The poor are getting poorer; the rich are getting richer, and it is wrong. But the reasons have more to do with technology than with greed, and that is what makes the solutions so difficult to find. The new technologies are capable of producing tremendous gains in productivity, but the profits have to be used to keep up with the technological advances, both in the acquisition and in the training required. There is simply no money left over for those who have neither the technology nor the skills. What is worse, any expenditure on the poor merely seems to be prolonging their agony. A government that tries to buck this harsh reality is simply going to end up with more poor people - better fed for today maybe, but even more hopeless tomorrow.

There is a ray of hope, however, in the concomitant decentralisation of power that is also a feature of the modern economic landscape. One has to believe that money spent on empowering people is a better investment than money spent on technology. Never mind the science fiction horror stories; in the long run it will be people who control technology and not vice versa, and it will be the quality of the people that will make the difference between a progressive society and a backward one. That quality does not depend on the money supply, but it is contingent on wise economic policies. Such policies will seek to ensure that the new technology is appropriate to the nature of the society, and that the training in its use is humanistic as well as technical. The outcome must be a people who are equipped to respond creatively and effectively to new circumstances; a people in whom we can have faith regardless of the economic realities of the day.

The health care revolution is of a similar order. Satisfactory outcomes ultimately also depend on individual empowerment, and the biggest obstacle is also habitual dependency. People have taken it for granted that when they fall ill somebody is going to look after them. By that we do not only mean that somebody (the government or the insured) is going to pay for the medical treatment, but also that whatever medical treatment they want will be made available (by the doctors).

Not even the richest government in the world is able to pay for all the treatment that people need. Rationing is an inescapable development, and the only question is, how is the rationing to be made equitable. Neither are the doctors going to be able to treat all the problems that people bring on themselves. Indeed, the proportion of these complaints that doctors are able to treat is declining. Fat people with arthritis in their knees will just have to accept that the only real solution lies in weight loss and exercise, and that such a solution has nothing to do with doctors.

And so it is that health care reforms are pushing the decision-making closer and closer to people's homes. The emphasis on primary health care means a shift in resources from treatment to prevention; from hospitals to community health centres. Many people still interpret this to mean additional expenditure on the latter. They are in for a shock: the shift is real and inescapable. That is why some hospitals are going to be closed, and other hospitals are going to be charging more and more for their services.

A successful outcome is contingent on a profound change in what happens in the community health centres. No longer will they be simply providing treatment and referral for sick people, but also promoting wellness for everyone. That sounds nice enough; what is less obvious is that if they fail to promote wellness and keep people out of hospital, the whole system is going to fail, and for once it will not be the government's fault.

In this tough new world, jobs are only available for those who are able to do productive work, and good health will only be enjoyed by those who keep themselves healthy. Politicians who promise that they are going to make things easier are not only fooling the people, they are setting themselves up for a high fall. No one likes what is happening in Trinidad and Tobago today, but there are no clear answers to our problems. More than ever before we are going to need leaders with the brains to understand what is happening in the world, and politicians who are prepared to forego the promises and tell it like it is.