Imagine that you lived in a world where medical implants and augmented cybernetics were so cheap that even the poorest people in society had access to them. In this world, people learn skills by inserting a flash drive into their neck and installing the knowledge directly. Humans have replaced their arms with chromed fashion pieces, and the more extravagant people have replaced their whole bodies with cybernetics. With this society in mind, imagine that medical care and transport are obscenely expensive. Flying ambulances leave the scene of an accident because the victims aren’t in their network, doctors refuse visitation because someone didn’t pay for a more expensive package for their family member going into surgery, and when that family member dies with no explanation post-surgery, you have no recourse but to send them to a cheap crematorium. When you combine these two ideas, it seems a little far-fetched. A society rich enough that cybernetic augmentation is the norm being incapable of providing medical care at reasonable rates makes no sense economically. This is the world of ‘Cyberpunk: Edgerunners’.
‘Cyberpunk: Edgerunners’ is an anime that was released in September of 2022 set in the same universe as Cyberpunk 2077 and other properties under the Cyberpunk name. Created by Studio Trigger in collaboration with CD Projekt Red, Edgerunners focuses on the story of David Martinez, a poor kid who through the use of cybernetics makes a living in the seedy underbelly of Night City as an Edgerunner; a kind of mercenary. Before we continue, I highly recommend watching ‘Cyberpunk: Edgerunners’ on Netflix as I can confidently say it is one of the best shows to air this year (but be warned there is graphic violence and nudity). But as I’ll only be detailing events in the first episode, it is not mandatory to have seen the show to read the rest of this piece.
In the first episode, David and his mother find themselves caught between two street gangs committing a drive-by. The event causes the pair to be injured in an accident, but the Trauma Team swiftly arrives. David, feeling relieved by their arrival, yells for them to help his mother, only for them to leave moments later when they find the pair are not covered. For reference, Trauma Team is a private service known for charging a subscription-based membership service similar to AAA. The next scene shows a back-alley doctor telling him his mother is recovering fine in the hospital and will be ready to leave in a few days, but as David didn’t pay for the visitation package, he will not be able to see her until then. After some events in the episode, David returns to find his mother has passed away with the doctor not really paying much thought to it. Unable to pay for a proper funeral service, David settles for cremation and an urn. After being tormented by the persistent debt and charges throughout his life in Night City, David approaches a Ripperdoc (a medical professional specializing in installing cybernetics) to install a military-grade piece of cybernetics onto his body.
Before we go further, I’d like to explain to readers more about the genre of Cyberpunk. Cyberpunk is about dystopian settings with advanced technology. Worlds where corporations use wage slaves to further profits and on-payroll assassins to commit shadow wars with their competitors. Cyberpunk as a genre tends to portray the evils of capitalism and how the poor are incapable of having basic needs met when those needs are behind a paywall, how corporations will murder to maintain profit margins, and on the more positive side, how cybernetics are capable of improving our lives significantly. With this basic backdrop in mind, those with more economic literacy may see why the world of Cyberpunk and the genre doesn’t make that much sense.
In a world so rich that people would be willing to replace already working human limbs with robotic ones, there would be no way that the medical system would be able to be as expensive as it is predicted in Edgerunners without the intervention of government regulation. Trauma Team comes immediately to mind. In the United States, ambulance services are so obscenely expensive that some individuals use Ubers to go to a hospital or their caregiver of choice. There are multiple reasons for the high cost of EMS. One example involves the requirements that affect ambulance crews, such as the legal requirement to drive a person to the hospital and having no other option. (This especially affects over-users of the service with chronic conditions who may fare better by seeing a specialist at a private practice instead of the hospital.) Another area of regulation is Certificate of Need laws, which require a new ambulance service (or any service that has CoN laws, including hospitals) to be granted permission by its competitors to enter the market. Factors like these raise the demand to a much higher level but also reduce effective supply to meet that demand. Within Cyberpunk, it isn’t stated that these laws exist and as there are shown to be multiple ambulance services, ambulance rides shouldn’t be as expensive. Trauma Team may be a membership-based service, but AAA still provides services to non-members, they simply charge a higher fee, which can be paid off over time through various means.
Another way to look at this is, that as a society as a whole becomes wealthier, products and services become cheaper. The exception is goods and services under heavy regulation by politicians. Here’s a more mundane example presented by the economist Bob Murphy during a podcast: We in the united states are so rich that restaurants give free water and bread; they are willing to eat the cost because they make their money elsewhere. He states that we may become rich enough under a truly free-market (anarchist) system that one-day hospital visits will be either free or so cheap that nobody would have trouble affording their bill. Perhaps these hospitals would make their money from cybernetic installation procedures.
But what of recourse? Can a doctor charge someone to heal a loved one only for that loved one to die and get off scot-free? Of course not. Like any market, a seller of a product or services has to enact the discipline of constant dealings. For those unaware, the discipline of constant dealings is the concept of a private actor selling a good or a service having to maintain positive relations with their partners and customer base requiring that they act in the best and most honest way possible. A Doctor even operating as an independent contractor has to do their best to provide quality care, otherwise, their name and reputation as a physician will be ruined. Those who fail to uphold their reputation may never see another job again, and may have to find another career path or return to the natural state of poverty.
Another solution that is not presented in works of fiction like Edgerunners is the idea of Healthshares or Fraternal Societies. These are alternative systems of mutual aid that allow the poorest people to be able to afford healthcare. In the case of fraternal societies, these were organizations that collected cheap membership fees and provided bill paying for medical needs, and in some cases got around Jim Crow laws. These, however, were attacked by the American Medical Association, and politicians imposed sanctions on doctors practicing within Fraternal Societies. But in the world of Night City, the government doesn’t seem to have a grasp on the medical profession like it does in our dystopian authoritarian reality.
These are all different avenues to approach the medical market in the world of Cyberpunk: Edgerunners and in truth, our real world’s medical market. While I could go on with ways our medical system would be improved without the need for a welfare state, I feel this piece has served its purpose.
If you have a Netflix account, I highly recommend giving Cyberpunk: Edgerunners a watch. It’s 10 episodes of high-quality action and Sci-Fi. A story of love and growth in a world of neon lights and chromed-out mercs. I’ll finish this article with a question. If you could have any cybernetic enhancements, what would you want? Eyes that can zoom in with 4k quality? Multiple Arms? Or legs that can give you a 10-foot vertical? In the future, it may be more likely than we think.
This article does not necessarily reflect the opinions of The Liberty Block or any of its members. We welcome all forms of serious feedback and debate.