We're here and we've figured it out
The Population Health Blog is reading Joel Kotkin's "The New Class Conflict." While it hasn't gotten through all of it, the central premise is a refreshingly alternative explanation for our
national malaise. 

It's less a matter of conservative vs. liberal ideologies that are leveraging class warfare. Rather, it's us vs. an unholy alliance of the new internet-media Oligarchs and their fawning expert clerisy.

"The New Class Conflict" doesn't dive into the implications for health reform. That naturally prompted the PHB to apply Mr. Kokin's lens to our healthcare expert class. 

Let the readers decide if this shoe fits. It may be paranoid, but it sure is fun to think about.

A quick word on the Oligarchs: these are the fabulously wealthy who dominate Silicon Valley.  They truly believe their template for success can change society for the better. They are very willing to deploy their new-found billions to promote their progressive, technological and green mindset.  The fact that their solutions are enormously self-serving makes them no different than the industrial barons of the 1930s.
Enter their health reform "clerisy" allies. They are made up of a growing academic, media, not-for-profit and government-worker technocratic class.  Armed with their science-based insights, they are advocating, lobbying, funding and regulating away an old health care order previously dominated by church, lay-business and volunteer organizations. Markets and ownership are being replaced by the priestly wisdom of an unelected elite presiding over a regulated utility. And they are being cheered on by their liberal-progressive and highly creative allies who dominate the old and new social media.

Opposing views are not only unwelcome but drowned out by a self-reinforcing echo chamber of this clerisy's group-think. Unapproved thoughts on, for example, the old-fashioned ability of health insurers to pool risks, the virtues of fee for service to incent access and the merits of small physician-owned private practices are tut-tutted as sadly misinformed. The few who rise above the noise are labeled as in the pockets of fat cats or being right-wing ideologues. 
And who should be surprised that the oligarch's interest in information technology dominates their health care agenda? Electronic records will save health care from itself, decision support will usher in a new clinical wisdom and big data today will lead to miracles tomorrow.  And by the way, if that leads to additional billions flowing to the oligarchs, all the better.  All that remains is figuring out which city they should buy an estate in so that they can run for elected office and legislate a single payer system modeled after Microsoft and powered by Google.

Their hardest job?  Persuading consumers as well as front-line health care workers to "work against their material interests or traditional beliefs." Think about paying more for energy, giving up control of education  and letting the NSA troll Facebook's data for bad behavior. In the healthcare space, patients must agree to consume less health care with health insurance they don't want while letting more of their personal data be used. Front line providers have to do more with less income, less control and less prestige.

Oh, and the clerisy and their oligarchs remain personally insulated against the very policies that they promote for everyone else. If they need health insurance, it won't be a Bronze plan from an Exchange any more than they'll give up their big cars, private schools and internet privacy.

It's the 1% alright, but they're hiding in plain sight.

Frightening thoughts.

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