Sunday, September 11, 2011

The return of fatalism: One time-tested way to save money on healthcare--embrace illness and death

Is disease a blessed event hastening our path to heaven?   Should we look beyond the pain and suffering and focus only on the end goal?  It's easy to mock this don't-worry-be-happy-just-die admonition from a 1799 religious pamphlet:

Let us learn a lesson from the seafaring man, then, and regard the bright side of even our afflictions. Instead of considering sicknesses and diseases to be only so many painful visitations, let us try to regard them, also, as so many different roads to the golden gates of heaven.

Few admit to thinking that way today, but it does seem as if, in our dismissal of science, we are strangely returning to that sort of fatalism.   Every civilization puts certain things in the ascendancy as opposed to other things: One civilization builds pyramids, another buils cathedrals, another builds grands boulevards, another builds mcmansions.  In other words, each civilization makes a series of choices: What's important? monumentalism? clericalism?  royalism?  militarism?  economic dynamism?   Another choice is science and scientific advance--either a culture celebrates, and fosters, scientific advance, or it doesn't.   And if a culture doesn't celebrate technological progress, then, in a dynamic world, it is likely to not only fail its own people, but it is also likely to be overcome by rivals. That was the story of China relative to the West from 1500 to 1945 or so, and it could be the story, in reverse, of the 21st century and beyond.    On this 9-11 anniversary, we rightly pay tribute to those who were lost ten years ago today, but surely just as important is making sure that it doesn't happen again.  And such prevention requires active measures.  Passivity and fatalism are no answer--at least not a good answer.

And yet it sure seems that for the most part, we are on an anti-science course in America today.  Yes, we have plenty of schools and institutes with "science" on their nameplate, but oftentimes, they seem at least as interested in politics, and politically correctness, as science.   And of course, while the larger culture is happy enough to get a next-generation smartphone, the larger culture also seems happy enough to assume that these wondrous mini-machines will be developed and produced by foreigners.  And of course, the climate of regulation and litigation sends an unmistakable message: anything made in the USA can be targeted by bureaucrats and trial lawyers, as politicians either cheer them on or watch passively.   

Nowhere is this adversarial culture more evident than in the area of medical R&D. As noted here at SMS, there's been a crash in Serious Medicine, which will obvious and deleterious effects on all of us, and yet the political system has been clueless.

So today we spend money financing disease and its ravages, and yet we seem uninterested in intervening to stop the disease.  Out of the $2.6 trillion that the US spends on healthcare, only around $113 billion goes for medical R&D, and that category of R&D covers everything from cancer to botox.  In other words, as a percentage of our total spend, very little is directed toward urgent national problems, such as Alzheimer's.   It wasn't always thus--for a while, we focused on polio, and we beat it.  For a while, we focused on AIDS, and we beat it back, at least in the US.    But now, we seem content just to deal with the ravages of disease.  And yet ironically, this approach isn't cheap at all, because the epidemics we confront are not the quick death of the black plague, but rather the slow disability and death that come from chronic illnesses such as Alzheimer's Disease.    So we get the worst of both worlds: no cures and we spend a fortune. 

Except maybe for a lingering few Christian Scientists and maybe some Greens, we don't do this out of a religious or quasi-religious feeling, but merely out of inertia and sloppy thinking, backed up, of course, by some quiet players who gain money and power out of the status quo.  After all, plenty of current constituencies benefit from a definition of healthcare that focuses on retroactive finance, as opposed to proactive science--think nursing homes, financiers, and non-science-minded "experts" in "public policy." 

The French critic George Bernanos argued,  “The worst, the most corrupting of lies are problems poorly stated.”  And so we see today, the problem of healthcare has been defined away from cures and defined instead as long term care.  And so the issue becomes insurance of various kinds, and not science of any kind.   So we might as well embrace the fatalism of that 18th century pamphlet. 

Hat tip: Marc Abrahams at 


  1. The fatalism that a cancer victim huddles together with is a morbid acceptance of the result. Of course if our mission statement is only to treat and not to also focus on R&D and find the cure, a sardonic fatalism for those afflicted in America will prevail.My mother(RIP} and to some extent myself always were fatalists. When we boarded a plane we had a great time having a drink and watching a movie. Subliminally we knew that if something happens up there you are not even going to know it.

  2. I'm all for cures first.
    There is nothing wrong with fatalism for some cancer victims, i.e.; those with small "oaten" cell lung cancer. Actually it isn't fatalism, its Reality. I support all R&D regarding this disease. Even more so, I want to know who the politicians are who want to put the tobacco industry out of business!
    Now if they could wrap their "'Fender' wooden guitar" minds around this idea then maybe the next time around I'll vote for them.
    Five weeks ago my wife's brother & sister died on subsequent Fridays from Lung cancer. Just think: loosing your brother and sister in one week.
    Yea, I'm all for cures; but, in the mean time, I am for politicians who want to kill the Tobacco industry!
    And Jay's right in his comment, a good stiff drink makes plane rides easier.
    Good column Jim!

  3. I want to know who the politicians are who want to put the tobacco industry out of business!