Are people worthless? It occurred to me that this is the underlying assumption in many ways when we regard public expenditures as sunk costs for which we don’t recognize getting anything of value in return. That’s the primary way in which cuts to those expenditures can be viewed as, essentially, a purely good thing. After all, if we killed everyone off, taxes and government would go away entirely. Nirvana!
I’m not sure how closely related the cause of the firing neuron is to the idea that came to mind, but here is the article that triggered my thought. It was a column about the economics of health care. Particularly this passage:
If we actually prevent diseases or conditions, would our bills go up in the end? People would live longer and develop lots of other chronic diseases that can be expensive to control or treat. And they would draw Social Security.
In the fiscal sense, health improvement can cost us money. But that totally ignores the value to society.
For example, H.I.V. prior to antiretroviral therapy was like a death sentence. With the introduction of those drugs, we took a killer and made it more like a chronic illness. There was a lot of hand-wringing about how do we pay for the drugs. But that completely ignores the value to society.
We think of health care as an expense, but we really should be thinking of health care as an investment. We want to invest where we have the greatest return. I would put prevention in that bucket.
In some fashion, which I have not entirely pinned down yet, I think this also ties into the world view where the biologically human life is of critical importance before birth and after brain death but where the biographical human life in between those points is a matter of relative indifference.
This raises some good points to ponder:
1) A sort of Malthusian dilemma – if everyone quits smoking and eats right, Social Security will go bankrupt faster.
2) Health care is always rationed in some way – end of life care eats up a huge portion of expenditures. IMO this expense is similar to expensive funerals – it’s part of our culture to avoid death at almost all costs, and then once the end comes we spend outlandishly on coffins, crypts, etc. Our culture has extended this high-spending approach to pets…some people spend $10,000 keeping their 18-year-old cat alive, and many funeral homes offer pet funerals.
3) Whether Obamacare comes to be or not, society somehow eats all the costs of care, via insurance, for the majority of us who can’t pay all their own care in cash. What do we do about people who need a lung transplant because they wouldn’t quit smoking, or a liver transplant for an alcoholic ? Should they get less care because they engaged in empirically harmful behavior ?
4) Healthcare for the poor (Medicaid) and elderly (Medicare) is covered by a government program (for the most part). Why isn’t all government spending prioritized in order to provide the greatest good to individuals ? Example, the city of Indy extorted $650 million from taxpayers to build a new stadium for the Colts – that money would have provided a lot of healthcare. An actuary could compute how many poor peoples’ lives could have been saved or extended with the stadium money – and demonstrate how spending on low priorities basically kills people because that money could have been spent on healthcare for the poor.
5) The kind of basic preventive measures in the article (obesity, smoking) would cost a lot less than Rx research. If we all could just stop our dangerous behavior, the benefit would be many times the benefit from every drug in the pipeline. The hundreds of millions in tax abatement given to Eli Lilly over the past 20 years could have provided much more good if applied to preventive healthcare.
(whew!)