There seems to be a lot of talk about the Affordable Care Act since the Supreme Court’s decision last week.  There is plenty of discussion about the individual mandate and whether or not it is a penalty or a tax, how the insurance companies and health care providers will have to adapt to the changes and how it can be repealed.  But is anyone else out there wondering how we are all collectively missing the proverbial elephant in the room, and overlooking its fatal omission?  How on earth could this health care system last?  And I’m not just talking about the billions of empty dollars required to implement and sustain it.  I’m talking about the larger question of how any system could last that is inextricably dependent on a ready supply of resources that are being consumed faster than they can be replaced.

When I am at work as a staff nurse, I am part of the problem.  I necessarily consume a steady stream of disposable single-use products during the course of caring for my patients – pre-filled plastic saline syringes, plastic and paper medication wrappings, plastic IV fluid and blood product bags and tubing and their plastic wrappings, plastic lumen caps, plastic isolation gowns, plastic cups and straws, plastic juice containers (and there are excellent evidence-based reasons for all of it).  I run around to my patients’ rooms with a “Jetson” – essentially a computer cart that is on 24 hours a day, 7 days a week – to scan wristbands and medication bar codes prior to giving medications.  Then I sit down at desktop computers (also on 24/7) to document my assessments, page physicians and mid-level providers as needed, and write progress notes on my patients.  I try to use alternatives as much as possible, for example, often there are cloth isolation gowns in the isolation carts that I use.  And the non-profit hospital I work for has chosen to purchase cups with post-consumer recycled content, to virtually eliminate styrofoam, and to divert dozens of tons of waste through their recycling program.  Nevertheless, I can’t help but wonder, even in the midst of my frenzied compulsory consumption, how this will all continue as we progress further along the downslope of Hubbert’s Curve.

There is plenty of evidence that we have, in fact, reached and surpassed the peak of global oil production, despite insignificant variations from year to year, changes in definitions of “oil” that might skew the numbers, and the fact that we can still rely on fossil fuel resources whose production has yet to peak (e.g., coal).  But no matter what your position on peak oil, it’s hard to argue with the fact that oil and other fossil fuels are resources that we are consuming faster than they can be replenished.  And knowing a little bit about how the healthcare system operates, it’s also hard to ignore that our health care system is almost literally dripping with them, given the amount of oil-based plastic products that pervade it, the amount of oil required for the production and transport of pharmaceuticals, and the predominantly coal or nuclear electricity required to run our health care facilities and power our electronic medical records.  And what to speak of how the burning of these fossil fuels contributes to climate change and the havoc it has the potential to wreck on our civilization, much less how poorly prepared we are to mitigate its effects on human health?

Although I welcome any and all information to the contrary, since obviously it would be better for my future career as a nurse practitioner if these observations were flawed, I won’t spend any more time focusing on the problems; there is plenty of that kind of information out there already.

Let’s start thinking about something we can all agree on – how to ensure the health and wellness of all people REGARDLESS of the availability of cheap fossil fuels.

What is your vision for a sustainable healthcare system?  I’d love to hear yours, and I’d be glad to offer my own constantly evolving vision for how we can continue to ensure human health and wellness.   Feel free to join the conversation over at the Sustainable Healthcare Group