I have become very interested in societal collapse, as an American physician. I see a vast and counterproductive revolution in the delivery of medical care in the United States, which is incontrovertible. I fear that there is a positive feedback for this collapse, simply the misunderstanding of what is causing the collapse, and what could prevent it. The causes of the collapse are mistakenly identified as the solution, and as the apparent “solution” is hurried along, the collapse speeds up.
First, before I undertake this discussion, there may be many confusing versions of what the practice of productive medicine really is. I suggest that all societies express a hierarchy of needs, like Maslow’s needs expressed about individuals. The basic needs are ubiquitous to every rational human group. They may be considered, in a way, societal ADL’s.
Provision of food, water and clothing are key factors. Means of treatment of food, water, shelter and clothing to maintain or improve their utility to humans – fuel, sewage, construction materials and laundry come to mind – are self-evident “second-order” ADL’s to preserve the fundamental ones.
All rational societies, i.e. those that can perceive sickness and death – concepts probably evident to our extinct brother hominids’ cultures – will desire a means of curing the former and avoiding the latter. Therefore, medicine in general is an essential self-evident organic part of every rational society or tribe. “Medicine” is not a gift from Government; it arises as an element of natural law, in the manner of life, liberty and the pursuit of happiness.
Joseph Tainter, whose work I am now reading, postulates four main elements inherent to societies that are pertinent to their collapse:
1. human societies are problem-solving organizations;
2. sociopolitical systems require energy for their maintenance;
3. increased complexity carries with it increased costs per capita; and
4. investment in sociopolitical complexity as a problem-solving response reaches a point of declining marginal returns.


There is an economic model is proposed by Thomas Homer-Dixon and by Charles Hall in relation to our declining productivity of energy extraction, or energy return on energy invested (EROEI).(lifted from Wikipedia)

This measures the amount of surplus energy a society gets from using energy to obtain energy. Their argument is literally about fuels. However, it works metaphorically looking at energy as capacity to do things.
In this situation, money is linked to the capacity to cause things to be done. However, Marx’s ideas break down when he assigns labor as the added value to raw materials. It is productive labor that adds value. The difference is not trivial.