Friday, May 21, 2010

The Root of all Evil

Dear Prof. Smith,

There's a facebook status meme going around, asking people to set this slogan as their status for the day
No one should die because they cannot afford health care, and no one should go broke because they get sick.

It also asks for "politicians to get this right".

The gap between getting it right and the current state of affairs differs, of course, from place to place and across demographics. Nonetheless, whatever partial solutions are implemented in Italy or the Phillipines or the United States of America, there are common and basic problems that the perfectly-sensible appeal to justice above highlights.

People get sick

As a fact it is simple enough. For instance, the very earth we tread is riddled with opportunistic critters more than happy to eat you alive; those we encounter most often do this on a miniscule scale at snail's-pace so that you usually won't notice. Enough, however, have truly debilitating side-effects, or progress with such rapacious speed, that (ordinarily) a relatively small portion of our society is in some state of general incapacity or bodily peril, and it behoves those of us who are able to help them in some practical way.
And there are other woes that may befall us --- injuries mechanical and chemical, from carelessness, abuse, or innocent mishap. Some people regularly poison themselves --- sad, but true.

This raises the question of what, in general terms, should society do about it? And I say "society" should do something about it because those who are sick or injured are often themselves least capable of properly treating their ills.

Passive voice

Speaking vaguely, it is easy to recognize that, when possible, treatment should be applied, suitable to the patient and her condition, in such a manner as to alleviate the debility caused by her illness, so far as this is reasonably possible. I say "reasonably", not to invite slitherisms, but simply as recognition that in some cases there really is nothing that can be done.

History has shown us that there is a degree of both natural aptitude and learned skill that help to improve the success of this process: that is, doctoring requires ability and training. In other words, most people aren't suited to be doctors, and it takes a large investment of time to become one. On top of that, the doctor has to pay attention to his present task, which may require extended operation or periodic observation. As such, it's impractical for a surgeon or physician to also, say, tend his own farm, or opperate an independent taxi service. Doctoring will have to be his profession, even the core of his vocation. "The labourer is worthy of his hire", so he should, and worthily can, make his living by his medicine.

The Root

In modern terms, this means that the doctor has to be paid. That means, money has to change hands. We have all heard tales of odious clever folk with steady hands who have decided to squeeze the medical profession for every drop of gold they can manage; it's not blood-money, perhaps, but these tales do give doctor's bills some of the smell of ransom. And that's too bad, really, because as people doctors really do need to bring in a living, and we really do need them.

Something akin, but much more abstracted and impersonal, has happened to the chemical design/engineering industry, particularly the pharamceutical sector, wherein publically traded companies are required by market fiat to collect as much money as can be managed from production and sale of carefully-packaged medical substances, with the effect that chronic health maintainance, especially against rare conditions, can easily become hugely expensive on a per-capita basis even when the total resource cost of treating all cases of any given illness is negligible in comparison to the needs of all people.

Something of this love of money has infected pretty much every necessary profession --- police, firefighters, doctors, nurses, sanitation crew, infrastructure maintainance, tutors --- and it shows up most whenever one of these groups bands together in professional solidarity and does whatever they reasonably can to make the rest of us uncomfortable, until whoever has accepted responsibility for paying them agrees to pay them more. Whatever that means. Unfortunately, there are places where no-one has particularly made it their responsibility to care for doctors; (the apothecaries take care of themselves). In such places, while a doctor may not withhold treatment when the patient can't pay, there will be sick folk who just won't see a doctor, fearing the long-term financial cost. Getting medicines you need, or an extended stay in hospital, can be even more daunting.

The injustice, the cracks that spread from this one hurt, the love of money when it infects medicine, are that a sick person can be thought of as a burden --- it's not clear on whom --- and even may think themselves too much of a burden. In truth, the burden is the sickness itself, and the patient bears the worst of it! A person who is successfully treated of an illness is then able to work again, and will generally prove to be a positive good for all those around her.

Hacking away at that root.

I will have more to say about this in another letter, I think, but for now I want to just remember that the love of money is the evil here, and there's not much we can do if most-everyone stays attached to it.

There are plenty of reasons it's silly to love money --- money won't say nice things to you, keep you warm, bandage your scraped knees, or feed you: it's only good when you replace it with other things. Put another way, money is a medium for communicating gratitude, or indebtedness. It's a rather indirect medium, too, and it's probably not the best --- except perhaps for many of the rest.

As a medium of gratitude it wields the two-edged sword of simplicity: most everything that can be got can also be given a rough money-value, so we don't have to argue about how many bushels of loganberries are the value of a *goat*, versus their repsective values in raw stilton: we just ask how much does *each one* cost money-wise, sell our thing for cash and then buy what we want out of the rest of the market; so that's handy. It's a *standard measure*, more or less.

But actually, that's not quite how the real world works. Certainly, the materials and labour that go into making stilton and getting it from the dairy to your dinner table are reflected in the farmer's asking-price, and the grocer's. But then there's that thing about scarcity and demand; and demand varies not just between products, but also between buyers, and in any one buyer from day-to-day. In some ways, that is as it should be, but in others... In brief, many independent considerations get added-up to fix the price of a thing, which is, I expect, a misfortune subject to a form of Arrow's Impossibility Theorem. More fully, the process of making things is a multi-dimensional phenomenon, but when we decide between making and buying various things, largely the question becomes one-dimensional: will it fit my budget? I propose that this artificial flattening of reality is conceptually one of the first real pitfalls of econo-centric politics. Later I hope to write more properly about why that is, and perhaps make some suggestions on what to do about it.

So, expect to hear from me again, soon. I'm curious of your reactions, but keep in mind that I'm not finished!

Chester Jones


Arkanabar T'verrick Ilarsadin said...

While love of money is root of all sorts of evil, I don't think it is what drives up medical costs, whether these are expressed as money (as in the US) or time (as in Canada). It is the heavy foot of government. Here is an article by Thomas DiLorenzo. And here is one by David Goldhill.

/dev/null said...

It's an interesting observation; I'm curious what you suppose makes Government's foot so heavy --- and why should it be so apparent in medical services. But note I'm not suggesting that doctors and nurses and so-forth are generally over-payed: it's more likely they're overworked!

It occurs to me recently there's something similar going on, though in a subtler way, in higher education, and PhDComics (oh! my sources... :P but Jorge has good sources himself) has noted the strongest correlate of tuition to be a University President's salary.

But bear with me: I'm not critiquing medical service as such, but the all-pervasive economic sphere it inhabits.

Thanks for your comment; I'll read the articles you mention later, for now I must entertain!

/dev/null said...

On review, both articles are hopelessly bound to the notion of improving medicine while remaining mired in the prevailing views of how people ought to get on with living together --- that, vaguely, is what I mean by "the economy". A secondary problem is that both articles are stuck with contemplating the difficulties of improving medicine in the USA while keeping the models of private/public enterprise native to the American economy, but as both authors are living in the USA, that's understandable.

On the other hand, they do both highlight that love of money is indeed deep among the roots, although they locate it among legislators and pseudomedical service providers.

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