The debate we’ve experienced so far has almost consumed us. And, it seems the debate is less about healthcare reform than it is a debate about our values. I wrote about this early in my post: Healthcare Reform Debate: It’s really about our values.
But what’s bothersome about the debate, regardless if you have health insurance and/or can afford healthcare or whether President Obama is a socialist or a failed progressive or not. It's the tone. Would you agree? Or maybe, it's the imbalance between tone and substance.
I’m reading Clay Shirky’s book Here Comes Everybody. If you haven’t read it, you should. Around page 45, he discusses the different forms of sharing and collaboration everybody can use now. At the end he discusses [t]he commonest collective action problem is The Tragedy of the Commons*.
This is where individuals are incented to damage the collective good.
As long as everyone refuses to behave greedily, everyone benefits...
And this is the Tragedy of the Commons: while each person can agree that all would benefit from common restraint, the incentives of the individuals are arrayed against that outcome.
People who benefit from a resource while doing nothing in recompense are free riders.
The resource here is...the commons. That’s our treasured right to have a debate, in public. The free riders are those who offer nothing to, or worse, benefit from this commons while effectively destroying it with vitriol and names, half-truths, and outright lies and money and resources to propagate those lies in order to defend their positions.
Mr. Shirky says we have, generally, two ways to deal with the problem of free riders.
1). Eliminate the commons. In this case, eliminate the debate or the opportunity and means to have a debate. But, we’ve already tried that. In fact some of the pent-up anger from either side in this conversation is the result of having this conversation denied for 10-20-30 years. Here’s a timeline for the changes in our healthcare system over the past century.
Looking at it, I remember little debate over these incremental changes that have occurred. Oh sure, there’s the debate in the ’90’s. It was effectively squashed by many of the same industry players and their representatives in Congress who remain in their positions in this debate. We allowed it, mind you.
2) Governance. The other option, from Mr. Shirky, for mitigating the Tragedy of the Commons is through governance, or mutual coercion, mutually agreed upon. We’re disallowed in some way from acting in our own interests at the expense of the group’s interests. Taxes are a common way. So are civil and criminal penalties.
We have those in place now, even for this debate:
* Peer approval. There’s peer approval that regulates our behavior with each other. That’s been long gone judging by the recent town hall behaviors and members of Congress.
* Taxes. Taxes already exist in our current healthcare system, though they are hidden and disconnected from their source. The taxes are paid in the costs of a healthcare system that’s the most expensive while at the same time failing to deliver the highest level of care for the highest number of people. Everyone shares in this, even those with health insurance and who can afford the costs of their healthcare. The costs of those unable to afford the costs of our healthcare are borne by those who can afford them. Multiple points of data show this. They include:
- costs of personal bankruptcy borne by customers of the companies whose services remain unpaid by those filing for bankruptcy
- higher hospital costs as hospitals seek to recoup their losses
- lower productivity from higher numbers of sick days by employees and their families
- higher health insurance premiums
- etc, etc.
* The Tragedy of the Commons was brought into our national discourse in 1968 with Garrett Hardin, a professor of biology at UCSB in this article published in 1968.