GreenStar Medical is the health care services arm of the GreenStar Community Cooperative and similar to its partner GreenStar Education it would have the lofty goal of realizing free universal access to health care for all citizens of TMP communities. This is obviously not something that could be achieved very early on, the first communities built by the Foundation CIC likely to be within existing nations and limited to their health care service offerings. But as communities are developed in progressively more remote locations they will be required to assume more and more responsibility for their health services –particularly emergency health care. Over time a robust health care infrastructure would develop across the collective community of TMP settlements –and then eventually contract as key new technologies such as medical nanotechnology enable progressively more sophisticated health care with a decreasing dependence upon large infrastructures to support it. Long-term, GreenStar Medical will also face great challenges in coping with the changing nature of economics in relationship to labor in health care services and will have to address the special situation of devising methods of providing very high sophistication of health care in the relatively small communities TMP would initially develop in space.
Health care is one of the more problematic issues any community can face and in terms of key logistical issues facing remote community development is a close second only to transportation/communication as critical to sustainability. Today the problems of health care are one of the single largest drags on the progress of civilization. It has become, in economic impact, akin to a world war that never ends and there seems to be no single cause of its many problems or definitive solutions.
Health care is one of the Industrial Age’s greatest failures, the one thing it was never able to find an effective way to industrialize. It could industrialize the production of drugs, medical equipment, and even the training of physicians but the actual process of health care defied this owing to the fact that it could not be mechanized and demands total customization for each patient. As medical technology advanced, its collective body of knowledge exceeded the individual’s ability to learn the totality of it while techniques in surgery became so dependent upon manual skill and finesse that in order for a surgeon to perform them with efficacy he had to perform them regularly enough that his skills would not go ‘stale’, like a professional musician isolated from his instruments too long. So as a compromise the tactic of categorization and specialization was employed. Health care in the western world was broken into ever-increasingly specialized areas of activity that could be individually ‘centralized’ for ‘mass processing’ by specialist medical practitioners and technicians working in different facilities in either separate buildings or mass centralized clinics. Though utterly logical to the Industrial Age mind, this has proven a dismal failure. It has run into a medical equivalent of computer science’s Amdahl’s Law which says you cannot double the performance of a computer by doubling the number of processors because you simultaneously double the amount of instruction communication necessary. And so like a computer that sees diminishing returns on performance from the addition of each new CPU, so too has the health care system seen diminishing returns on cost/performance the bigger the system has become and the more numerous and specialized its practitioners. Thus we arrive at seemingly illogical situations as in the US, which boasts the highest level of sophistication in medical technology in the world and, possibly, the largest number of physicians per capita and yet, on average, can only provide its citizens with a Third World level of health care. Indeed, in the US one is confronted with the bizarre statistic that the higher the per-capital number of physicians in a given state, the worse the average level of health care and the higher the cost!
To make matters worse, like many of the services our standard of living depends on, health care relies on a cash economy where people are willing to do relatively distasteful jobs for money and where most people go into medical school with the anticipation of earning much wealth as physicians. Though this certainly isn’t about to happen overnight, cash-based economics as it exists today will eventually go into decline in favor of resource-based economics as the technologies of the Post-Industrial age enable increasingly larger portions of the population to live well as they wish without salaries through their own independent industrial production. How many doctors and nurses would there be in the world today if no one needed to work for cash to live? They say medicine is a ‘calling’. What if that calling was the only compulsion left driving aspiring physicians? That is a question we may face in the future.
How then can TMP address this situation? There are no quick and simple solutions but there is potential in emerging Post-Industrial technology to empower the general practitioner as never before, delegate much more of the overhead of health care to patients and machines, and reintegrate the fractured structure of medicine into a flatter, more intelligent, more dynamically responsive network. The communities of TMP offer a good proving ground for this as they face the tremendous challenge of offering as high a standard of medical care as possible with as streamlined a set of facilities and lowest overhead in labor as possible. We may imagine that an Aquarian marine colony of 100,000 is quite a large community. But relative to the typical scales of infrastructure common in the western health care system, this is virtually insignificant. Many health care facilities require huge populations to cost-justify, compelling some people to travel great distances to these key facilities. Through GreenStar Medical and in cooperation with GreenStar PharmaTech, the Foundation CIC would need to find ways to spread the costs of facilities and services over a much larger community while at the same time striving to constantly increase the capabilities of local clinics of very modest scale.
Many of the same strategies employed by GreenStar Education would also be employed here, such as the employ of more sophisticated general practitioners with more cross-discipline training, a far greater emphasis on preventative health care from a far earlier age, reliance on the compactness of TMP’s arcology-like communities to allow personal residences to serve for longer term lower critical recovery facilities rather than large centralized hospitals, the use of telepresence and artificial intelligence technology for routine patient interview and long term health monitoring from home, the use of advanced courseware to enable local physicians to learn on demand, the use of telerobotics to enable surgical specialists to leverage their skills over many communities, automated surgical assist systems which can radically reduce the labor overhead during operations, the development of extremely compact and multi-functional medical analysis devices that can be operated without trained technicians and specialized facilities, techniques and devices to aid in the safe and reliable performance of simple medical procedures by the untrained including the patient himself, and the development of new systems for the on-demand manufacture of drugs, medical supplies, and equipment.
These will not be easy accomplishments but they will be crucial if TMP is to realize the creation of sustainable communities in space. There will be no ‘mainland’ infrastructure to provide back-up as on Earth. Communities will be separated by months or years of travel time and must meet an infinite diversity of potential health needs from at-hand resources. And in the future the nature of health care may become much more complex as a consequence of biotechnology and nanotechnology. Genes and the brain will increasingly become the province of clinical intervention for a steadily increasing number of reasons. The culture cultivated by TMP will see new attitudes toward criminal behavior calling for clinical intervention as an alternative to cost-inefficient incarceration. Functional ‘corrections’ of genes and the brain will become commonplace, along with the integration of communications technology to enable personal AI augmentation. People will be modifying their own bodies in ever more sophisticated ways for health, work, and aesthetic/recreational reasons, posing ever greater challenges to a potentially shrinking medical community. GreenStar Medical has its work cut out for it.