using these approaches, many got well and recovered completely.
> "for a particular neighborhood is working out" <-- I think you meant "isn't" here.
> "seems like a way of sneaking in the claim “childcare is good” or “childcare is important” without having to talk as explicitly about values" <-- Ahhh! (Only slightly-topically, hasn't the locus of the word "healthy" shifted to encompass "good"/"morally-right"? Like, you don't talk to someone about whether there's something wrong with their actions or tendencies; you question whether it's healthy.)
Thanks for the catch!
Huh! I've never seen anything like that here.