|Confession time. The reason for my late and sporadic postings over the last week or so is that I pinched a nerve in my neck, and I’ve been doped up since then. The choice of the Resilience topic for the Open Thread during my absence was a bit ironic — the injury came from doing strenuous physical work (mowing and pushing my heavy scrub-cutter around our very hilly lot), when I get almost no proper exercise of any kind and have lousy posture. It’s given me some time to think about our troubled health care system, about why idiots like me get injuries like this when we know better, and about a suggestion from several readers that perhaps the solution to health care is to pay people for staying healthy.
The idea has a kind of immediate provocative appeal, but I don’t think it can work. In the first place, systems that provide financial rewards for staying healthy (like some insurance schemes) don’t actually reward you for staying healthy, they reward you for not seeking medical help and for not filing claims, which is not the same thing at all. This is the same perversity that encourages people who are victimized by vandals from not filing a perfectly justifiable insurance claim because they know their insurance premiums will then rise by more than the amount of their claim. This is a depraved but very profitable way to run an insurance business. As a means of providing equitable and functional remedy for accidents, illness or injury, it is horrific. It unquestionably results in unnecessary and avoidable human death and misery, overwhelmingly to the poor and weak, simply out of the fear of economic penalty.
Some organizations offer standard “sick days” each year that you get as extra vacation days (or as a monetary bonus) if you’re not sick. The consequence of this is to treat sickness as a kind of crime that you get rewarded for not committing. It assumes what Malcolm Gladwell has called “the Moral Hazard Myth” — that whenever you offer insurance for something, it automatically leads to rampant abuse. In other words, that people — especially the poor, weak, and unemployed — are lazy exploiters of public largesse. Organizations I know that have tried “sick day” policies ended up with sick people coming to work, spreading their illness and doing poor quality work because of it, so they could “save up” their sick days for extended vacation.
Insurance companies have also tried, in a superficial and sloppy way, to reward people for avoiding behaviours that cause illness (like having premiums for smokers that are twice those for non-smokers). The general consequence of such policies is (a) it encourages addicts to lie, and (b) it encourages insurance companies to spy on people so they can catch people lying so they can keep the premiums but not have to pay any claims. Great system, huh.
The problem with all such schemes is that it is impossible to say when an illness is the result of hereditary factors (genetic predisposition), when it is the result of environmental exposures (in the home and workplace and society at large), and when it is the result of behaviours over which the patient has (according to some philosophies, anyway) some degree of control. Or, to put it another way, it’s impossible to say when and to what degree it’s the patient’s fault they were sick or injured.
So while the idea of paying people to stay healthy appeals to me in a wry kind of way, I think it is basically an unworkable idea. So what might work better? Are there other ways, other than financial bribes and penalties, that can actually change behaviour in a way that will make people healthier?
There’s a company in our community that provides a free, supervised exercise facility to all its employees, and a subsidized cafeteria that offers only healthy foods. I think they’re on the right track — they’re rewarding behaviours that repay them as an employer (through healthier, more resilient workers), without getting specific about who’s to blame when an individual becomes sick or injured. It’s a ‘no fault’ system.
What is needed to supplement this is more honesty in our society and our economy about many of the things that are bad for our health, but which are very profitable, and which therefore are rarely recognized or addressed as the social evils they really are. Alcohol, for all its benefits, sucks billions out of the economy in death and violence and injury and illness every year, yet we still tolerate advertisements that show its consumption as an essential ingredient of personal happiness. The meats, and many other foods we eat that are advertised to the hilt (especially the fat, salt and sugar-laden “fast-food” varieties) are chemical cesspools that unquestionably add billions of dollars to annual health care costs.
The real answer, I would argue, is not rewarding people for staying healthy (because we can never determine when their health or lack of it is due to their behaviour or factors beyond their control), but rather health care innovations that address the real, preventable causes of illness and injury:
We cannot expect those with vested interests in the current health care system to reform it. We need to create our own organizations to develop, in Open Source form, these three types of health care innovation. We will have to do battle with the lawyers, corporations, politicians and preachers and some medical practitioners, who will not yield power of the current massive, extravagant and dysfunctional system easily. But like all disruptive innovation, our work in these three areas will be subversive. The regular health-care system won’t know it’s been rendered obsolete until it’s too late. And there are many in the existing health-care system who recognize the need for these innovations and the distress of the current system, who will be more than willing to join us in making the new, responsible, patient-centred system work.
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My Bio, Contact Info, Signature PostsAbout the Author (2016)
--- My Best 100 Posts --
Preparing for Civilization's End:
What Would Net-Zero Emissions Look Like?
Why Economic Collapse Will Precede Climate Collapse
Being Adaptable: A Reminder List
A Culture of Fear
What Will It Take?
A Future Without Us
Dean Walker Interview (video)
The Mushroom at the End of the World
What Would It Take To Live Sustainably?
The New Political Map (Poster)
Complexity and Collapse
Save the World Reading List
What a Desolated Earth Looks Like
Giving Up on Environmentalism
The Dark & Gathering Sameness of the World
The End of Philosophy
The Boiling Frog
What to Believe Now?
Conversation & Silence
The Language of Our Eyes
Cultural Acedia: When We Can No Longer Care
Several Short Sentences About Learning
Why I Don't Want to Hear Your Story
A Harvest of Myths
The Qualities of a Great Story
The Trouble With Stories
A Model of Identity & Community
Not Ready to Do What's Needed
A Culture of Dependence
So What's Next
Ten Things to Do When You're Feeling Hopeless
No Use to the World Broken
Living in Another World
Does Language Restrict What We Can Think?
The Value of Conversation Manifesto Nobody Knows Anything
If I Only Had 37 Days
The Only Life We Know
A Long Way Down
No Noble Savages
Figments of Reality
Too Far Ahead
The Rogue Animal
How the World Really Works:
If You Wanted to Sabotage the Elections
Collective Intelligence & Complexity
Ten Things I Wish I'd Learned Earlier
The Problem With Systems
Against Hope (Video)
The Admission of Necessary Ignorance
Several Short Sentences About Jellyfish
A Synopsis of 'Finding the Sweet Spot'
Learning from Indigenous Cultures
The Gift Economy
The Job of the Media
The Wal-Mart Dilemma
The Illusion of the Separate Self:
Did Early Humans Have Selves?
Nothing On Offer Here
Even Simpler and More Hopeless Than That
What Happens in Vagus
We Have No Choice
Never Comfortable in the Skin of Self
Letting Go of the Story of Me
All There Is, Is This
A Theory of No Mind
The Ever-Stranger (Poem)
The Fortune Teller (Short Story)
Non-Duality Dude (Play)
Your Self: An Owner's Manual (Satire)
All the Things I Thought I Knew (Short Story)
On the Shoulders of Giants (Short Story)
Calling the Cage Freedom (Short Story)
Only This (Poem)
The Other Extinction (Short Story)
Disruption (Short Story)
A Thought-Less Experiment (Poem)
Speaking Grosbeak (Short Story)
The Only Way There (Short Story)
The Wild Man (Short Story)
Flywheel (Short Story)
The Opposite of Presence (Satire)
How to Make Love Last (Poem)
The Horses' Bodies (Poem)
Distracted (Short Story)
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A Conversation (Short Story)
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