I’ve been completely absorbed of late reading Jared Diamond’s brilliant 2005 book, Collapse: How Societies Choose to Fail or Succeed. I’ve read many an illuminating book on public policy, sociology, culture and the arts. But this one is one of the most intellectually penetrating and magnificently argued I’ve read in a long time.
Diamond looks at a variety of societies with regard to momentous changes—mostly for the worse—in their core economic, cultural, and environmental foundations. Among the most compelling: an examination of Rwanda’s genocide; a look at the collapses in the various Mayan societies; and, most riveting of all, an examination of the complete collapse of Easter Island society prior to the sustained interaction of Easter Islanders with Europeans, a collapse that included the utter destruction of the island’s environment, and a descent into famine and cannibalism.
Of course, not all chapters in the book focus on the apocalyptic: the chapter “’Mining’ Australia” is absolute must-reading for anyone who might wish to understand what long-term economic and environmental “sustainability” means in the world’s only continent-nation, with its vast scenic wonders, but relatively poor core set of natural resources. Diamond offers a particularly trenchant example of poor natural resources policy around timber exportation there. After going through a broad look at why natural resources sustainability is at significant risk Down Under, he talks about the exploitation of Australian timber for export in a way that is counterproductive and unsustainable. He notes that, “Of Australia’s forests standing at the time of European settlement in 1788, 40 percent have already been cleared, 35 percent have been partly logged, and only 25 percent remain intact. Nevertheless, logging of that small area of remaining old-growth forests is continuing.”
He goes into a detailed, but extremely compelling, look at how Australians are chopping down significant portions of their remaining forests to sell wood chips to the Japanese at about $7 per ton, with the Japanese turning around and creating paper from those wood chips, and selling the finished paper for about $1,000 per ton, including to Australia. It is clear that there is a fundamental flaw in that process; as he points out, this is yet another example of how the lack of a conscious, sustainable policy around the economics of dwindling natural resources in a particular society can lead to long-term economic and environmental damage.
Later, in his brilliant chapter “Failure to Perceive,” Diamond widens out to talk about the tendency among all societies to fail to perceive looming threats to their sustainability when those threats come in the form of slow trends concealed by wide fluctuations in activity, as with climate change. One threat that the leaders of the U.S. healthcare system are coming to understand is the core threat of economic unsustainability around healthcare costs. As a result, pioneers are moving forward to develop accountable care organizations, both within the two Medicare shared savings programs, and in concert with private health plans.
What’s particularly interesting is the medical group development aspect of all this. As I note in this issue’s cover story, considerable strategic planning and cultural change are required for medical groups to successfully master accountable care. Indeed, developing any sort of ACO requires a massive shift in the entire way in which a patient care organization or collaborative operates.
Yet that is precisely what our society is asking of us in healthcare. The current cost trajectory alone is unsustainable. So we must trudge ahead, as difficult as the path may be. Meanwhile, for negative exemplars of what happens to societies that fail to heed such warnings, one need only to look to the Easter Island model of utter failure.