By Mary Logan
An article on the difficulty of building truly green buildings and recent discussions about the healthcare system triggered thoughts about a major transition problem that is occurring over and over again—the problem of a complex hierarchy that demands feeding with extra energy. Previous posts about the added complexity that digitization brings are pertinent here, but this post is about the general problem of how we respond to limits by adding complexity, and what it might take to remove complexity at the top of the hierarchy without collapse.
Green buildings within a growth economy
The article that triggered this post was Mehaffy and Salingaros’ article on why green often isn’t and their observation that attempts to build green often results in energy and material-wasting buildings for several reasons. The authors ask, “What’s going on? How can the desire to increase sustainability actually result in its opposite?” First, green components are “bolted-on” to existing wasteful 21st century structures, resulting in even more energy and material use. Second, the buildings exist within a larger system, with goals and rules that they are subject to. Those rules are part of the feedback that promotes the goals of the existing system. The main goal in the US system is promotion of growth and profit for existing powerful players. Codes and existing contractors make new ways of thinking and doing difficult in many ways. This goal of profit is inescapable, so any building must first address the existing profit incentive of powerful players. The authors appropriately blame the unsustainable nature of high density fossil fuel-designed buildings operating:
“. . . almost entirely within the industrial assumptions and engineering methodologies of the ‘oil interval’. . . . The eye-catching novelties of one era will become the abandoned eyesores of the next, an inevitability lost on a self-absorbed elite fixated on today’s fashions. Meanwhile the humble, humane criteria of resilient design are being pushed aside, in the rush to embrace the most attention-getting new technological approaches — which then produce a disastrous wave of unintended failures. This is clearly no way to prepare for a ‘sustainable’ future in any sense” (Mehaffy & Salingaros, April 2013).
Instead what is needed is buildings at a lower level of hierarchy, buildings that do not rely on consistent electricity, water plumbed from hundreds of miles away, and density that can only be supported with an energy basis of high quality fossil fuels. Once fossil fuels become expensive or unavailable, we will need a different form of construction, that is supported instead by passive, renewable energies and local materials, with less density to allow for human-powered transport needs.
Both major principles of transformity and autocatalysis are in play here. In many parts of the economy, as energy inputs plateau and start to recede, bureaucratic responses to energy scarcity and resulting economic problems are to add complexity rather than remove it. People do not see the added cumulative energy and materials that are required to sustain what is already there, and then to add even more technology. This is the principle of transformity–adding complexity on top of what is already there requires more energy and materials through transformations. The only way to cut the inputs is to move back down the hierarchy in design to a more ecological approach that works with nature instead of fighting nature through added technology. But backing down the hierarchy is difficult, because of autocatalysis, or the positive feedback loops that feed the complexity, which are solidly in place. In Mehaffy and Salingaros’ example of green building above, the idea of components being bolted on is an example of the principle of transformity, while the inability to run outside of the rules of the construction system is an example of how autocatalysis sometimes traps us into systems that respond poorly to the need to change, resulting in overshoot.
The players that are now attached to the system and making a profit demand and protect the system as it is. The financial system at this point acts as a voracious funnel to continue to funnel profits upwards towards profit. As the financial power at the top expands, it promotes further inequities and further resistance to change. So any change must come by adding added complexity, rather than removing rigid, powerful vested interests such as insurance companies, corporations, the legal system, and so on. The policy arena becomes resistant, and then atherosclerotic. Finally it ruptures. The choice is to try to create local experiments or demonstration projects in some of these more fossilized profit-centers in anticipation of failure of the system, or just wait until it collapses and begin again. Waiting for collapse doesn’t seem to be an ideal solution, so how do we approach doing things differently?
Healthcare’s death grip on the current system
The healthcare system is another example of unsustainability and resistance to change. Our western healthcare subsystem is part of the economy at the very top of the hierarchy, with many transformations required to build its complexity. Because of the strong profit incentives, creating change by backing down from complexity is difficult. Attempts to limit extreme over-treatment such as intensive care at the end of life are hard to avoid, due to embedded ethical and legal rules and the systemic goals that drive diagnostics and treatment. Basic preventive care and health promotion are basic assumptions of a functional complex, high-energy economy, while the emphasis in healthcare has shifted to extreme, life-prolonging treatments for covered or wealthy clients, with inadequate care for the uninsured or inadequately insured. Those assumptions of basic health provision, including clean food and water, adequate plumbing, healthy immunity within the population, and other assumptions are being hollowed out as populations grow, energy inputs wane, and health maintenance of the population diminishes. Much like the construction example above, healthcare’s existence at the top of a hierarchy but still operating within the current oil-interval makes it almost immune to change. Medical ethics advocate maximum testing and treatment, while the legal system solidifies the status quo, and the insurance system promotes whatever increases its own profits—more insured people getting inappropriate, excess, expensive care that allows skimming. Physicians and well-paid healthcare managers have expensive debt such as large home mortgages to pay, which requires maintenance of the status quo. This autocatalysis promotes perpetuation of the system, even when everyone agrees that the system is broken.
Attempts to change the system result in incremental changes that do not disturb the status quo, for the most part. Powerful insurance companies that skim profit from the beginning of the money pipeline are allowed to stay and to set prices–they are even promoted through laws that mandate that everyone must pay these private, wealthy companies. The rest of the healthcare system must struggle with the leftovers after profits are skimmed, with hospitals and consumers getting the dregs. As long as the financial system stays afloat, the insurance companies will keep their grip on the system, with prices for consumers and other weak players becoming higher or even out of reach.
What might green healthcare look like?
Any new experiments in descent will have to arise organically out of descent, either through local collapses in the healthcare and/or economic system (Fuchs, 2010). Attempts to begin something new in healthcare outside of the insurance and legal systems will not work. The financial system at this point acts as a voracious funnel to continue to funnel profits upwards towards profit. So how do we remove the profit motive and dodge the corporatocracy, abandoning the premise that more is better that has fostered our careers, forming the basis for our society?
I’ve highlighted construction and healthcare here, but other subsystems of the economy are similarly entrenched in the goals of a high-energy growth economy. Education is increasingly relying on technology, expansion of bureaucracy and testing, and encroachment of the profit-motive. Government relies increasingly on corporations and other organizations that promote profits for one group of lobbyists or another. Everyone promotes digitization as a solution for problems, at a time when consistent operation of electronic information systems is becoming increasingly difficult to keep up.
So barring collapse, how do we work outside the current system to develop demonstration projects for buildings, for healthcare, for renewable energy, and other sustainability goals? I think we have to answer that question first, to change some of the really rigid profit-making systems in capitalist society such as government, education, and healthcare. If we’re not going to wait until everything collapses before we pick up the pieces, how do we describe and carry out a demonstration project such as a health care clinic that operates outside the limits and constraints of America’s extreme healthcare system, that are not subject to the rules and ethics of the current system? Perhaps the first step is to imagine it. Individuals are circumventing building codes and creating small houses out of sustainable materials. But healthcare seems trapped within the larger system. If I want less healthcare, or ecologically oriented healthcare, I have to abandon the system for the most part.
What would a healthcare system that really promoted Health Care instead of Sick Cure look like? We have forgotten what those words mean. A Health Care system would have to be divorced from the insurance payment system, and the emphasis would need to be on prevention. A bioethicist and environmental medicine expert would be needed, and there would need to be some way to bypass and make toothless the current emphasis on high-tech cure and end-of-life treatments. Basic preventive care and health promotion could be provided for all at low-cost, with tertiary or extreme cures only available elsewhere through referral, for more cost (if people can pay). Health promotion would need to include assessment of food relocalization, measures of resilience such as community/social supports, general stress levels, transportation, food security, and other basic needs, all weighed against higher order needs. Tools could be devised, people could be counseled, those at the end of life could be encouraged to weigh quality of life against extreme measures, and so on. Geriatric patients could be assessed for polypharmacy, social isolation, and other problems of aging and our high-tech culture. Children could be assessed for nature deficit, computer addiction, over-treatment for medicalized diagnoses such as attention deficit disorder and other disorders of modern life. Home assessments of water and food purity would be available. Families could be examined as systems, and extended families could be encouraged. Classes on financial frugality, growing your own food, eating lower on the food chain, and so on could be a part of the clinic. Some of these ideas are portrayed in the book, God’s Hotel, by Victoria Sweet, if you’re interested in reading more about this.
At the end of empire, the economic system at large has a death grip on profit-making subsystems, preventing the radical change that is needed. How do we begin to imagine what is really needed, rather than proposed incremental changes that only add to complexity and hasten collapse? Any ideas?
Header: In the Talkeetnas, by Toby Schwörer