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Up until now, the German scheme of health care provision has called for more medications, more care for the sick, more drugs, more high-tech in hospitals and doctors‹ offices, or more AI and health apps so we can optimize our own health. But while these measures may generate more economic growth, they do little to improve individual or social health. At this point the German health care system annually costs—in total--around 500 billion euros or 6,000 euros per capita, more money than the entire federal budget. So, where are the benefits of this prodigious investment, and what would really be good for our health? My therapeutic strategy is to rethink and totally reconstruct health and the health care system.
 

Understanding and action

Both scientific findings and sober cost-efficiency studies of existing health care options are driving policymaking toward a historic turning-point. The health care system is not a component of the capitalist economic order; rather, it is a prerequisite of society’s development. Healthy people are more successful and more socially productive. For that reason, we should treat health as a measure of economic and social prosperity, again regarding the money spent as a means to an end. Health services that gauge their meaning and value in monetary terms do nothing but further the business of human suffering. They utterly fail to produce health at a reasonable price.
 

Medical codes of ethics oblige doctors to serve the health needs of individual persons and of the entire population. Their servile, pliant behavior when confronting the seductions of mammon creates confusion. The economist John Maynard Keynes’s comments on this point hit the mark: »The love of money as a possession rather than as a means to the end of enjoying life’s pleasures is recognized for what it is: a rather disgusting disease, one of those half-criminal, semi-pathological tendencies which, with a shudder, we leave to specialists in mental illnesses.«
 

»Today’s most widespread illnesses embody individual responses to social dislocations.«
 

Currently, the most common diagnoses of illnesses in the health care system are anxiety, depression, high blood pressure, back pain, or a variety of reactions indicating a mismatch between patients and the living conditions that they face. In other words, today’s most widespread illnesses embody individual responses to social dislocations. They are symptoms of a social disease, not signs of individual organ failure. The complaints registered by sick people always have socio-cultural and psychosocial roots as well. Illness must be understood, treated, and prevented in full awareness of those roots. We are talking about a form of medical care that seeks social health and applies the appropriate therapy to society.
 

Those insights were first aired by the social health movement in Germany 40 years ago and subsequently by the World Health Organization’s (WHO) Ottawa Charter for Health Promotion. A healthy society, one that foregrounds well-being, constructs a health care system that operates in radically democratic and socially integrative ways.  The Ottawa Charter of 1986 pleads for a radical democratization of the health care system. Civil society organized at the local level, i.e., in life-worlds inhabited and grasped by ordinary people, must see to it that we have »clean cities,« healthier living environments, and a healthy balance between human beings and the community.
 

Human beings are not machines
 

Present-day medical care traces illness back to its material substrate: bodily functions and microbiological determinants. This reductionism is lucrative, but it isn’t healthy. Human beings are socio-cultural entities, and the health care system must take into account not just the health »competence« of individuals but also their social flourishing. Workplace enhancement and health maintenance skills for individuals and their life-worlds are the strategies of the future. A modern health care system enables people to respond skillfully and efficaciously to the risks of illness, get organized, and not let dogmatic experts lead them around by the nose. In this sense the local community takes on the burden of continuously organizing social cooperation that sees to the health of all citizens.
 

To harmonize each person’s power of self-determination with its implications for the social structure.
 

Rudoph Virchow understood the human organism to be an ideal state in which the discrete cell-citizens cooperate as autonomous individuals. An adherent of moderate liberalism, he made every effort to harmonize each person’s power of self-determination with its implications for the social structure. Looked at in this way, the local community is an emergent web of life that promotes health and minimizes the risks of disease for the sake of its own self-preservation. Local health care policy and welfare provision treat individual illnesses as indicators of still-unfulfilled tasks: improved educational options, healthier living arrangements, civic engagement and participation. The provision of health care is understood as a social immune system designed to ward off the dangers of illness in the life of society. Thus, the community continuously strives to attain a health-enhancing culture of cooperation.
 

The findings of present-day science prove unequivocally that body, mind, and soul or individuals and the community form a single networked organism. Psyche and brain, the nervous system, hormones, and the immune system cooperate. The social milieu and the life-worlds of the individual person—everything is connected to everything else and exerts a mutual influence upon both individual and social states of health. Today psychoneuroimmunology (PNI) illuminates these complex correlations. Stress research, resilience studies, psychosocial experiences, and psychosomatic medicine all confirm this truth as well: human beings are not machines; they are living beings and social systems. Far from being cogs in a machine, they are instead living networks.
 

Society as an organism
 

Thomas Fuchs, a psychiatrist, summarizes the findings of brain research as follows: »The brain is mainly an organ that mediates the organism’s relations with its environment and our ties to other human beings. Those interactions are continually changing the brain, turning it into an organ that bears biographical, social, and cultural imprints.« Trust harmonizes the brain: trust in one’s own competence; trust in the loyalty or honesty of other people, and confidence that things will get better. Both well-founded and pathological mistrust produces anxiety, insecurity, and leads to chronic psychosocial stress, which also demonstrably increase susceptibility to infections.
 

The body simply does not function like a complicated clockwork with genetically pre-set wheels and pendulums. The psychoimmunologist Christian Schubert puts it this way: »what interests me are human beings as a whole in all of their idiosyncrasies. And I know that we have here the key to a better, more individualized, more successful practice of medicine.« Schubert is calling for a new way of thinking in medicine and research that takes the whole person into account: one that ventures a radical transformation in the structures and cultures of our health care system. In that case the health care services of tomorrow would not be a machine tended from above, but a self-organizing system created from below. Communications technology, now integrated with the internet, has been building social brain structures and nerve networks that can be deployed like an individual brain, whether for good or evil ends. These new technologies have augmented the capabilities of social communities both local and global. Moreover, they have democratized measurement and evaluation in medicine. Soon just about everyone will be able to record a personal EKG or measure their own lab samples and look up medical information on the internet. Doctors as repositories of expert knowledge will no longer be needed. But we will need doctors who help people evaluate knowledge wisely and apply it conscientiously.
 

The age of politicians and physicians as welfare-providers of the matters they control is over
 

What the printing of books once did for the diffusion of knowledge and experience, the instruments of communications technology now accomplish by enhancing the decision-making capabilities of civic communities. The exchange of ideas at the global level can be linked to local, self-organized actions. This leap ahead in cultural development renders hierarchical power structures superfluous since it ensures that relationships will be transparent and clearly visible to all while encouraging forms of organization resembling living organisms. The age of politicians and physicians as welfare-providers of the matters they control is over. The World Health Organization’s Ottawa Charter postulates that democratic participation and civic engagement are the foundations of a healthy society. The health scientist and government advisor Ilona Kickbusch elaborates on this point: »promoting sustainable development means simultaneously promoting health and vice-versa.«
 

So, it’s vitally important to think of the health care economy as one that is − or ought to be − oriented to the common good. Furthermore, we should summon up all the courage and energy we can to make such an economy a reality. Finally, we should strive to create a market in health care not driven by profit-seeking nor guided by greed. Also, by transforming the health care economy into a non-profit institution, we would be liberating healers and care-givers. Medicine and care practiced for the common good can stoke people’s enthusiasm: A health care system geared to welfare economics overcomes the tendency to regard money-making as the purpose of medical care, encourages societal growth, and stimulates shared progress.
 

A health care system on this model would have altruistic effects, acting as a sort of societal yin. It would heal the wounds inflicted by the yang, the selfishness of a capitalist economy. Health care policy for a humane society can cure the illnesses of populist seducers and agents. Subsidiary solidarity based on health as the key criterion would be a new prescription for social democracy.