04 March 2011

Elements Of Ideal World

Charles Stross has bemoaned at his excellent blog the shortage of writers of utopian, as opposed to dytopian science fiction. There aren't enough people envisioning a positive visions of a good society of the future. I'll take a stab at some pieces of what that should look like today.

Health Care

* Health care billing is invisible to the patient who presents an insurance card, pays a co-pay that is easily determined and known in advance, and never hears about the financial part of the transaction again. The behind the scenes billing process would be highly automated, provide appropriate incentives to health care providers, resistant to fraud and inexpensive.

* A larger share of health care services would be provided by reasonably autonomous health care professionals less expensive and less comprehensively trained, but still carefully technically trained, on a par in expertise and compensation with nurse practioners, physician's assistants, EMTs, and midwives.

* The health care system, somehow or other, would provide universal coverage regardless of ability to pay, and everyone who worked a full working life would be in a pension system that would assure them a tolerable standard of living that was not deeply less generous than the one they enjoyed while they were working.

* A comprehensive, evidence based set of lifestyle recommendations for a healthy life would be easy to understand, easy to access, annotated with the genuine impacts of not following them and their evidentiary basis, and widely followed.

* A comprehensive, easy to access, evidence based authoritative catalog of ineffective treatment for medical conditions would be available as a persausive tool, and false marketing of ineffective treatments with medical claims would be regulated.

* A standard part of the labor and delivery package for every child will be a full genome and biomarker analysis that would become a part of that child's medical file for life and would be available on a privacy protected basis for medical researchers, and would be digested automatically for parents in a way that flagged issues and traits relevant to the child's future mental and physical health care, and educational and parenting needs.

* Cavities would be dramatically reduced by a "vaccine" administered to children around the same time as other childhood vaccines.

* Effective vaccines would be available and widely administered for all significantly harmful viral illnesses.

* Effective treatments to end the causes of injuries and diseases like Type II diabetes, cancer, chronic fatigue syndrome, spinal injuries, and autoimmune disorders (like M.S. and Lupus) would exist and provide relatively inexpensive mostly outpatient treatment.

* Birth control would be near universal for those not ideologically opposed to it from puberty onward, in place until an affirmative decision to have a child was made, capable of being ended without negative long term effects, and not disruptive of normal hormonal balances.

* Effective permanent correction of nearsightedness would be widely available and have an extremely low failure rate.

Mental Health

* Mental health care would be easy to access even by impaired people, would be provided on a categorical basis without regular eligibility evaluation to people diagnosed with conditions that are generally life long (while also having the capacity to address acute and temporary issues), would employ mostly professionals with less comprehensive education and compensation than M.D. trained psychiatrists but the authority to prescribe mental health meds and specialized technical training in mental health care. This would be handled on a more wholistic model than the transactional disease model common today - most mental health patients would see a treating professional at least once or twice a year their home and at least once or twice a year within some context of their daily life outside their home and outside the professional's office.

* Substance abuse would be treatable highly effectively with drugs. Improved, cheap diagnostic "labs on a chip" would facilite more accurate diagnosis of mental health conditions and would reduce the amount of trial and error involved in developing optimal treatment plans.

* An effective permanent "cure" for PTSD would be developed.

* There would be significant "nudges" to influence people needing it to obtain mental health care without going all the way to a court order to compel it involuntariliy in the vast majority of case.

* Evidence based, reliable risk assessment tools and early warning systems would identify people who should not possess firearms due to their current mental health and be implemented in a way that provides genuine and effective barriers to access to firearms for those individuals during those periods.

* The stigma of needing mental health care would be reduced. Indeed, mental health care might be integrated into a larger comprehensive system that reviewed the overall well being of each individual on a regular basis in a wide variety of respects.

* Minimally restrictive residential options for significantly impaired individuals with mental health issues would be about as common as and about as decent as assisted living facilities for the elderly are today.

* There would be adequate psychiatric hospital resources for the most severely impaired individuals with mental health issues, sometime accute and sometimes long term, which would be comparable in quality of life to the nicer private rehab centers today.


* Medium and large sized cities would have transit systems that would make up a large share of intracity passenger and parcel traffic, and all places would have transit systems sufficient to meet the needs of those who can't drive.

* Intracity transportation, including cargo delivery, would be almost entirely with electrically powered vehicles in urban areas, and these vehicles would have enhanced safety systems to intervene in cases of operator error or incapacity. Intercity freight bound for urban areas even as small as very small cities and towns would move predominantly by rail rather than trucks.

* High speed rail would have a large share of of inter-city passenger and parcel traffic for distances of under three hundred miles between major urban centers and high volume destinations.

* A family taking a trip on an airplane for Thanksgiving or Christmas could reasonable expect to arrive at an airport 45 minutes before takeoff and make their flight; business traveler traveling light at non-peak times could reasonable expect to arrive at an airport an airport 30 minutes before takeoff and make their flight. Checking baggage would add only about 10 minutes to a typical traveller's travel time.

* Commercial airports would routinely have good quality transit that is comfortable, accomodate typical amounts of luggage easily, and be faster than travelling by car and parking at the airport, and no more expensive than it is to drive to an airport in a car and park there now.

* Most ocean freighters would use some form of sail to be more fuel efficient.

* Very low population density areas would be connected by airplanes, boats, and airships rather than roads, which would be removed from these areas.

* Hydrocarbon fueled vehicles would be predominantly used in niche applications in rural settings and in ocean fishing and pleasure boats where a dense electrical repowering grid for vehicles taking short intracity trips was not practical.


* Electric vehicles, wider use of transit and freight rail, and wider use of alternative fuels would dramatically reduce petroleum consumption.

* Wider use of renewable energy sources like improved solar and wind technology, tidal power, heat pumps with underground loops, and micro-hydropower would reduce coal consumption.

* Comprehensive conservation efforts would reduce energy consumption through means like better insulation, less electricity hungry appliances and devices, and more efficient energy storage devices.

* Nuclear fusion power including recycling of spent high level nuclear waste would provide a much larger share of electrical power and would be available in small scale versions that do not pose weapons proliferation risks in many small communities. Reasonably safe nuclear waste diposal facilities would come on line eliminating existing backlogs and meeting future needs.

* A significant share of coal consumption would involve converting coal into synthetic liquid and gas phase hydrocarbon fuels that would reduce the amount of air pollution generated by the coal. Coal burning would be subject to carbon taxes that reflected their environmental impact and as a result would be used only in niche applications where there were not other economically viable alternatives.

Food, Agriculture and Rural Life

* Organic farming would become the predominant type of agricultural production for most kinds of agricultural products. Petrochemical use in agriculture would decline greatly.

* Automation and other technologies would continue to increase productivity of farms per farmer resulting in a greatly decreased population in places with farm economies. Farmers would be more affluent as a result, and would mostly send their children to boarding schools for middle school and high school since population densities would be too low to support decent local day schools close enough to home.

* Most fish would be produced in fish farms. Better management of commercial fishing and water pollution would restore wild fisheries as well.

* Subsidies for rural living designed to assist economically stuggling farmers would be ended, this would also discourage exurban living.

* Rural governments would be consolidated to serve much larger rural populations over much larger areas and improve the professionalism of the services they provide.

* Meat consumption as a share of total food consumption would be reduced somewhat and more diverse kinds of meats would be available at affordable prices.

* Door to door delivery of mail in rural areas where it is not cost effective to do so would be replaced by post office pickup.


* A system of state funded, secular schools would operate like charter schools do today and local elected school boards would cease to exist. Students would be allowed to choose to attend any of these school free of charge, schools would be compensated based on enrollment and enrolled student need, schools that failed to secure enough students choosing to attend or failed to meet minimum standards would fold, and neither the state board of education nor elected local school board would have day to day managerial control over their operations. Instead, there would be basic health and safety standards, minimum business model approvals, some standardization of the admissions and transfer process, and impartial government administered student performance and satisfaction evaluations. The schools would have the same sort of legal status as public colleges and universities as governmental entities subject to constitutional standards applicable to public actors such as due process and the First Amendment.

* A system of higher education funding that would provide financial assistance to students through scholarships with both need and merit components. The system would commit to meeting 100% of financial need through grants for the best students, 100% of financial need through a combination of grants and loans (no more than 50% loans) for students with less academic merit, and on public grant or loan assistance for academic higher education for studnets with only marginal academic merit.

* Quality vocational education programs would be a respectable and reasonably popular choice for students who were not particularly strong academically and completion of these program would provide graduates with a reasonable prospect of a steady employment in an upper working class to middle middle class career.

* High school graduates would leave school with significant practical knowledge of physical health and mental health matters in connection with the health care system, to the extent necessary to care for themselves, family members, and strangers in emergency situations in a way consistent with evidence based best practices in a manner rooted in a genuine layman's level understanding of the physical processes behind what they need to do.

* Students at high risk of failing academically, ending up engaged in criminal activity, lifelong economic failure, and dysfunctional relationships would be accurately identified by an early warning system in place by pre-school that would devote significant resources starting as early as possible to support them in changing their course, and to the extent that high risks are not corrected by adulthood to intervene appropriately to protect them and others in a pro-active way that is only actually punitive to the extent that it authorized by crimes, child abuse and neglect, domestic violence, financial defaults or similar events.

Criminal Justice

* Criminal defendants are entitled to a public defender with a manageable case load who is paid enough to attract competent lawyers without regard to ability to pay. Criminal defendants can opt to use the funds that would have been used for their defense to apply towards the cost of hiring private counsel instead.

* The primary penalty for failing to enter into a plea bargain would be a court cost assessed against defendants found guilty to cover the cost of the public defender, the prosecutor, and the judicial system in the case, rather than large differences in sentencing outcomes.

* Evidence based statistical evaluation instruments would pay a strong part in determing the kind of sentence appropriate for particular crimes, and the evidence would be regularly re-evaluated in a transparent and open process. Only individuals whose release would pose a significant threat to others from serious recidivism incidents would be released.

* The criminal justice system would make wider use of sanctions intermediate between probation and long periods of incarceration in prisons, particularly for non-violent offenses, such as electrically monitored house arrest, large but proportionate fines and restitution awards, and low security community corrections/low security facilities for low risk prisoners.

* The process of integrating incarcerated individuals back into the community would be more structured, more supportive and less punitive, particularly for the first two or three years, in order to reduce recidivism.

* Prostitution and recreational drug use would be regulated from a public health perspective, but not criminalized.

* Incarceration rates would be significantly lower.

* Prisons would be safer for prisoners and guards, and prison gangs would be more effectively disrupted.

* Law enforcement officers who were caught lying or engaging in police brutality would routinely and promptly be fired even in cases where the proof of the misconduct while solid, was not beyond a reasonable doubt, and would be entered into a national registry of bad cops. The past cases of bad cops would then routinely and systematically investigated to determine if anyone else had been a victim of misconduct by the officer, and law enforcement associates of dismissed bad cops would be have their past patterns of conduct investigated. Incentives to engage in police misconduct would be identified and addressed. Law enforcement officers who did not personally engage in misconduct would have strong incentives individually and collectively to report it and cooperate in investigating it. Employers of law enforcement officials would be vicarciously liable for misconduct by their law enforcement employees without regard to fault.

* A systematic process to allow for the early release of individuals who were given excessive sentences that would not longer be imposed under existing law and sentencing standards whose post-incarceration conduct was acceptable, would be established.

Family Law

* Gay marriage would be legal and accepted.

* The welfare state and legal system would be more accomodating of and sensitive to the needs and expectations of people in extended family and communal living arrangement situations.

* An early warning system and societal norms would encourage earlier intervention in potentially coercive or violent relationships by better informing and empowering potential victims.

* The financial consequences of a divorce in terms of property division and maintenance would be highly predictable due to well defined and easy to apply rules that afford at least rough justice, and as a result, would be far less acrimonious.

* Disputes over parenting time, parental decision making, child abuse and neglect and paternity would be segregated into legal system separate from the financial part of a divorce that would apply without regard to marital status. In this system, advocates for each party, who would not necessarily be lawyer, would be available without regard to ability to pay. This system would be set up to reflect the fact that parenting issues are ongoing matters, rather than something to be resolved once and for all.

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