The chances of winning the lottery are remarkably small, yet people still buy tickets. On some level, these people know the bad odds but still want to spend their money on false hope. This cognitive dissonance proclaims “I know the likelihood is low, but I could be the one to beat the odds!“ Our brain clearly has a dopamine response with this behavior, and this desire to beat the odds is found throughout our society: lottery tickets, Las Vegas, underdog stories and even healthcare.
We all have a terminal condition – called life. Some peoples’ lives are more expectant than others. But frequently, and throughout life, there exists this same cognitive dissonance that they will be the one to beat the odds. There are many ways people rationalize poor health decisions, whether it’s thinking about how Fidel Castro smoked his whole life as an excuse for their own tobacco use, or motivating grandma to undergo aggressive chemotherapy because of a human interest story on a local news channel about a cancer survivor. We like to try to beat the odds against us even though in the end the house always wins and everybody dies.
How do we design our healthcare delivery knowing these poor individual choices and cognitive dissonance tendencies? Currently in our quasi capitalistic system, individualistic poor choices are respected while cost overruns are socialized. We as a society want the Las Vegas treatment for our healthcare: fancy, shiny and new treatments that may provide marginal quality-of-life benefits. But our society can’t stomach the bill for these treatments and uses the magic of government to socialize the costs across the tax base even to future generations. It’s almost worse than buying a lottery ticket which is two bucks for a minuscule chance at several million dollars. With our society’s healthcare, as is commonly seen in many end-stage terminal diseases, we buy the several million dollar ticket for the minimal chance of maybe a month or two of shitty existence for grandpa in a nursing home. It’s not an exciting jackpot for most of the healthcare lottery tickets our society buys.
So how do we as a society change that? Many people may recognize that healthcare is broken, but the prescription is more of the same: individualism and capitalism that led to this Frankenstein to begin with. I believe that instead we need an authoritarian state to reign in these individualistic and capitalistic tendencies. I believe we should have the best care for the most people, not just lottery tickets for our terminally ill. I believe we need doctors who feel duty to their community and promote revival of a true fiduciary relationship.
However, this requires the community’s trust and begs the question: who decides? Who will be in this trusted role as community and health advocate? Right now our healthcare system, instead of outsourcing, has insourced foreigners into our communities. Conglomerate Incorporated Hospitals abuse our country’s visa system to flood primary care with doctors, usually from Asia, who are foreign to our culture and ideals. Do we as a society want to import foreigners to lead our communities? Is this the invisible hand at work?
On a fundamental level most people understand this is wrong, yet it continues apace by the forces of individualism and corporatism. The idea that healthcare has any relation to laissez fair ideals could only be believed by true idiots or libertarians, and Government intervention through Medicare probably makes healthcare the least free out of all industries.
My own unscientific observation at a major medical professional society would estimate that white male doctors in primary care represent 15 to 20% in a sea of foreigners. Whites make up decreasing proportions within medical schools, much to the celebration of the schools’ administrations, and what few survive the gauntlet of antiwhite admissions policies frequently are chased into subspecialties that pay more but are further removed from the community fiduciary relationship.
We need doctors who speak our language and understand our culture. When asked “what would you do if this was your mother?“ there must be a baseline of cultural communication. On some level our current system recognizes the problem of cultural differences within healthcare, and promotes “cultural understanding” seminars as if this learning can be presented on a PowerPoint slide or that true cultural understanding could ever span racial divides. Trusting that capitalism will respect this cultural communication was a terrible mistake, and has led to this dystopic Las Vegas with dying patients spending all our healthcare dollars on false hope while the corporatist hospitals and drug companies laugh all the way to the bank.
I believe in cultural self-determination, and would rather have a culturally cohesive healthcare system that can only offer aspirin rather than the imported profit driven monstrosity that sells bells and whistles with the bill sent to the next generation. I believe the best way to change our current system is to form a strong state that has its peoples’ interests at heart, an ideal in mind, and severed ties with the capitalistic and profit motivated forces that have perverted our system.