A New Ethical Dominion for Healthcare, from Scarcity to Abundance: Metcalfe’s Law + Moore’s Law + Pragmatism = A New Cure Strategy for GOP

The Pastors Cancer
AP Photo/LM Otero

I. A New Ethical Dominion: Maximizing Health in the Information Age.

In the wake of two Supreme Court decisions ratifying the Affordable Care Act, aka Obamacare, there’s a new reality in American health, made possible by new technologies: It’s actually less expensive, to say nothing of more compassionate, for Uncle Sam to help people stay healthier. That is, it’s foolish to try to ration healthcare, or to seek to trick people into spending less on their own well-being. Instead, true political wisdom, true pragmatism, tells us that we should help Americans become healthier and thereby consume less from the healthcare system.

Some might ask: Is the arrival of national health insurance a victory for the Left? For statism? Perhaps. But it’s also a victory for the Judeo-Christian concept that we are our brother’s keeper; the idea of coverage for everyone is fair is deeply embedded in our collective national moral imagination.

So if we can come to see the American healthcare system in all its glorious potential—as a system for helping people to stay as healthy and hearty as possible for as long as possible—then we can see it as a system for nurturing personal independence and individual autonomy as well. And for sure, good health is the true path to spending less, for the simple reason that good health is less expensive than sickness.

One final point: cutting-edge computer technology can lead the way. Indeed, as we come to fully appreciate the power of high-tech networks to improve our health, we can see the emergence of a new ethical dominion, in which each of us play a constructive role in the health of all of us.

Okay, so here, at long last, in the second decade of the 21st century, we’re ultimately on the hook for the cost of everyone’s healthcare. And so, in the name of maximizing human freedom, let’s figure out a strategy for making everyone healthier and less dependent on the system. That’s how we’ll save money in the long run, because, again, healthy people don’t cost as much as sick people, and healthy people generate more economic activity, including tax revenue.

This new reality of healthcare is a point worth pausing over, because it suggests a new opportunity for the Right to shift the argument on national healthcare policy—from the mere distribution of health insurance to the actual creation of better health for all.

To put the issue a bit differently, if we take universal coverage as a given—that is, if the fight over universal coverage is over, as it would seem to be in the wake of the 2012 presidential election, as well as those two Supreme Court decisions, one in 2012 and one in 2015—then the only question left to wrangle over is this: How do we save money by spending less per patient?

And here again, if healthy people cost the system less than sick people, the proper course for a wise and frugal government is clear enough: Let’s make people healthier, and while we’re at it, let’s use our brains and take concerted action to get that public-health goal accomplished—and so let’s have a national Cure Strategy. Let’s stop talking about simply spending less, which brings up completely justifiable fears in the public mind of a British-style system of rationing, and let’s start doing more, in the form of enlightened leadership, to help people keep their good health.

This argument—that good health is less costly than illness, and so let’s have a healthy population and thereby spend less—has not sunk deep into the political system, to put it mildly. Indeed, the Democrats, the self-declared party of compassion, are still on record as wanting to restrict what they spend for each enrollee in Obamacare. Meanwhile, the Republicans, having lost the political and judicial argument over universal coverage, simply don’t say much at all anymore about Obamacare anymore. Oh sure, Republicans snipe about the generalized ills of Obamacare, but one doesn’t hear much these days about the specific pledge to “repeal and replace.” It’s possible to imagine a true replacement model for Obamacare, a replacement that preserves the core idea of universal coverage while leaving out all the stupid stuff in the ACA; it’s possible for Republicans to develop a replacement for Obamacare—but they just haven’t done it yet.

But in time, the Republicans will, because a political bonanza awaits the first party fully to comprehend the new realities in this technological age and to seize the opportunities it offers.

II. The Four Wins of the Cure Strategy 

Today, good health is not just a win, it’s actually a win-win-win-win—four wins. That is, it’s a win for patients, but it’s also a win for the budget—because we’re spending less. And third, it’s a win for the economy, because healthy people are more productive; one can look back at US history and see a close link between the rising life expectancy of the population and real per capita GDP. And  fourth and finally, it’s a win for the economy, because a strong health sector will be generating health services that people in other countries want to buy, even as we develop new technological spinoffs. This last idea, that the healthcare system should be seen as an economic asset, has been a particularly tough one for the left-wing healthcare nomenklatura to get its head around.

Indeed, the political Left, which was the architect of Obamacare, has clearly not grasped all these implications from its handiwork. Instead, it is still locked into its own austerity model that is deeply unpopular with ordinary voters.

III. The Democrats Cling to Scarcity

Emblematic of this “scarcity thinking” is the work of Dr. David Blumenthal, one of the architects of Obamacare.    Blumenthal’s exact title in the government, from 2009-2011, was National Coordinator for Health Information Technology, and yet by all accounts, his influence was broader inside the administration than his wonky title might indicate.

Indeed, in a much-cited 2001 New England Journal of Medicine article entitled “Controlling Health Care Expenditures,” Blumenthal laid out the eventual Obama policy in stark terms. New medical technology, he argued, is the major driver of healthcare costs, accounting for two-thirds of the increase. And so, he wrote, let’s have less new technology—that’s how we’ll save money:

“All successful measures for controlling expenditures… are associated with longer waits for elective procedures and reduced availability of new and expensive treatments and devices.” 

Yes, “longer waits” and “reduced availability” are desirable in order to save money—those will be our “successful measures,” Blumenthal says, for saving money.

That was 2001. In 2008, Barack Obama campaigned on a Democratic platform that called for spending $2500 less per person on healthcare.

To Blumenthal and the new administration, it was all so simple: The government would save money by doing less.   Yet in the real world, of course, it’s hard to implement such a rationing scheme.

As Dr. Drew Altman the president of the liberal-leaning Kaiser Family Foundation noted in 2009, a huge gap between the views of the policy elite and the popular mass on healthcare; the elite was firmly convinced that a third of healthcare expenditures are wasted (that’s where the Democrats got their $2500-per person figure from in 2008), while the masses think, by a more than 4:1 ratio, that they aren’t getting enough treatment. Yes, a full 67 percent of ordinary Americans think they should be be getting more treatment. We can readily see that it’s hard to make a treatment-limiting scheme work in such an environment.

An early battle in the Obama administration’s effort to control costs came later in 2009, when Blumenthal’s Department of Health and Human Services sought to cut back on mammograms for women. The popular backlash was ferocious: “This is how rationing begins. This is the little toe in the edge of the water,” declared Rep. Marsha Blackburn (R-TN). The administration backed down, and yet just this summer, in 2015, they were back at it again, still trying to restrict mammograms.

We might pause and note that it’s a shame that so many smart people inside the government are working so hard to keep women from being healthy, but their determination is a tribute to the power of an idea—in this case, the simplistic idea that blindly chopping away at healthcare expenditures whenever possible is a good thing.

Indeed, the fallacy in Blumenthal’s thinking is three-fold:

First, to think that we can spend less by doing less misses the new inclusive reality of Obamacare. That is, if everyone is covered for the entirety of his or her life—“cradle to grave,” as they say—then the system is liable for the costs of the patient till death, including his or her long-term chronic illnesses. And so, for example, if a patient develops the dementia associated with Alzheimer’s Disease (AD), care becomes very expensive, requiring 24/7 nursing that can last for a decade or more. Changing the bedpans of AD dementia patients is low-tech, to be sure, but it’s labor-intensive and thus costly. And that’s the problem: In some instances, such as AD, huge expenditures come from doing nothing. So a smart system would be proactive on AD. It would be looking to stop AD from happening, or at least to delay its onset—not just finance it when it does happen.

Unfortunately for us, Blumenthal and the Obama administration have been mostly silent on the issue of trying to cure AD. And as they say, it’s hard to defeat a foe if you can’t even name it. As a result, the healthcare system must bear the massive expense of AD; today, as the Alzheimer’s Association estimates, it’s more than $200 billion a year, heading toward a cumulative $20 trillion by mid-century.

The point here is that it would be a lot cheaper, as well as kinder, if we had a cure for AD. Then we wouldn’t have to think about managing—read: rationing—the care of the desperately medically needy.

Second, Blumenthal & Co. overlook the reality that if we’re healthy, we can get back to work, and that puts money back into the system. Healthy people are not only less expensive to care for, but they also generate wealth, even pay taxes. As noted, it’s no accident that over the last two centuries, life expectancy and real per capita GDP have closely tracked each other.

Third, the Blumenthal worldview overlooks the economic value of medicine as a job- and wealth-creation engine. That is to say, our healthcare system is a lot more than just a cost, it it is also an economic asset. In the US, our hospitals are almost always crowded, and the better hospitals often fill with foreign patients—that is, people bringing their money from around the world to get treatment.

So while it might seem that the easy answer is simply to spend less per patient—as Blumenthal wrote, “longer waits for elective procedures and reduced availability of new and expensive treatments and devices”—the reality is that this approach costs money, both by allowing conditions of chronic health-dependence to fester and by missing opportunities to sell willing customers more medical treatment.

So, under the influence of such static-analysis “bean counters”—pursuing their wrong-headed notion of how the health-economy works—the Democrats are stuck in tragically obsolete thinking about the healthcare system they have created.

And so here we see the Republican opportunity: Once the GOP fully realizes that everyone is going to be covered, it only makes sense to look for smart ways to save money in that coverage. And that means cures, not reduced availability and longer wait-times.

In this new environment, if everyone is being covered, then we’re all on the same team, healthcare-coverage-wise, and so now it’s best to shift the focus to getting everyone cured. From being covered to being cured: That’s the paradigm shift we need.

Yes, for purely practical reasons, let’s have a strategy aimed at cures. If that strategy works—and our own national history, including the successful campaign to create a polio vaccine, suggests that it will—that would not only be more compassionate, but also less expensive.

For the reasons noted earlier, we might start by tackling Alzheimer’s. This much is clear: If we had less AD in America, we’d have a healthier, happier, and wealthier population.

Moreover, as we shall see, thanks to new cyber-technology, the fact that everyone is covered makes it easier to think about everyone being cured.

IV.   The Impact of Metcalfe’s and Moore’s Law

Today, when we speak of “everyone,” we are inevitably thinking about larger and larger networks. And so we can apply the Internet wisdom known as Metcalfe’s Law to our public-policy conundrums. Metcalfe’s Law holds that the value of the network is the square of the number of connected nodes on the network. That is, a network of three nodes has a Metcalfean value of 9, a network of four nodes has a value of 16, and so on and on, up into the infinities of Big Data.

Metcalfe’s Law is a powerful and rigorous evocation of the value of a network—for the same reason that a brain is powerful, based on the number of neurons it has, or that an urban cluster is economically valuable, based on the number of contacts and customers it has. Indeed, Metcalfe’s Law is surely one of the most powerful evocations of market forces ever articulated; it tells us that a big network is powerful and valuable, and that bigger networks are even more powerful and valuable.

Republicans, of course, respect the power of market forces as described by Metcalfe’s Law, and so it’s not surprising that they are beginning to express themselves in Metcalfean terms.

For example, we can look to what the Koch Brothers are saying: The headline in The Washington Post on August 4, reporting from the Koch Brothers’ recent donor conclave in Dana Point, Calif., reads, “Charles Koch invokes fight for civil rights as model for political activism.”

Indeed, the civil rights movement is a powerful cognate to Metcalfe’s Law: the greater the human network, the greater the potential for justice.

Moreover, we can quickly see that Metcalfe’s Law and the more familiar Moore’s Law—the latter more of an observation and a prediction than a law, that processing power is doubling every 18 months—are closely related. Both laws are all about the exponentially increasing power of big networks.

We can readily see that under Metcalfe’s Law, as powered by the technology implicit in Moore’s Law, the gains in knowledge come from adding to, not subtracting from, the network. That is, one might say, the moore the merrier.

Indeed, when Moore’s Law is combined with Metcalfe’s Law, we see a profoundly powerful tool for expanding our collective brain power and problem-solving capacity. Indeed, because of the unfolding of Moore’s Law over the last 50 years, a computer chip made this year will be 133 million times faster than it was in 1965. We might note that even the giddiest free-market economist would probably hesitate before claiming that any supply-side tax cut would increase economic growth 133 million-fold.

As we can see, there’s little, if anything, more powerful than science, unleashed. Indeed, it’s a profound libertarian point to think about how supremely powerful the human mind, freed of regulation and superstition—free to pursue its dream to the utmost—can truly be.

And out of these big networks comes comes the true gold of the Internet era, namely, Big Data.

Why is Big Data so valuable? What makes it so important? It’s because within Big Data are the secrets of solving vexatious and costly problems, including the problem of disease.

And yes, it’s paradoxical that the stuff of Big Data—the electronic ones and zeros—is so cheap. Just as ordinary sand is the key component of the silicon in computer chips, so the mere electron is the key component in data.

Philosophers and publicists have extolled on this paradox of simple elements creating data of great value. And yet for our purposes here, all we need to do is exult in the fabulous wealth that has resulted.

V. Big Data Unlocks the Secrets of Health

Indeed, it’s only because of Big Data that we know the full health value, for example, of other simple products, such as aspirin and garlic. Yes, those simple, inexpensive, generic pills—cheap as dirt—have  proven to decisive in reducing heart disease costs across America. Thanks to aspirin and garlic, a middle-aged American with, say, early symptoms of angina might need only to start popping dime-a-dozen pills to stave off more serious heart problems for a decade or more. If that sounds too good to be true, well, it’s true.

As one cardiologist put it, taking garlic is a “love letter to your heart.” It’s a lot cheaper to take a couple of simple pills than it is to have open-heart surgery or coronary bypass. Garlic and aspirin are even less expensive  than statin drugs. And of course, garlic and aspirin are a lot less costly  than having a heart attack. Or being incapacitated or dead—that’s costly, too.

Some might be tempted to say, of course, that the deduction that aspirin and garlic help reduce heart attacks was more a case of good doctoring, and that the Big Data was the caboose on a medical train that was already rolling down the track to better health.

And that could be the case, but Big Data has proven itself in many fields as a lifesaver. For example, the Federal Aviation Administration (FAA) has had a Big Data-sharing system in place for decades, and it has worked to cut passenger aviation fatalities by 99 percent in the last half century. That is, in a bit of enlightened policymaking that seems to have eluded healthcare policymakers, the FAA simply ordered the airlines to report all safety issues to the agency. The FAA anonymizes the data, so there’s no legal liability, and then works out protocols for safety procedures that are resolutely enforced on all the airlines. And the result has been a spectacular success: Tens of thousands of Americans are alive today because of the FAA’s data system.

So as we can see from the success of the FAA, if intelligence and compassion are designed into the architecture of a system, the results will be intelligent and compassionate.

VI. Coumadin: Teachable Moment, or Trial-Lawyer Bonanza?

And yet in healthcare, it’s no certainty that this hard-earned FAA-type methodology will be applied. We might consider, for example, the question of blood thinners in nursing homes and hospitals. Earlier this month, in a big front-page story, The Washington Post chronicled the use and misuse of the blood thinner Coumadin, which is the trade-name for the generic drug warfarin. The Post, along with Pro Publica, got its hands on a trove of data from nursing homes in Iowa, to see where Coumadin is being used properly and where it isn’t. We might note that Coumadin is a particularly tricky medicine to use: Use too much and the patient is at risk of bleeding too much, use too little and the patient is at risk of a blood clot—and either can be fatal.

And here we might pause to note a law that the FAA doesn’t have to worry about: HIPAA, the Health Insurance Portability and Accountability Act of 1996. In a million ways, most of them Naderite and “mickey mouse,” HIPAA cuts against the usable accumulation of Big Data by the system.

And here’s where a new politics, taking advantage of these new political realities, can help. We might note that prior to Obamacare, the strongest argument in favor of HIPAA has been the protection of medical privacy as a way of protecting the issuance of health been insurance to the needy. But that sort of red-tapey privacy protection is much less critical if people can’t have their health insurance taken away under any circumstances. Yes, medical privacy is still an important goal, but if medical data can’t be used to make economic judgments about the selling and holding of health insurance—the industry term was “adverse selection”—then the stakes are thankfully lower.

So as of today, it’s hard to know what will become of the Post article on Coumadin. Will it be be used to improve medical understanding? To help medical professionals learn better how to manage dosage levels and thus help their patients? Or will the information be used to launch a new wave of lawsuits?

We know that the Coumadin crisis could potentially make for a great “teachable moment” about the value of Big Data, but only if policymakers see it that way and act accordingly. If not, and the trial lawyers take over instead, that will be the detriment of our medical knowledge. A new wave of lawsuits will put medicine into a defensive crouch.    If so, that will mean new cover-ups and new layers of fear and denial in American nursing homes, lots of money changing hands in courtrooms—and it won’t necessarily help patients’ health one bit.  No one ever got cured by a lawsuit.

Instead, the real goal should be move to a data-rich system in which both the doctor, and the patient, have access to the best medical understanding.

VII. Star Trek to the Rescue?

Yes, we desperately need a Big Data “Tricorder” approach, making this information instantly available to us. A Tricorder? As in the TV show Star Trek? Yes. The layer of fiction aside, the idea of machine that channels algorithms from the cloud is well accepted; that’s why the real-world libertarian-oriented X-Prize Foundation is offering a specific X-prize for the first such “Tricorder” device. The idea is that each medical professional, and each patient, would have a state-of-the-art checklist, constantly updated with the speed and certainty of a computer, to work from and consult. With such a Big Data system, that there’s much less chance of an oversight. There are plenty of recent sad medical cases—of Andy Warhol in 1987, of the twin children of the actor Dennis Quaid in 2007, and of the late Joan Rivers in 2014—which demonstrate that the affluence of the patient is no barrier to incompetence.   So with the Tricorder, or something similar, the goal is simple: First, get the best possible information to all the players in a medical transaction. And second, replace the “gotcha” mentality of an ex-post-facto lawsuit with the real-time systemic benefits of machine learning.

Unfortunately, in the absence of enlightened political leadership that would push, say, the Tricorder idea along, it is likely that the more-lawsuits scenario will win. So the tort lawyers will get richer, and, starved for optimum information, we will all get sicker.

What we must do, instead, is envision a larger, smarter system. Indeed, as we think about what it might look like, our thoughts might drift back to the points made by the libertarian economist and computer visionary George Gilder in his 1980 best-seller, Wealth and Poverty. Gilder’s argument, in that hugely influential book, is that capitalism is ultimately about generosity. And from there, we can see that a free and smart people would ultimately come up with a cohesive and inclusive  system like… Big Data.

As Ronald Reagan, a Gilder fan, echoed the author in his 1980 acceptance speech at the Republican National Convention in Detroit, “Our message will be: we have to move ahead, but we’re not going to leave anyone behind.” And so Reagan brought the conservative movement to a new place—what Jack Kemp called, “The Good Shepherd” model. And it’s amazing how well that sort of Judeo-Christian message plays in a Judeo-Chistian country; as a challenger in 1980, Reagan carried 44 states.

VIII. The New Reality of Abundance: The Republican Opportunity

As American society makes the shift from a presumption of scarcity in healthcare to a presumption of abundance, many things will change. Indeed, both parties will be well-advised to adjust their thinking in light of the new techno-reality:

Republicans will have to get used to the idea that thanks to the miracles of technology, the marginal cost of more valuable information is virtually nothing—so why not give it away?

And yet the adjustment on the left will have to be even greater. That is, Democrats of the David Blumenthal stripe will have to unlearn their paternalist planning ways; bureaucrats who built their careers on the presumption of scarcity might have a hard time learning to be generous—even if, as we have seen, generosity is cost-free. This shift in thinking might be particularly hard for Democrats, since most of them have been schooled in the Green-inflected “limits to growth” argument that presumes that we must always have less. That limits-to-growth idea came along before Big Data, and the David Blumenthals of the world have yet to embrace that new thinking.

And so here we come to the massive Republican political opportunity: to put forth a vision of effortlessly abundant and manifestly more effective health care, i.e., cures.

Certainly the Koch Brothers seem attuned to new vistas for their effort. As that August 4 Washington Post article details, the Kochs are consciously trying to broaden their political outreach to reach “the middle third” of the electorate that does not, as Charles Koch explained, identify with libertarian ideology. Indeed, as we saw earlier, the Kochs see themselves as leading something akin to a new civil rights movement. That’s a stated ambition both inspiring and risky; if the Kochs can succeed, they have gained much, but if they fail, they will have opened themselves to accusations of hyperbole.

In particular, the Kochs might think closely about their optimum strategy in the near-term. Surely, for example, they don’t want to lead into the 2016 elections with an explicit or implicit policy of taking away people’s health insurance. Obamacare is far from technically effective in achieving its stated goals of universal coverage, but it has led to a dramatic cut in the number of Americans who don’t have health insurance. So surely peeling that benefit away is not at the top of the Kochs’ to-do list.

And that’s certainly that’s the view of the new Republican majorities in Congress. As Politico noted recently in a piece headlined, “Senate downplays Obamacare repeal,” the new GOP contingent in the Senate is not rushing to repeal the popular parts of Obamacare.

To be sure, conservatives might be mistrustful of Senate Majority Leader Mitch McConnell, but they might do well to note that the Republican “point man” on the Obamacare issue is Sen. John Barrasso. He’s an MD, but more importantly in this case, he’s a certified conservative. In 2014, Barrasso was one of just 21 Republicans in the Senate to win the “ACU Conservative Award,” alongside such better-known right-wing stalwarts as Jim Inhofe, Rand Paul, and Pat Toomey. In other words, Barrasso is no “squish.” And so if he says that the GOP has not yet been able to come up with a satisfactory approach to “repeal and replace,” we must believe him—it’s hard to do.

Indeed, if, as Charles Koch says, the goal is to create a “truly free society,” as he said, “If we cannot unite the majority of Americans behind the vision, then we’re done for.” Well, if the goal is to unite a majority of Americans, then the place to start on healthcare is surely not taking away people’s health insurance.

Then they might ask, in the spirit of goal-oriented pragmatism, What’s the best way to use healthcare to advance the cause of a free society? And the answer might be: Let’s get every freedom-loving American to live productively and healthily for another couple of decades because of better medicine—better than would otherwise be the case. Such a spurt in libertarian longevity would advance the cause of liberty, as well as Republican political fortunes.

It is has been widely reported that David Koch has been battling prostate cancer for the last few decades. Born in 1940, has said that his goal is to see cancer eliminated in his lifetime, and he has given generously to many different anti-cancer charities.

Well, here’s a chance for him to not only to achieve his goal but also to help every other American. Surely that counts as good politics. In fact, thanks in large measure to President Richard Nixon’s “war on cancer,” launched in 1971, the cancer death rate for Americans fell 22 percent from 1991 to 2011. To put the data another way, in 1975, there were about 3.3. million cancer survivors in the US. Today, there are 14.5 million cancer survivors, four times as many as 40 years ago. So we can see, immediately, that part of the political effort would be to remind those 11.2 million Americans that they owe a debt to the selfless scientists of the anti-cancer effort.

Some might maintain, of course, that Obamacare is an abridgment of freedom. And perhaps it is, but if it’s a tax as the Supreme Court has said, it’s surely no worse than any other tax. Indeed, the realities of modern medicine tend to cut against the virtues of individualism. The long-lived rugged individualist of the future is likely to be, even so, a highly connected individual. As noted, Big Data puts a premium on human interconnection; in the most literal sense, it’s the staff of life for medicine. If, as 17th century English poet John Donne wrote, “no man is an island,” that truth is even more true now.

In the meantime, surely the right can appreciate the wisdom that a good way to see freedom prevail is for the Koch Brothers, now both in their late 70s, to live and stay active until they are, say, 100 or more. To a billionaire, the cost of covering everyone is a lot smaller than the cost of one of them dying. And in fact, it’s not just billionaires who should feel this way on the strictest economic grounds; if you do the math, most Americans—and so the country as a whole—would gain economically from being alive and healthy and working longer. (Especially when everything is getting cheaper, e.g. using aspirin and garlic to fend off heart disease, thus staving off the expense of, say, open-heart surgery.)

IX. Thomas Jefferson Called It, More Than Two Centuries Ago

As we have seen, the “secret sauce” of Metcalfe and Moore’s Law is greater knowledge; in this Information Age, it’s knowledge that’s really valuable. And so gaining that knowledge is a stupendous achievement, but once it’s gained, it might as well be shared.  Indeed, the always sagacious Thomas Jefferson seems to have seen the genius of Big Data well in advance; as the former president wrote in 1813, “That ideas should freely spread from one to another over the globe, for the moral and mutual instruction of man, and improvement of his condition,” is, indeed, a wondrous thing. Indeed, he continued, the propagation of ideas “seems to have been peculiarly and benevolently designed by nature, when she made them, like fire, expansible over all space, without lessening their density in any point.” That is, with an idea, we can all have it, and all benefit from it, without taking anything away from the ides itself.

As we can see, the fusion Metcalfe’s Law and Moore’s Law, pragmatically applied, could be transformative to our politics. That is, the abundance of Metcalfe and Moore could make fools of those who wish only to traffic only in scarcity. The geniuses of the future will be those who have a plan for replacing the the old calls for stingy limits, to be replaced by new traffickers in near-unlimited open-source abundance.

X. The Infinite Promise of Non-Rival Goods.

We might note that the economic term for such knowledge is “non-rival”;  economists make a distinction between rival and non-rival goods. A rival good is something that is inherently limited, like, say, 19th century French Impressionist paintings, or houses with a nice ocean view. By contrast, a non-rival good ha no such limitations.   With non-rival goods, the scarcity strategy makes no more sense than rationing typewriters if the currency has shifted to the electronic ones and zeroes of computer programs.

Healthcare may never be truly inexpensive. That is, even if, in the future, it is dispensed by robot doctors and apps—and the the dirt-cheap fruits of mass- but personalized production—such knowledge will still be expensive to  acquire. And so there will always be a role for government in making it cheap—or, if one prefers, a role for private charity.

But healthcare, as a non-rival good, will likely be less expensive than rival goods. A night in a hospital might never be truly cheap, but it’s easy to see how it could be cheaper than a night at a five-star hotel.

Indeed, new technology has a  way of continuously flummoxing the old conventional wisdom. For example, the FDA has recently approved the first 3-D printed medicinal pill. Such 3-D printing, in conjunction with the personalized medicine made possible by Big Data, will allow for variable but ultra-precise dosing per pill, which is exactly what patients needing blood thinner, for example, will want and need.

Indeed, despite the best efforts—perhaps we should say, the worst efforts—of the Naderites who wrote and rule over HIPAA, it’s possible that visionaries will yet produce a Tricorder that will guide medicine.

Indeed, even the rich will benefit from the ease and immediacy of  the robot doctors of the future, which will some day perform diagnostics, and even surgery, with the same precision and immediacy as a cell phone today.

And so yes, perhaps it’s ironic that this new world of medical potential  is possible because we’re in a new era, because Obamacare is the law of the land. Indeed, as we consider the possibilities of Metcalfe, Moore, and Big Data then go on into further fields of personalized medicine and 3-D printing, we can see the value, however unintended, of settling the old disputes over insurance coverage.

Yes, as noted, the truth is that Metcalfe and Moore have taken us into a new ethical dominion of health, in which we all, in effect, be looking out for each other through the mechanism of our shared common data.

The challenge is to help everyone see this new dominion, this new paradigm, this larger vision of abundance in health and healthcare—the sooner the better!