Like Deschooling, Medical Nemesis is a critique of institutionalization. However, Illich did walk the walk and refused treatment for the cancer that killed him. I don’t know whether this was a refusal of medical science or a refusal to submit to a corrupt institution – I suspect the latter.

This does raise a question about alternatives. One of Illich’s points is that medical practice is not evidence based but rather refers to “best practice”. This sounds a lot like education. Another point regards the structuring of health as a commodity which is then delivered by the healthcare system. Commoditization requires us to construct health as a thing that can be bought and sold. To be healthy, we need to buy-in to the system by becoming patients, if we can afford it. Then, it is only a matter of whatever the market can bear.

Nationalized health systems are not the answer so long as health remains a commodity since, as with any “free” thing offered to the public, demand will eventually outstrip resources and the system will crash. So, it is not just a matter of how to organize and distribute health care, but also of the social construction of health and disease.

In a way, we have the same dilemma in education. Learning has been commoditized. Those who pay can get and getting it means that they are better at earning and spending than are those who do not have it. To be a productive member of society means that you have a level of income that enables you to consume enough goods to qualify you for the Gold Card membership and we are clueless that we have lost our independence, our freedom, our dignity, or ability to make decisions for ourselves, that we have lost our futures and ourselves.

I believe this is the big story here.