Health care as a global public good translates into every person having access to the highest quality medical treatment at all times in all places. The importance of the health and well-being of the individual takes priority over any system of government, economy, law, or spirituality presently available. All currently fail to recognize and respect the divinity of the individual. The choice by the political leadership in the United States to limit our ability to receive care when we are in need creates significant barriers to individual actualization at all stages of life. Whether through the long-term consequences of an illness, the crippling debt many absorb in emergencies, or death from denial of care, our present systems of meaning and value fail to address one of the most basic and common struggles of being human—illness and injury. Of all the eight dignities, a global health-care system is perhaps closest to our grasp.
Anthropologist Margaret Mead spoke of the first evidence of civilization as being a fifteen-thousand-year-old human thigh bone with a healed fracture. “Such signs of healing are never found among the remains of the earliest, fiercest societies. In their skeletons we find clues of violence: a rib pierced by an arrow; a skull crushed by a club. But this healed bone shows that someone must have cared for the injured person—hunted on his behalf, brought him food, served him at personal sacrifice.”29 Many nomadic warrior tribes would not devote the necessary focus, energy, and resources to mending such a serious injury. That the healing of the injured could signify the dawn of human cooperation is a moment in our time experience worth remembering. Empathy for the other is a defining characteristic of what makes us human. Most historical religions developed some form of the golden rule: to treat others the way you would desire to be treated.30 So why does a country so loudly devoted to spirituality like the United States reject translating this spiritual belief into a system? We reject the frameworks and ideas supporting the dictation of individual well-being by private interests in their entirety. Health care is a human dignity, an undeniable right for inhabiting the immediate present. This is a glimpse of the exponential progress of our shared intelligence. What the birth of civilization and the rebirth have in common is that both are determined by our choice to be healers. Humanity made that decision in the past. Now we must make it again, this time with the added resistance of a well-financed network of organizations.
Many organizations throughout the US work to demonstrate the data, need, and public demand surrounding transitioning the US to a public health-care model. Every other industrialized nation on the planet provides universal access. These programs differ in application, but all believe health care is a human right and dignity. The health care system in the United States fails patients and doctors alike. Patients pay on average twice as much for their care compared to other industrialized nations in the Organization for Economic Cooperation and Development (OECD). Despite this, US rates of chronic disease are double the OECD average, and the country ranks number one in avoidable deaths and people entering our hospitals for preventable causes.32 A separate study estimates a national health-care system in the United States would save about 13 percent of total costs (about $450 billion annually) and could be funded for less money than is currently being spent by employers and households paying for existing premiums. It concludes that approximately 68,000 lives would be saved per year under a nationalized health-care system.33
Our health-care organization fails medical professionals by burdening them with processes and procedures supporting the for-profit insurance industry. Doctors in the United States spend about four times more than doctors in Canada dealing with insurance providers. Nursing staff, including medical assistants, spent 20.6 hours per physician per week interacting with health plans—nearly ten times that of their Ontario counterparts. If US physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately 27.6 billion dollars per year.34 Medical practitioners are also frequently unable to provide patients the most technology advanced and low-risk procedures due to insurance regulations. In ophthalmology, laser eye surgery is recognized by surgeons as the ideal choice for both patient safety and procedural outcomes. However, many insurances only cover the outmoded physical surgeries that use hand-held scalpels to operate on the eye. In this example, for-profit insurance companies dictate a less effective and higher-risk procedure so they profit more. This type of greed is unacceptable and a foolish squandering of our shared progress. It also illustrates how profit incentives corrupt the nature of health-care practice. It is unethical and immoral to dictate the dignity of care one receives in relation to their capital holdings.
Arguments supporting the continued privatization of health care often focus on performance, but there is no relationship between the extra costs of private health care and patient outcomes.35 A study of Medicare data on 4.8 million patients and 4,571 hospitals, 237 of which converted to a for-profit model, showed no discernable difference in the quality or frequency of care offered to individuals.36 A separate study found that for-profit health-care institutions changed the type of services they provided, focusing on the most profitable services such as surgery while neglecting to advance less profitable avenues such as home health care.37 Hospitals operating under profit-driven models also have higher rates of repeat patient visits, calling into question the patient benefit of these additional appointments.38 Debunking the argument that a for-profit model is necessary for efficiency, a 2006 study by the Congressional Budget Office demonstrated that operating expenses in for-profit hospitals were only 0.5 percent lower than nonprofit hospitals.39
The origin of coupling employment and health care in the United States began during World War II. Tight labor markets forced employers to improve their incentives to attract workers to their factories.40 Thus began the practice of tying employment to health care. In 1945, President Harry Truman introduced an opt-in public health-care system but ultimately failed due to strong resistance from lobbyist groups and corporate interests.41 Similar to the propaganda tactics of the present, Truman’s efforts to nationalize health care were decried as “socialism” in an effort to reduce their popularity. The intertwining of health care and employment has always prioritized the interests of the corporation over the individual. Our journey toward enshrining health care as one of the eight dignities in many ways frees us from the decisions made by men long dead.
When it comes to health care as a human dignity, the foundational question we must ask ourselves is, how expansive can we imagine? We want to build a society of healers because it is an area of focus that will always be in demand and will benefit humanity in the imaginable future. To do this, we must think beyond health insurance, reimagining several aspects of how we organize medicine and care. How can we accelerate the ability of medical professionals and organizations to experiment and innovate in their respective fields? What do the pathways toward mastery look like within medical verticals, and how can we best encourage access to them? What are superior alternatives for advancing and distributing medical technologies?
These questions go beyond access, moving us toward deeper agency for all participants within health and medical verticals. We understand that even our baseline examples of national health-care programs exist in perpetual conflict with for-profit models of care facilitation, experimentation, and innovation. Our goal is to shift health care toward a direction of endless innovation and progress, self-sustaining and ever-evolving, without concern for shareholder profits. Systemic actualization offers an alternative: a system of health care where people are prioritized and projects are shared between organizations to accelerate progress and access for the people they serve. Global health-care DAOs will seek to address these questions and more through the development of a global cooperative of medical innovation and implementation.
If a medical global cooperative seems complex on the surface, it’s because it is. Every specialty vertical leverages unique tools and equipment to perform its best, but there are commonalities among all medical practices that provide a good starting point. Consider the material needs of any medical organization, such as disposable sanitary items, including masks, gloves, and needles. We begin by requiring all hospitals to perform audits detailing the flow of sanitary goods into and out of their operations, focusing on quantities in relation to geography, time of year, and other relevant data points.
After sufficient information is collected, we can use algorithms to identify common trends between the independent organizations and begin the work of consolidating purchases and distribution to maximize efficiencies in the manufacturing and logistics of said goods. Complete public ownership of hospitals empowers us to reorganize the purchasing of these goods, leveraging the total buying power of all firms to reduce material costs and sync deliveries to be as fuel and time efficient as possible. The purchasing process becomes a collaborative effort, where each organization contributes their purchasing needs for a specified time frame and the total material bill is presented to the manufacturers with a specified price point. Sanitary disposables make a good use case for several reasons. There is little to no innovation in the sector; a latex glove serves its purpose independent of the organization using it. Production costs are relatively stable, allowing the global cooperative to set purchasing points that reduce costs while avoiding instabilities in availability. They are also necessary to the operation of these organizations, an unavoidable cost of performing health care that is not going away anytime soon.
How do we ensure manufacturer adaption and cooperation within this new operational framework? Sticking to our example framework, most organizations making disposable sanitary products do so as part of a much larger product line. There are several legal innovations we can create to help facilitate this process. We can create a process where the disposable manufacturers enter cooperative sales agreements depending on individual capacity. For example, the total order of the hospital cooperative might exist as three separate agreements broken down into a 50 percent, 30 percent, and 20 percent split among manufacturers—all three manufacturers taking on both shared and independent responsibilities within the contract. The global hospital network is not subject to standard market operations; instead of soliciting bids, it puts forth a project and designates which manufacturers will produce the goods at what price. One possible pitfall is that smaller organizations are unlikely to produce the products at the same cost as the larger organizations, creating potential conflicts with the price points set by the hospital co-op. However, an organization would rarely attempt to enter such a saturated market vertical without already possessing the scale of clients to serve. These goods are not innovation or competitive centers for the organizations producing them.
As with the other global public DAOs, our objective is to create an entirely new set of laws to govern our relationships with the world. Sticking with the sanitary disposables example, we might leverage corporate modules to create new goods classifications to spin off these specific production verticals to a public ownership classification within the existing organization. This allows greater degrees of cost and price control as well as operational efficiencies. We support this objective by customizing the incentives for the spin-off modules. In our current example, we might embed incentives into modules such as public assistance in material purchasing, reducing tax costs associated with labor during the production process, access to publicly owned logistic and transportation networks at no cost, and more. In keeping the benefits directly aligned with the module's operation, we ensure that the benefits apply to certain standardized items and the raw materials necessary to produce them. This solution of breaking apart the independent aspects also offers a smooth transition for the worker, as operations continue as usual within the independent organization—only the bookkeeping changes. This streamlining of material goods at scale reinforces a deeper cooperation within humanity and our medical verticals beyond the borders of the corporation and the nation-state. Corporate modules are only limited by our imagination and allow us to radically reshape organizational operations within globally integrated economic verticals.
Consider also medical research. Today, basic discovery research for new medicines is funded primarily by governments through university grants and philanthropic organizations. Late-stage development is funded mainly by pharmaceutical companies or venture capitalists. Transitioning from the initial discovery to a drug that functions as intended is capital intensive and subject to high failure rates, with cost estimates exceeding $1 billion.42 Organizations and people with the resources to fund these projects do so with the intent of recouping their investments through the profits. For-profit companies now handle much of the innovation in medical devices, technologies, and medicine development.
As we might expect, having verticals of medical advancement dependent on profit seekers creates a system that overlooks and ignores aspects of our health that are less lucrative, such as rare diseases. It also creates unnecessary inefficiencies such as redundant research, where companies focus on problems that another organization has already resolved. Operationally, these companies waste hundreds of millions of dollars advertising new drugs to sell more. The United States has developed health-care systems that prioritize maximizing drug distribution to benefit the bottom line. A public global health-care network will serve to make medical research more efficient, expansive, and progressive.
Reimagining medical research and development is necessary because it is a path to progress for all of humanity. Global health-care systems owned by the global public reject the idea that collective medical progress should be bound to the profit interests of a small minority of shareholders. We challenge the notion of competition as the ideal form of advancing medicine, instead opting for a form of organization where medicine development and distribution falls under the global public domain. This is accomplished by developing public institutions and laws binding medical research, testing, and development into transparent public access, making past and present progress accessible to all. It’s a form of organization ensuring the most efficient use of time and resources during all development phases, allowing experimental individuals and groups to explore processes in different directions. It removes the opportunity for organizations to profit by denying others access to information. It is at its core a removal of financialization from human health care in all verticals. Most importantly, the transition of medical development to the public sphere ensures that everyone possesses the access necessary to receive the care they need. It represents a major step toward eliminating birth lottery as the primary determining factor in individual access and agency.
To illustrate this concept, we can use the most direct comparison: open-source software. Individuals and teams work together on projects by improving the original source code or integrating additions. Everyone involved in the project begins with all available knowledge at their fingertips, allowing them to leverage the totality of collective progress toward problem solving and iteration with the moment. Completed improvements are submitted to be incorporated into the main product line or remain as independent additions to serve a specific purpose. In the case of disagreements on direction, groups can split into separate productivity paths. It is a system that encourages collective progress to the highest degree, allowing anyone with the knowledge and time to contribute. Contrast that to private medicine development, which occurs behind closed doors to closely protect information to generate profits, and we can see why the public domain model is ideal for a systemically actualizing society.
So how do we address the costs of developing new medicines under a system of open access information? Can organizations remain solvent when they spend billions of dollars and hundreds of hours developing medicine while simultaneously sharing that information and research process with the world? The answer is yes, if we’re willing to continue pushing the limits of our structural imagination.
Currently, profits from medicine development are typically concentrated in the first company to successfully pass governmental regulations and patent the development process. This model encourages the price gouging we currently experience in nearly every medical vertical. Medicines necessary for survival are marked up as much as 5,000 percent above cost to satiate the greed of a small minority. Companies leverage the pain and suffering of some for profit while outright denying others access to care because they lack capital. When we align the production of medicine with profit incentives, we create a health-care ecosystem that perpetually gets more expensive and more exclusive each year.
Consider how a health-care system that cannibalizes the people it serves for the benefit of a few might function as the crisis continues to spread. More death and misery. If our vision of medical development is limited to a model where making money off the pills is the primary focus, it’s only a matter of time before an even more significant portion of our population will not have access to the best our species can offer. Our present disregard for the other lacks alignment with the single truth and the relational universe. Transitioning health care into a global public vertical helps align these systems with our reimagined core values.
When all medical development projects are public-facing, research becomes less about ownership and more about participation. A global health-care DAO empowers the tracking of organizations' involvement in a project by both hours and milestones by using software to record labor investment. Organizations register to participate in projects by committing teams and resources to aspects of the development. Material costs incurred are reimbursed through collective fund pools so long as they are project-relevant and within the established scope of the research being conducted. Medicine, as an aspect of health care, takes root in the idea that quality care and progress belong to all of us as a birthright, so we have to make sure we align our incentives with our values, imagining a scenario similar to our medical disposables example. Research and development firms would be paid for their contributions in relation to the total project.
It’s important to note that under our public model, researchers receive compensation for both their successes and (genuine) failures. We cannot frame medical development as a public service while only rewarding the winners. This defeats the purpose of a more inclusive structural approach and ensures that only the most prominent firms will benefit. Teams completing project milestones will receive additional rewards beyond the standard compensation. These bonuses flow directly to those participating in the various work verticals, not to organizations or owners. Similar to standard practice, all processes and progress must be well documented and replicable by independent third parties in order to finalize completion.
New initiatives spring to life through public needs and in coordination with experimental research firms and academics. Global standards for medical research and development expand the amount of potential research and experimentation occurring at any given time. The health-care DAO would ideally facilitate this connectivity while also empowering professionals to become involved with projects of interest, creating pathways for deeper connections between medical professionals and researchers to collaborate.
Rewards and compensation for projects can be determined based on demand, difficulty, and potential for success. Checks and balances such as projects requiring a certain number of participants before launching, random peer review audits, and democratic feedback can be embedded into our process to diminish fraudulent activities. We can imagine a steady stream of projects that make persistent, incremental progress over a broad scope of medical verticals, as well as bolder attempts to solve big problems that may be out of reach in the present moment. Organizing the advancement of medicine in this format breaks the stranglehold large corporate monoliths presently hold over us. Through this open and democratized approach, we reimagine the progress of medicine beyond profit motives, giving way to a new era of research and development.
Because our objective is to create a cooperative global health-care network, it is essential to develop alternative pathways of learning and certification for medical professionals. Most doctors leave medical school saddled with debt. The median medical student owes 232,800 dollars at the time of graduation.42 Assuming a thirty-year loan at 6 percent interest, that financial burden increases to a lifetime total of 502,471.30 dollars. This debt combines with the established frameworks of operation to encourage profit-seeking behavior by doctors. Health care as a human dignity embraces our core values of relation and equity in recognizing the individual divinity each possesses. We cannot inhabit such a system when those taking on the responsibility of our care and well-being are forced into circumstances of extreme debt. We should seek to develop medical professionals with a passion for healing and the capacity necessary for the prolonged direction of focus and energy toward deep learning. Finances before or after the long and arduous training should be a nonfactor. Doctors and other medical professionals should be incentivized with a standard of compensation beyond the eight dignities, but not through the commodification of the patient. The health-care DAO would be the ideal organization to facilitate medical education and training and is in alignment with the larger theme of the best DAOs becoming the best schools. We can imagine that over time this direction of focus and energy will intertwine with a permanent research institution. The health-care DAO might also serve to support the research, development, and proliferation of medical devices and automation technologies. When we frame our collective well-being as the intention of health care, a publicly owned global system is the most logical and effective method of realization.
Earlier, I mentioned how the establishment of health care as an inalienable human right is perhaps the most closely realized of any of the eight dignities. Should the United States choose to transition into a public health-care model, it could easily marshal the rest of the world to join a collaborative project. Health care is the path of least resistance toward the first major global public works project. It would reinforce unity in moments of increasing uncertainty, laying the foundation for our collective cooperative powers to flourish in the development of an alternative framework of humanity. That our political class lacks the courage necessary to join the rest of humanity in classifying health care as a human dignity is pitiful and unlikely to change because our representatives partner with private interests in resisting public health care. There have been prolonged efforts by organizers and activists to bring a public health-care option into the political dialogue, but all have failed to do more than accomplish some minor political theater. Their error was not in their intent or effort but rather in believing that those representing a hierarchical system of law and politics would ever serve as a vehicle toward broad public works. To this end, the health-care DAO may serve as an alternative, incrementally progressing through specific physical locations in the US while organizing morally advanced societies toward the global cooperative model.
Systemic actualization is an effort toward the empowerment of a more expansive human time experience, one where the individual is unburdened by the birth lottery they inherit. Good health and access to care are fundamental to individual actualization; without it we lack the security to pursue our productive activities in the directions of our choice. We choose to embrace health care as one of the eight dignities because it is profoundly freeing, ensuring that our productivity and participation are not limited to the scope of organizations that provide health care. It is one of the most fundamental projects we can undertake in our journey toward systemic actualization, one that is within our grasp. A global public health DAO will have profound impacts on how we view ourselves and others within society. It is a direct expression of our core values of relation, equity, and enthusiasm for life. Only when all have access to the collective knowledge and resources of humanity’s medical capabilities can we truly claim to prioritize the divinity of life within the moment.