The scale and subtlety of our country’s dependency on oil and natural gas cannot be overstated. Nowhere is this truer than in our medical system.

Petrochemicals are used to manufacture analgesics, antihistamines, antibiotics, antibacterials, rectal suppositories, cough syrups, lubricants, creams, ointments, salves, and many gels. Processed plastics made with oil are used in heart valves and other esoteric medical equipment. Petrochemicals are used in radiological dyes and films, intravenous tubing, syringes, and oxygen masks. In all but rare instances, fossil fuels heat and cool buildings and supply electricity. Ambulances and helicopter “life flights” depend on petroleum, as do personnel who travel to and from medical workplaces in motor vehicles. Supplies and equipment are shipped — often from overseas — in petroleum-powered carriers. In addition there are the subtle consequences of fossil fuel reliance. A recently retired doctor informs me, “In orthopedics we used to set fractures mostly by feel and knowing the mechanics of how the fractures were created. I doubt that many of the present orthopedists could do a good job if you took away their [energy-powered] fluoroscope or X-ray.”

Despite this enormous vulnerability, public discussions of health care routinely ignore the prospect of peak oil. The proposed reforms, which seek to cover more people while holding down escalating costs, amount to little more than fiscal maneuvers. They take no notice of ecological resource constraints that will set limits on our ability to give people access to medical care.

The coming scarcity of fossil fuels, on top of inflationary costs in medicine (the prices of oil and natural gas are approximately four times what they were in 1999 and rising) and the expenses of treating Baby Boomers (a cohort twice the size of its predecessor), could overwhelm a medical system already in crisis. We can avoid collapse, however, by reducing medicine’s present consumption of energy and creating a health-care system that reflects our actual relationship to resources. Ironically, peak oil can be a catalyst for creating a health-care system that is cost-effective, ecologically sustainable, and congruent with a democratic social ethos.

At present we have a tiered health-care system. At the top is a Ferrari model of care that reflects our affluence, fascination with technology, and extravagance. Ferrari care has made possible the treatment of rare life-threatening diseases and expensive procedures like organ transplants, but it has also been used for esoteric and often redundant testing and vanity procedures such as botox injections. At the bottom is a jalopy model serving over 50 million un- and underinsured Americans who very often receive no treatment, defer treatment until their condition cannot be ignored, or face economic ruin when they seek adequate care. If the two tiers persist after peak oil, they will eventually be preserved by force — armed guards at gated medical facilities — for the few able to pay, while the rest of Americans are relegated to the jalopy and faced with overt rationing, triage, and curtailment of medical care. Such an outcome would be an overt contravention of democratic values — most Americans tell pollsters they believe that health care is a human right, not a privilege awarded those with higher income.

What then should we do? The best democratic option is to replace both the Ferrari and the jalopy with a Honda. The post-peak Honda health-care model will of necessity operate with fewer overall resources and less energy than today’s health-care system, and at lower cost. But it need not result in poorer quality of care. Although the United States spends more on health than any other nation — per capita health-care costs in this country are three times those in Great Britain and more than twice those in Canada — we do not have the best health outcomes. A study in the Journal of the American Medical Association in 2006, for example, reported that “white, middle-aged Americans — even those who are rich — are far less healthy than their peers in England.”

The commonsensical Honda model will emphasize public health — the prevention of disease and the promotion of health within the population as a whole — over treatment medicine, which focuses on restoring health to chronically or acutely ill individuals. Typically accomplished through the diffusion of information, low-cost therapies, and the promotion of healthful nutrition and lifestyle, preventive medicine allows people to avoid or postpone disease, and to stay clear of the costliest and most energy-intensive sectors of the medical system — doctors’ offices, pharmacies, and the hospital. In the Honda model, treatment medicine would continue, but its role would be brought into better balance with the vastly more cost-effective and energy-efficient mode of preventive health care.

The public health system arose in the early decades of the last century as a response to fears of infectious diseases in our country’s crowded cities. Its outlook is inherently egalitarian — if the entire community is not protected, then no one’s health is assured. Public health is no longer the force it was when it sent “ladies in white uniforms” into communities to preach the Gospel of Germs, explaining the relationship between hygiene and disease prevention. Today, public health is overburdened and underfunded, receiving about 5 percent of health-care dollars, with the balance going to treatment medicine and to biomedical research.

Despite funding inadequacies, public health is in place and functioning. Public health workers, for example, educate about and test for HIV/AIDS and other sexually transmitted diseases; they interdict infectious diseases like avian flu; they create emergency plans to deal with a variety of disaster scenarios; they monitor waste management and air and water quality. No new system needs to be invented or institutionalized to meet the health-care challenges of the coming energy transition, or, for that matter, those of climate change.

Already, some public health officials are beginning to address peak oil’s effect on health care. On the national level, the Center for Environmental Health at the Centers for Disease Control is investigating impacts of petroleum scarcity on pharmaceuticals. In Congress, a Peak Oil Caucus led by Roscoe Bartlett (R-MD) and Tom Udall (D-NM), is looking into the health risks posed by economic decline and mass unemployment, which peak oil is likely to trigger. At the local level, Indianapolis’s Marion County Health Department is the first in the country to begin planning for maintaining public health services under differing scenarios of energy scarcity.

Late though the hour is, we can still avert the worst health consequences of an energy downturn, but doing so will require transforming our entire health-care system. The elitist impulse to perpetuate Ferrari care for the explicit benefit of the few at the expense of the many will persist after peak oil, and substantial citizen action will be needed to put into effect the affordable, egalitarian Honda model. Medicine itself could play a central role in this effort, by educating those who are unaware of the sweeping changes peak oil will initiate. Reprising its inaugural campaign against germs, public health could become a platform for disseminating a Gospel of Energy Conservation. For the most part, the medical community is as naÏve about peak oil as the rest of the citizenry. As one public health official told me after hearing about medicine’s reliance on oil, “Oh my, I never thought of it that way. This is serious.”