Those of you who didn’t fall asleep last time might still wonder about that hint I dropped about the health insurance. Aren’t people just sometimes too uninformed and too comfortable to know their own best, and shouldn’t we just stop pampering them and try to get them to take responsibility for their own lives?

Again, science has proven that it’s not all that simple.

When people find themselves in Big Trouble, they will focus on the here and now. An extreme example is torture. What torture tries to do is to make people tell the truth to make the torturer stop. What happens is that when the body believes it will die in a few moments, it will do literally anything to make it stop. This includes not only confessing to the most surprising things, like the Swedish soldiers who “confessed” to being 95 years of age, and that was only during a drill; it also includes confessing to espionage in times of war, or other stuff that is completely lethal; the point is that the torture will stop now, and we will live for another hour, which might be enough time to get out of the predicament. Or not, but this isn’t really relevant. What the body has done, quite irrespective of what we wanted it to do, is to let us survive the immediate danger.

This is known as applying a steep discount to the future. That is, when sacrificing long-term benefits for short-term benefits, the long-term benefits will get less weight. We all do the same calculation when we put money in the bank: we forfeit a benefit now (ice cream binge tonight) for a higher reward later (we get the money back with some interest—OK, that last bit is a generalisation; these days it seems we pay for the benefit of having the banks taking care of our money, but the principle is still valid). I have a day time job, so I can live with, say, a 3% interest (inflation and then a little bit). But someone who is convinced that their future is very bleak will put a very high value on today’s drinking binge, and a very low one on tomorrow’s empty wallet. There’s a subconscious calculation involved: we might all be dead tomorrow, so why worry about that? If my chances for long-term survival and success lie somewhere between “questionable” and “doubtful”, why should I care about the long term at all?

This is why young, unemployed men hold up convenience stores, often acting very confused when they emerge on the street holding a wad of money in one hand and a gun in the other, because that was pretty much their planning horizon. Fast cash now outweighs a possible prison sentence. (Or a very likely one, if the plans really ended just outside the door.)

Is there a reason for this?

Some people believe it’s down to genes, and in a way, it is. But the thing is that we all carry the same genes. If our brains calculate that our chances of long-term success in the rat race are so slim they can be ignored, this means that we should ignore them. We’re probably better off doing some high-risk, high-payoff activity like robbing a bank. It’s actually perfectly rational; it maximizes our chances of reproductive success, improving them from “zip” to “slim”.

This also applies to medical insurance. It’s for the fairly distant future, and a future that might not ever arrive, at that. If you’re low on cash, it’s completely irrational to spend what little you have on insurance, or so our subconscious success calculator tells us. It probably worked well in the above-mentioned hunter-gatherer societies, and this is why evolution has produced this end result (or, if you prefer, why God made us this way; again, it doesn’t really affect the argument since it’s based on what we observe human beings doing, not on the underlying reasons for the design).

The point is that we’d all act like this, if our chances of long-term success were nil. Investing in the far future is strictly a first-world problem; for many people today, and for most people throughout history, the immediate problem is survival tomorrow.

Does this mean the poorest in our societies will never take out medical insurance?

Look, I haven’t tried to push any conclusions down your throats, right? But I’ll volunteer a few observations.

Firstly, to me, it seems reasonable to build our societies based on what we see people doing and how we’ve established that we function. Designing our society the way we think it should operate, and then trying to make people fit society, has never actually worked. (If you don’t believe me, ask those who have tried to breed the Socialist Superman or the Aryan Übermensch.)

For the tax system, as discussed in the previous post, this means that although you can arrange it in many different ways, they can produce different end results even though the actual money collected stays the same. What you want is a system where everyone agrees to play along, which means that you can do pretty much anything that takes your fancy as long as people feel they get something out of the system. For the poorest, this might mean getting more out of the system than they put in, when seen over an entire lifetime; for the richest, the payoff might rather be a lack of starving hordes trying to get in through the front door.

Most European countries have gone down the road of making medical services a public good. That is, we consider it so important that, e.g., a clinic doesn’t go bankrupt on me halfway through my chemotherapy that we do a lot of it through taxation, mandatory national health insurance, and overall, a very high lowest level of service. It seems to work; people don’t take it for granted, nor do they run to the doctor for every sore toe, nor do they die in droves on street corners; we’re aware that it costs money and that this is where a fair amount of tax money ends up, and so forth. It’s OK to be opposed to this for various reasons, but “it doesn’t work” is not one of them. (You’re allowed your own opinion, but not your own facts.) But whatever system you design: either there has to be a certain amount of “mandatory” built in, or there will have to be widespread acceptance of the fact that young, innocent, blameless people will die even though it could have been prevented. Your choice.

Also, the observant reader will have noticed that a lot of the destructive behaviour outlined above depends crucially on the people involved having a very bleak view of the future. We’re talking here about people who leave school at 18, go to the employment agency, and are told that they will never get a job for as long as they live. (Yes, this actually happens. Every day.) So a lot of the damage—maybe even all of it— can be undone simply by giving everyone a good reason to believe that they can improve their lot. Traditionally, the U.S. has excelled at this: need I say more than The American Dream? And in my experience, this is also a characteristic of many U.S. Conservatives—they truly want to build a society where dedication and hard work will always allow you to be better off, and where there are no limits to your possibilities. Many European Conservatives, to the contrary, are completely indifferent to this aspect, if not outright hostile to it.

The other solution, generally preferred by a group vaguely referred to as “the left”, is to re-distribute resources so that nobody is ever completely without; the idea is not to simply remove the lowest rungs of the ladder (there would still be one labelled “lowest”), but to get them so close to the ones above them that the step is not insurmountable, and to provide handholds for those in danger of slipping.

Again, the preferred solutions are up to you. You’re still allowed your own opinions.

But never, ever, your own facts.