The Role of Government

Common Sense Medicine extends to more than health and health care. A significant part of our book – The Boids and the Bees: Guiding Adaptation to Improve our Health, Healthcare, Schools, and Society – is how to guide social change. That means politics.

Most political arguments use fear to motivate their respective bases. Reading Daniel Kahneman’s Thinking Fast and Slow shows why this is done. Fear input is shunted to the midbrain where responses can be faster and more likely to save one’s life. But at the same time the responses are limited in scope. The midbrain’s evolutionary development took place in the age of the reptiles; it is often called the reptilian brain, and responses are those we see in reptiles: fight, flight, or freeze.

Politicians like fear because the responses are much more predictable than those more strategic adaptations that come from the human brain. Kahneman is in Israel and people there are applying his views to their country’s policies with their Arab neighbors. One of the best comments is from recently resigned (in protest over the rightward shift in the government) Defense Minister, Moshe Yaalon, who said: “In our tactical decisions, we are operating contrary to our strategic interests.”

Political decisions in our country today are seldom strategic; they are reptilian responses to perceived threats and they need to be labeled as such.

The major difference in our political parties is how they see the role of government. Both sides see a prominent role for a common defense. But even here we often see that role as protecting our overseas corporate interests as much as protecting our homeland. It’s comparable to the view of the surgeon: everything can be helped with a knife. When the military is equivalent to Teddy Roosevelt’s big stick it can be used to solve many perceived problems.

But there is more to government. Our Preamble says the role of government is to ‘create a more perfect union, establish justice, insure domestic tranquility,. . . promote the general welfare, and secure the blessings of liberty to ourselves and our posterity. . . .” There is more to government than defense and we aren’t doing too well.

We at Common Sense Medicine think that all policies ought to be measured by how well they help in these five areas; we already spend far too much on defense. We also think that we, as living and adapting organisms, need a safe rather than fearful environment in which to adapt in healthy ways, and that small changes are needed instead of redoing on a massive scale. We are not that different from the butterfly igniting the change that leads to the hurricane.

These changes require a change in thinking. We tend to think in mechanical terms. We take things apart to fix them. We see them as doing what we want; they are all predictable. But when agents can adapt, and adaptation is a characteristic of all living organisms, the ability to predict goes out the window. When we realize this simple difference we will also realize the value of promoting healthier adaptations. When we do that we will also make strides in the other goals of government.

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*Insurance is designed to pay for the unexpected crisis. Health insurance started that way in the U.S. but gradually, because the companies we work for were paying for it and getting a better tax break, it morphed into paying for it all. That means we have less interest in getting the ounce of prevention than if we were paying for some of those costs. Children we talk to about the dangers of drugs just say they’ll get a brain transplant if they burn theirs out. That’s why we think that Health Savings Accounts should be promoted by the government more; they put the individual back in a position of responsibility in making more choices in their health care. With Health Savings Accounts an ounce of prevention is worth a pound of cure.

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