The Value of an "American Life"

We have a natural, and just, tendency to value the lives of our countrymen over the lives of others. Citizenship contains an implicit contract to protect and defend one another.

However, we have another implicit contract with the other members of the human race. All religions, all models of morality, contain injunctions to care for one another, regardless of ethnicity. When Jesus Christ taught about what it meant to be moral, he used the example of the Good Samaritan - teaching that compassion and love should cross country borders. We clearly have a greater responsibility to other Americans, but we have some moral responsibility toward everyone.

The recent health care debate in American has left me wondering whether we have skewed this balance too far in favor of our fellow Americans. We certainly have some problems with our health care system. It is inefficient, and unfair. We should fix it. Political blogs and shows are replete with comparisons to the European and Canadian health care systems, and their comparatively better standard of care. But why are we comparing ourselves to these other OECD countries, instead of being compared to all countries in the world?

It could be argued that we should be compared only to this small subset of countries because we are similar to them, and we can learn from their successes. I believe that the other reason is because we don't want to deal with the harsh truth about the rest of the world. We are arguing about whether or not it's worth expanding government coverage to all US citizens, at a cost of $129,000 per year of extended life (that's the amount that Medicare has implicitly decided on). In the rest of the world, people are dying of diarrhea and tuberculosis. The cost per year of extended life for these diseases is $20-$200. We have decided that an American life is 1,000 times more valuable to us than an African life - that we would let 1,000 Africans die instead of 1 American.

This is wrong. I believe that future generations will be aghast at depth of our nationalism. We have the opportunity and the means to save millions of lives in the developing world, and we will be judged for not acting.


Image by goulao on Flickr.

The Coevolution of Man

Kevin Kelly often writes about how people and tools have evolved together, and how we can no longer truly be distinguished from our technology, and we certainly couldn't survive without our technology.

I definitely agree with that point, and I would argue that some of our technological advances have been so dramatic that they have, in a sense, almost changed us into a different species. The changes wrought by these new technologies are so dramatic that I would argue that people living before and people living after the advent of these technologies have fundamentally different kinds of lives. Technologies like this are obviously very rare, but here are a few:

Language: Language almost certainly progressed very slowly, but language is now almost the sole means by which we think, communicate, etc. When we think about Helen Keller, we feel so desperately sorry for her, not because she was blind or deaf or mute - plenty of people have those afflictions without arousing such deep pity - but because those afflictions shut her out from the world of language. It is when she finally understands language that her life becomes heroic and understandable - before that she is only pitiable. Thinking of what it meant to be a human before language seems impossible.

Writing: Before the advent of writing, all knowledge was local knowledge, both in space and in time. You could never know more than the sum of what your neighbors knew. Ideas and inventions died with their creators. Writing now touches nearly every aspect of our lives. Like language, it seems impossible for any civilization to exist without writing.

Industrial Revolution/Urbanization/Globalization: Before the Industrial Revolution, most people were farmers, living in self-contained communities. Unless you were royalty, you probably made your own shirts, grew your own food, and neither you nor anything that you owned had ever travelled more than a dozen miles. Because of the resources needed to provide everything for yourself, most people only had a few changes of clothes, a very simple diet, and small, sparse homes.

Now, we think nothing of buying shirts from Thailand, TVs from China, bananas from Mexico, and shoes from Singapore - in fact, we could probably buy all of those things at the same store, within a few minutes of our homes. We no longer make our own clothes or grow our own food. Chances are that you are not a farmer - that you don't even know anyone who is a farmer. The lives that we lead now would be wholly foreign to a pre-Industrial farmer.

The Internet: Although it isn't there yet, I believe that the Internet will change the world as much as any of the other technological advances. Just like language and writing enabled not only more conversation, but a different type of conversation, the Internet is not just like a new version of TV or newspapers or books, but it is something new and different. It is changing the way that we do everything - from buying and selling things to finding new friends to learning to working - the Internet democratizes everything. Instead of learning about the Iran elections by watching the news, we can talk with regular people in Iran. Instead of just listening to music by a band that we like, we can write suggestions to them on their MySpace page. Instead of finding a job in a big company, we can be employed by the Internet - as a blogger or an editor or an eBay buyer and seller.

Like many people, the Internet is an integral part of my life, and the things that I do would be dramatically different if it didn't exist. It is truly amazing to me that 10 years ago just over 50% of Americans had ever used the Internet. My school experience seems anachronistic, in that I actually had to research things in a library, using card catalogs to find books. In 7th or 8th grade I spent hours and hours trying to find basic information for a report on Indonesia. I looked through book after book to find and compile a small percentage of the information that is now on the Indonesia Wikipedia page. We are gathering the world's knowledge together, and we are figuring out how to use it. As computers get smarter, and as that data continue to pour in, the Internet will subsume more and more of our lives.


Each of our past advances has enriched the human experience. I am sure that there will be some bumps on the road, but I think that we can be confident in predicting that the Internet will again change for the better what it means to be human.

Collective Decision Making

In 1984, the U.S. Government started studying 10 sites in the United States to find a location that would act as a repository for nuclear waste from U.S. nuclear reactors. By 1987, Congress had narrowed the list to one location: Yucca Mountain, Nevada.

By almost any measure, Yucca Mountain appears to be the ideal candidate. 80 miles north of Las Vegas, it is a barren desert, without any cities are towns - practically without any living creatures at all. The site was used to test a number of nuclear weapons, and it is owned by the government. We have spent $9 billion studying Yucca Mountain, and haven't found any compelling reasons why it shouldn't be used for nuclear waste disposal.

So, some 22 years after Yucca Mountain was selected, why is our nuclear waste still being stored in much more dangerous temporary locations? Why did Energy Secretary Steven Chu say "the Yucca Mountain site no longer was viewed as an option for storing reactor waste"?

I would argue that Yucca Mountain hasn't happened because Nevada voters didn't want it to happen, and because Nevada voters have power incommensurate with their numbers. In 1980, '84, and '88, Republican presidential candidates won in Nevada by 29 percentage points or more. As the Yucca Mountain issue became more prominent, Nevada voting patterns changed dramatically. Ever since 1988, Nevadans have consistently voted for the winner of the election, who has won by less than 4 percentage points (http://www.fivethirtyeight.com/2008/04/electoral-history-charts.html).

While it could certainly be argued that demographics accounted for much of the change in Nevada politics (a growing Californian population, for example), I would argue that the change could potentially be attributed to collective, subconscious decision making.

Just like our brains "decide" on our breathing, heart rate, etc. without our conscious input, I think that it is possible that our societal "brains" make decisions about our society without any individual directing, or even being cognizant of, the decisions being made. I would argue that there are many decisions that are made at a societal level, with inputs and responses that are not fully understood by the individuals involved.

Why Health Care Costs Will Not Go Down

We see newspaper headlines almost daily bemoaning the increasing cost of health care. On Thursday, President Obama spoke at the "White House Forum on Health Care Reform", repeating the scary statistics that we hear so often:

You know, we're here to discuss one of the greatest threats, not just to the well-being of our families and the prosperity of our businesses, but to the very foundation of our economy. And that's the exploding cost of health care in America today.

In the last eight years, premiums have grown four times faster than wages. An additional 9 million Americans have joined the ranks of the uninsured. The cost of health care now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes.(http://www.washingtonpost.com/wp-dyn/content/article/2009/03/05/AR2009030501850.html)

The fact is, he is right. Health care is taking up a larger and larger portion of the average person's budget. Health care costs are increasing. The typical reasons given for high health care costs fall into one of three main camps:

1. People are greedy - this argument says that some group of people - typically insurance companies, doctors, or malpractice lawyers - are too greedy. Costs are increasing because they are taking a bigger and bigger slice of the pie.
2. Government is not involved enough - this argument is that socialized medicine allows the government to set prices and quality of care.
3. Government is too involved - this argument says that if we just let the free market work, then health care costs would come down. The huge influence of Medicare and Medicaid is actually raising prices.

I think that some, or maybe even all, of these camps could be right. I am sure that costs could be lower if we made some changes to the structure of how health care is delivered. However, I believe that there is a much more fundamental reason that health care costs are increasing.

The reason that health care costs are increasing is because health care in the U.S. is so good. Health is the classic inelastic good. People will spend whatever money they have if spending that money will save their life. As the better and better health care saves more and more lives, people live longer, and require more health care.

Since this is the main point of the whole post, I think that it's worth illustrating with an example. In hypothetical country Moribund everyone has a heart attack every 20 years. In Moribund there are two cities: in city A, there are 500 citizens, and a mediocre doctor, whose rate of successful heart operations is 50%. In city B, there are also 500 citizens, but they have a great doctor, whose rate of successful operations is 90%. In both cities an operation costs the society $100 (either the individual or the government - it doesn't really matter).

After 20 years in city A, there will have been 500 heart operations, costing $50,000, but only 250 people will have survived.
In city B, the cost will also have been $50,000, but 450 people will have survived.

After 40 years, city A will have only 125 citizens, and will have spent $75,000 on health care.
In city B, they will have 405 people, and will have spent $95,000 on health care.

Obviously, this little example is not true to the real world, but you get the point. The better health care is, the longer we will live. The longer we live, the more often we will require health care. And because health care is so inelastic, we will pay a greater and greater portion of our income for it.

Image by salimfadhley