Moreover, the Affordable Care Act is merely the latest in a century-long line of legislation ostensibly aimed at increasing the affordability of health care, but which by subsidy have locked in a status quo of needlessly high levels of costly treatment required in order to receive any level of health care, crowding out innovations in the lower-cost methods and self-help advocated by Dr. Gordon.

As Ivan Illich observed in 1975 in Medical Nemesis:

“Awe-inspiring medical technology has combined with egalitarian rhetoric to create the impression that contemporary medicine is highly effective. Undoubtedly, during the last generation, a limited number of specific procedures have become extremely useful. But where they are not monopolized by professionals as tools of their trade, those which are applicable to widespread diseases are usually very inexpensive and require a minimum of personal skills, materials, and custodial services from hospitals. In contrast, most of today’s skyrocketing medical expenditures are destined for the kind of diagnosis and treatment whose effectiveness at best is doubtful.”

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“Many economists believe that health care costs will continue to rise. Even more distressing, the Affordable Care Act will likely reinforce current practice, which dictates surgical and pharmacological interventions that can be expensive, inappropriate, burdened by side effects and, often, ineffective.”

Moreover, the Affordable Care Act is merely the latest in a century-long line of legislation ostensibly aimed at increasing the affordability of health care, but which by subsidy have locked in a status quo of needlessly high levels of costly treatment required in order to receive any level of health care, crowding out innovations in the lower-cost methods and self-help advocated by Dr. Gordon. As Ivan Illich observed in 1975 in Medical Nemesis:

“Awe-inspiring medical technology has combined with egalitarian rhetoric to create the impression that contemporary medicine is highly effective. Undoubtedly, during the last generation, a limited number of specific procedures have become extremely useful. But where they are not monopolized by professionals as tools of their trade, those which are applicable to widespread diseases are usually very inexpensive and require a minimum of personal skills, materials, and custodial services from hospitals. In contrast, most of today’s skyrocketing medical expenditures are destined for the kind of diagnosis and treatment whose effectiveness at best is doubtful.”

Such will be the inevitable result as long as the necessity of bailing out the capital-intensive, mass-production model of delivery of uniform service by a favored professional elite to passive recipients — the bête noire in all of Illich’s work, from health care to education to energy — is assumed necessary to guarantee a modern standard of quality. Which it is not. In the same year’s Neighborhood Power, David Morris and Karl Hess observed: “We are most dependent upon outside experts when we are ignorant — and we are probably most ignorant about our own bodies. Even our cars are more open to common-sense knowledge than our bodies.” In surveying the simpler forms of health care, Morris and Hess conclude: “Surely such service could be administered by less than fully trained M.D.’s.”

Historian David T. Beito, in summarizing his extensive research on the lodge practice which provided low-cost health care to millions of members of early twentieth century fraternal societies before the model was deliberately crowded out, notes that they “opened up rare opportunities for many working-class Americans to compare and experiment and empowered them with the necessary economic clout to break free from the confining view that health care was merely a generic good.”

The ephemeralization of twenty-first century technology would only make a revival of lodge-style cooperative, nonprofit, red-tape-free provision of basic health care even more feasible. Just like Morris and Hess’s urban farming and solar power, as the perverse effects of the current model become too widespread to prevent its crumbling, such current overlooked successes as the Ithaca Health Alliance could spread from isolated exceptions to a burgeoning essential in a post-industrial society.

As Dr. Gordon notes, legislation ostensibly aimed at increasing the affordability of health care has had the effects of locking in a status quo of needlessly high levels of costly treatment required to receive any health care and of crowding out self-help and innovations in lower-cost methods. This will be the inevitable result as long as the necessity of subsidizing the capital-intensive, mass-production model of delivery of uniform service by a favored professional elite to passive recipients is assumed necessary to guarantee a modern standard of quality.

Historian David T. Beito notes that the lodge practice system which provided low-cost health care to the members of early twentieth century fraternal societies “opened up rare opportunities for many working-class Americans to compare and experiment and empowered them with the necessary economic clout to break free from the confining view that health care was merely a generic good.” A modernized revival of the lodge model of cooperative, nonprofit provision of basic health care, along the lines of the Ithaca Health Alliance, would avoid the perverse effects of the current mass-industrial model.

Michael Levy, an inmate at Arizona State Prison, arguably faced even worse neglect from prison healthcare providers. After 15 days of headaches and chest pains, he was only given ibuprofen. Fourteen days later he complained that these symptoms persisted in excruciating ways, and requested an MRI. Officials ignored the request, and he continued to file requests over several months. Eventually, Levy experienced an aneurysm and a stroke. According to Tucson News 4, “Doctors recommended the inmate do aggressive physical therapy, but Levy’s health care provider Corizon stepped in. … Corizon denied his rehab with St. Joseph Hospital and Medical Center in Phoenix ‘due to the cost of rehab.'”

These recent incidents of prison healthcare neglect are not unique. In her book Resistance Behind Bars, Victoria Law describes the case of Michelle Everett, a prisoner in Oregon who repeatedly requested medical care but was ignored. “She was given medical attention only after turning yellow,” Law writes. “After both hepatitis and cirrhosis of the liver were ruled out, she was told that a bile duct was obstructed, but that the prison could do nothing about it.”

For-profit companies often contract with prisons to provide healthcare. Yet their incentives differ substantially from what we would see from healthcare providers in a free market. While these companies are cost-sensitive due to the impact of costs on their profits, their clients are not prisoners, but the state. These contractors have a state-secured monopoly within the prison, so prisoners are not free to seek services from competing firms.  These incentives predictably produce abysmal care. Victoria Law describes two companies that engaged in particularly egregious forms of neglect. One is Prison Health Services (PHS). Writes Law:

A yearlong investigation by the New York Times found that the care provided by PHS was often deficient, flawed, and/or lethal. According to the Times, state investigators scrutinizing ten prisoner deaths came to the same conclusions after finding the same circumstances in each case: to cut expenses, PHS trimmed medical staffs, hired underqualified doctors, had nurses doing tasks beyond their training and withheld prescription drugs. The investigators also found that PHS allowed patient records remain unread and employee misconduct to go unpunished.

Similar neglect has been perpetrated by Correctional Medical Services (CMS). “An investigative article in Harper’s revealed that CMS stymies those seeking treatment for hepatitis C, requiring them to fulfill a long list of conditions, known as ‘the protocol pathway,’ before they can receive any care,” writes Law. This reprehensible behavior is predictable given the incentives prison medical contractors are given.

Problems in prison and jail healthcare are systemic. Prison healthcare services are often understaffed. Moreover, prison is characterized by cruel, austere, and punitive conditions, such as hard and uncomfortable beds and inadequate or unappetizing food rations. The only way to get more bedding or better food is typically a medical exemption, which means that understaffed medical services find themselves swamped with inmates who are simply seeking better accommodations. This makes it harder to detect serious medical issues and respond to them in time.

The mentally ill, the poor, drug users, and sex workers all face increased risks of health problems. Yet our society warehouses members of these groups in institutions where healthcare access is systematically denied. Problems with prison healthcare are not isolated incidents; they’re signs of a structural problem.