Heads or tails?
It’s a choice, with the occasional ‘balance on edge’, or ‘simply fail to come down at all’, which applies well to tossed coins.
It may sometimes apply to other things. Stepping over a cliff for example. Humans very often apply it a lot more broadly. Democrat or Republican. Black or white. Male or female.
It is a core theme in many of my books, that patently in a lot of cases, this is bullshit. 1)Things are seldom simple and entirely and perfectly described by a narrow simple category. If you think they are… you probably are behaving like a sheep, and haven’t actually looked carefully. Pigeonholes may work well for pigeons. They are lousy for people, emotions, philosophies or political positions 2)There is almost always another possibility, if not a myriad of them. Yes, you may have chosen to vote for one or other party. It is massively unlikely, unless you are, in fact, a prion (and incapable of independent life, let alone thought) that, if you actually thought about a party manifesto you would agree with all of it. And, if you really thought about it, inevitably humans choices come down neither A nor B but a percentage of A, a percentage of B and percentage of options through to zz. DRAGON’S RING – a choice between A & B… and actually neither are good. 3)We may simply be looking at the whole damn thing bass ackwards. Take health insurance as a simple example. What is it intended to do? Make sure that when you get sick you can afford to be treated and get better? Or in other words, that you can stay in good health? Right? Does it? As far as I can work out, only incidentally, and in fact the principal beneficiaries are people who only benefit if you are sick (especially as inevitably the insurers themselves have ownership or part ownership of the facilities for treating you). The IDEA of making sure you are not sick simply because you can’t afford treatment is a very desirable one. I’ve yet to meet anyone who thought they deserved to die or be sick and miserable because they didn’t have the money for treatment. I’ve met a few people who didn’t mind if it happened to someone else, as it never seems to occur to them, that someone else could be them someday, or their child, lover, mother or friend. So: it’s a good goal. But yet… when you think about it, the way it has been applied has been as counter-productive as possible, making affordability more a case of ‘how much blood can we take in how many ways from the host before it actually dies?’. If I were to announce with convincing evidence that I had a cure for everything that might ail you, and that I was going to release it, free, next week, I would give Flinders Island about 3 days before being nuked, in the process killing several hundred highly paid assassins and hitmen from every part of the medical business. (I’m ugly but not that much of a fool. I’d be elsewhere.). Yes, indeed, there are some wonderful doctors, nurses, radiographers and research chemists who would love nothing more than to say ‘my years of training and experience are now worthless, I’m unemployed and have to find a new job, and I am so happy about it’. But these make a small fragment of a fairly desirable group of people, and Doctors, nurses etc, make up a valuable but a very, very small fraction of the group whose livelihood depend on people being sick. A lot of these are salesmen, administrators, accountants, managers, board members, lawyers, CEO’s – not medical people at all. In fact, if you did a careful look at where the money from that insurance goes… most of it will be into this group (who don’t fix you when you’re sick) and the smaller volume into the actual cost of things needed and the people needed. And really, there is no incentive (especially, yes Discovery Health, I am looking at you, where the hospital facility is owned by the insurer) to limit that wastage. In fact, big talk aside, there is no value in keeping the insured healthy. If the insured never need a doctor, high premiums will put them off (unless insurers get the state to play ball and make them have it by law. At which point you may as well give the medical industry your salary check.). To look at this more logically there need to be serious incentives to the medical industry… to stop people needing their treatments and to make those as affordable and effective as possible. And actually the only way to do that is to reward the right things and punish the wrong. So for example they get paid… if you aren’t sick. If you are sick your premium reduces. If you’re incapacitated or die… they pay out. If you over-live your expected span… they get a bonus. And work out ways to get rid of the dead weight which adds no value. If the state wanted to interfere, the right way would to punitively tax the non-medical (or in the case of pharmaceutical companies non-scientists) personnel. Or make those non-tax-deductable expenses. Costs that cannot easily be passed on to the public, either via directly charging more, or getting the public to pay more tax to cover for largely un-needed expenses.
And those are just some of the possibilities. If you don’t want to go that far, maybe an effective basic state health service that forces private medicine to be competitive and offer more.
What underlies much what I write are simple questions: what are we doing this for? and is how we deal with it an artifact or accident or history, or really best for the purpose? I’ve used medicine as an example, but you could apply it to anything from energy supply to governance. Of course my possible answers aren’t right. But they’re about providing the right motivation to solve the problem, rather than motivating the creation of groups/institutions/bureaucracies whose lifeblood is keeping the problem vaguely under control but there forever.
The answer is inevitably neither A nor B but a big mixture of that and other things, and sometimes something new.