Health and Health Care: A Common Pool Resource?

In 2009 the Sveriges Riksbank Prize for Economic Sciences (Nobel Prize in Economics) was jointly awarded to Elinor Ostrom and Oliver Williamson for their works on the efficient management of resources. I propose that those interested in Health and Health Care, particularly in the monumental problems surfacing in the past 5 years, pay attention to the work of Elinor Ostrom. 

Up until her groundbreaking 1990 work, Governing the Commons: The Evolution of Institutions for Collective Action, most viewed misuse of resources held in common as an unsolvable problem as outlined by Garrett Hardin (in his 1968 article in Science)The Tragedy of the Commons. Overuse and lack of sustainable practices in pursuit of short-term profits inevitably led to the destruction of the resources themselves. The only imperfect solutions were either privatization or government control. Ostrom explored a third possible way, responsible collective action. From evaluation of the success of multiple long-enduring, self-organized, and self-governed common pool resources (CPR) she formulated 8 rules for their management:

1. Clearly defined boundaries: The Boundaries of the CPR must be clearly defined, as are those who have the right to utilize the resources.
2. Rules fit the local circumstances: Rules restricting time, place, technology, and units of use as well as labor and material required are related to the local conditions.
3. Collective choice arrangements: Those affected by the operational use rules can participate in their enactment and modification.
4. Monitoring: Monitors of the use of the CPR are accountable to the appropriators.
5. Graduated sanctions: Those who break the rules are sanctioned in proportion to the rules broken.
6. Conflict resolution mechanisms: Rapid low-cost arenas to resolve conflicts are present.
7. Recognition of right to organize: The rights of users to devise their own institution will not be cancelled by a higher authority.
8. Nested enterprises: While most of the governance can be accomplished at the local level, wider cooperation may be needed to avoid conflict with other enterprises.

Are Common Pool Resources the only common resources? In a later (2007) volume, Understanding Knowledge as a Commons: From Theory to Practice, editors Charlotte Hess and Ostrom explored the thoughts of a number of individuals on knowledge, particularly digital knowledge as a form of commons. Starting with the classic taxonomy of goods into 4 subclasses based on exclusion (the ability to limit dissemination) and subtractability (the extent that use lessens the fund available for others) the authors explore the blurring of distinctions of digital knowledge:

Unfortunately, as important as these concepts are, they became completely irrelevant in November 2019. Unbeknownst to most of the world, the rules changed with Event 201. Despite protestations to the contrary, this “tabletop exercise” foreshadowed the global catastrophe that was about to hit with Covid-19.

“Health” and “Health Care” became the mechanisms by which an unlikely combination of Cultural Marxism, Political Opportunism, and Crony Capitalism came to dominate the next 4 years. Instead of devoting his entire attention to the pandemic, Donald Trump was forced to defend against his first impeachment for a phone call with Ukraine. As worldwide fear of the pandemic that was predicted to cause massive death was carefully propagated, in March it prompted the unprecedented lockdowns to “slow the curve.” Meanwhile, in another unprecedented move, any attempt at early treatment was at first discouraged and finally criminalized. 

In order to eliminate the possibility of effective agents preventing the granting of an Emergency Use Authorization for the mRNA agents, studies on early outpatient use of hydroxychloroquine were cancelled and only authorized to be used in late-stage disease when they would be ineffective. That proved to be the modus operandi for all future “official” investigations into drugs other than the mRNA agents: use them too late or in the wrong dosage in order to debunk them.

Everything was predicated on isolation while we awaited the magic bullet of the “vaccines.” Health and Health Care were the clubs used to pound a terrorized global population into submission. Totally illogical statements, such as the one by a prominent physician advisor on the crisis that “I am science,” were accepted and even lauded. Wholesale cancellation of human rights was applauded. The definition of a “vaccine” was officially altered to meet the shortcomings of the mRNA agents. Testing protocols for safety and efficacy were drastically shortened. 

Informed Consent is no longer officially required and even frowned upon when it comes to mRNA agents. Despite minimal risks to children and infants from Covid-19, the mRNA agents were added to the Childhood Recommended Vaccine Schedule. 

In an ultimate oxymoron, the CDC states each patient given a covered vaccine should be supplied with a “Vaccine Information Statement” (VIS) to comply with the National Childhood Vaccine Injury Act, but that this should in no way mean that informed consent is required.

The slow march of the radical left described by Chris Rufo through the institutions in the United States had finally reached a critical point. It had captured academia and many corporate boardrooms. When the BLM riots erupted, it was actually stated that public health demanded people take to the streets, forgetting all of the nonsense about masks and public distancing. However, just a few months later, the pandemic was the ostensible reason for the changes in voting laws that led to a still unexplainable number of votes for Biden.

The knowledge arena was not immune. Increasingly, scientific papers that had supposedly passed peer review were retracted, some for valid reasons, others for unknown or false ones. 

The Committee on Publication Ethics (COPE) is a regulatory agency that supposedly guards against improper retraction but most of its budget is provided by 5 major publishing houses. In August 2019, Baffy, et al, warned of the dangers of concentrating access to scientific knowledge in the hands of those who may be influenced by nonacademic and nonscientific factors. Their warnings became reality.

On a variety of fronts, the Biden Administration attempted to limit access to knowledge of which it did not approve, through branding it as “misinformation, disinformation, or malinformation.” Fortunately, its proposed “Ministry of Truth” was put on indefinite hold and Nina Jankowicz, who channeled her own version of a song from Mary Poppins, resigned.

Although Congress found that the Biden administration attempted to coordinate an attack on dissenters, in Murthy v. Missouri the Supreme Court rejected the call to permanently block such collusion. However, the funding for Stanford’s Internet Observatory, which described itself as a watchdog against malicious “misinformation,” collapsed in June 2024. 

Even though it has been a mixed bag as far as ensuring free access to digital information, the resounding victory of Donald Trump in the past election, including the mandate of winning the popular vote, offers hope for the free flow of information for at least the near term.

In April 2024, Bill Rice wrote about his Nightmares of the Elite. In this nightmare, he saw that all of the truth-seeking organizations were captured by idealogues or rapacious robber barons (or both), and there was little he could do about it.

So, while it is intellectually interesting to discuss the esoteric differences between a Common Pool Resource, a Public Good, a Club Good, and a Private Good when it comes to Health and Health Care, until the devaluation done to Health by our Health Elites is reversed, it is pointless. Our Health and our Health System are only pawns used by those seeking political and economic power.

Our Health and Health Care system failed primarily because of a failure in leadership. The leaders of our Public Health institutions failed, the leaders of our Medical Organizations failed, the leaders of our Academic Medicine Centers failed. Unfortunately, many of our Health Professionals themselves (particularly in Medicine) failed. 

However, we did have our Heroes. Many are known to the readers of this site. Some will remain anonymous, but they know they gave what was asked when it was difficult. Though known only to a few, they are no less heroes of the most horrific medical scandal of our time. Most of these heroes paid, and continue to pay, a heavy price. That must change if we are ever to get back to the conversation on how to actually improve Health and Health Care.

Bill Rice did have a glimmer of hope. The only college that pushed back against the madness of the Covid lockdowns and the Great Ethical Collapse was Hillsdale in Michigan. I share his hope. While excellence in the STEM subjects is necessary for a career in the Health Professions, it is far from sufficient. We need to admit into, and advance within, the Health Professions those who also possess critical thinking, ethics, courage, moral responsibility, and leadership skills. Physicians in particular must be seen and see themselves as Leaders of Patients and not mere Treaters of Disease. 

These qualities must be encouraged early, in secondary or even in middle school, when one’s worldview is formulated. Hillsdale is the only academic institution with the vertical and horizontal reach to do that.

Here’s a thought: Imagine this next semester a multidisciplinary seminar at Hillsdale dealing with a study of Elinor Ostrom’s concepts of Health and Health Care resources. Imagine this being open to students of economics, public policy, and political science, as well as those in pre-professional studies. Imagine the possibility of bright students in Hillsdale’s affiliated secondary schools interested in these professions being able to join a similar seminar. Imagine those in Hillsdale’s Academy for Science and Freedom also involved.

Now let your imagination really soar: Could this be the impetus to establish a true vertically and horizontally integrated Community of Practice for Health Care Professionals, providing them with the very tools for self-organization and self-governance Elinor Ostrom noted were the hallmarks of successful management of Common Pool Resources? 

Imagination and recognition of the Adjacent Possible is the first step in building a Cauldron of Innovation.