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Rant: Higgsism and the Moral Dimension of Health

As most of you know (or can guess) I’m not content to accept received opinions about things like health insurance reform. I’ve been researching it and working it out for myself for a couple of years now. Most of the discussion online has been tribalist bullshit and not particularly useful, but I’ve managed to define a few things that make the whole issue of health insurance a lot harder to deal with than otherwise might be. What surprises me the most is that these issues almost never come up.

The first of these, in fact, I had to coin a name for: Higgsism, from the clueless protagonst of Samuel Butler’s wicked little gem, Erewhon. If you recall, while Higgs is jailed in Erewhon, he befriends his keeper’s daughter, Yram. Higgs watches, astonished, as people who fall into bad health are convicted of a criminal offense, yet people who have been caught embezzling are treated as though they were suffering from a headcold. When Higgs himself gets a headcold, Yram scolds him severely, and only at that point does he put two and two together. As poor Higgs puts it: “I never remember to have lost a cold so rapidly.”

It’s a great book; a sort of steampunk Gulliver’s Travels, and bears close reading. In a nutshell, what I call Higgsism is this: the belief that we have complete (or almost complete) control over our health, and that when we get sick, it’s because we have done something wrong, making illness our own damned fault. Just as the lucky prefer to ascribe their success to hard work, the healthy generally ascribe their health to pure clean livin’.

Alas, the more we look, the more evidence we see that health is more luck than skill. Matt Ridley’s 2004 book The Agile Gene describes the emergent nature of the human body, and how we’re at the mercy of not only our genes but also poorly understood environmental stressors of gene expression that come into play starting at the moment of conception. Beyond avoiding a handful of obvious hazards like smoking, recreational drugs, and promiscuity, there’s not a whole lot we can do. Eat moderately, walk a little, and get your sleep–but hell, if body weight is almost 80% heritable, health may be a steep climb indeed.

I’ve lived long enough to see a fair number of people die for no known reason. A healthy, trim, athletic nonsmoking man like Harry Helms with no family history of colon cancer dies of it. What did he do wrong? Carol’s late Aunt Berenice lived a modest life and never held a lit cigarette, yet she died of lung cancer. What did she do wrong? The truth is that they did nothing wrong at all. Yet these days, when somebody gets cancer, everybody starts thinking back to try and identify what the poor slob’s sin was.

The truth is grim: We control little of our own health, and what little we do control is often misunderstood (like carbohydrate metabolism) and not always universally applicable across the human species. (Milk is great for you–if you can digest it.)

The health insurance industry can only get away with medical underwriting because of the implied moral culpability of the unhealthy: If you’d just lived a cleaner, healthier life you wouldn’t have cancer or diabetes or ALS or whatever, so you’re a poor risk and deserve to go bankrupt and die. This widespread belief is why high-deductable catastrophic health insurance is unpopular: People see it as money going out of their pockets directly into the pockets of heedless reprobates who can’t or won’t adopt a healthy lifestyle, whateverthehell that is, while those who practice clean livin’ still have to pay for their own broken ankles and flu shots.

As long as we continue to believe that, we’ll be unwilling to face the truth: Health insurance is a sort of luck tax. The lucky pay the money while getting little back in terms of benefits. The unlucky get their lives saved through expensive treatments that they could never afford out-of-pocket. The moral dimension of health is almost entirely an illusion.

What’s the solution? I didn’t say I knew of one; in fact, I’ve often wondered if universal health insurance as we understand it is even possible. Yet even if it is possible, as long as we embrace Higgsism, I guarantee you we’re not going to get anywhere with it. You might as well give antibiotics to embezzlers.

There’s another part to this, which I’ll try to get to in coming days.


  1. Amen, hallelujah.

    I propose a simple rationale for healthcare: Since civilization is a communal effort, and since as part of that effort, we’ve found it most functional to value the lives and health of individuals in our civilization, the sensible thing to do is for our civilization to bear the cost of healthcare for all members.

    I also propose that we require of our healthcare providers a single, consistent price per hour of a given professional’s time or per dose of a given compound, or per procedure. My vet can do this. The fact that my current healthcare providers cannot for any procedure covered by insurance suggests that they are involved in a scam of their own – defrauding insurance companies.


  2. Brook Monroe says:

    “Just as the lucky prefer to ascribe their success to hard work….”

    I’ve read that four times and it still doesn’t make a lick of sense.

    1. It means: “The lucky don’t always like to admit that they’re lucky.”

  3. anon says:

    I’m certainly not going to be able to give a solution, either, but I think I can point out some things that need to be considered more than you appear to have in this post. Maybe some of this is in the additional part you mention you will be posting soon.

    One is that, while we call it health insurance, that might not be a very accurate name for it. I think of insurance as a way to attempt to defend against a financial catastrophe, not as a way to fund routine expenses. But most health insurance I’m familiar with is a lot more about funding routine expenses.

    Changing health insurance so that it only paid for the catastrophes might motivate people to make more judicious choices about the care they seek. Or admitting that we aren’t talking about health insurance (catastrophe) but about healthcare (routine) might make it more clear how to approach the problem. I don’t pretend to say that changing health insurance to true protection against catastrophe would, by itself, fix much, if any, of the apparently excessive costs that are part of our current healthcare system. I just think it is a, perhaps small, part of the changes that are needed. As for the other approach of funding all healthcare, routine through catastrophic, if that is what we want to do, we ought to admit that is what we are trying to do and plan rationally about how to do it, if that is even possible.

    The other point is that there are a lot of environmental factors that may affect health that most individuals have little or no practical control over: Various questionable ingredients used in most processed foods. Various contaminants present in most unprocessed foods (residues of pesticides, fertilizers, antibiotics, and growth hormones). The deviations from natural composition of food resulting from feeding farm animals unnatural diets and possibly effects from genetic modifications, if such can be proven harmful. Air pollution. Water pollution, including somewhat questionable treatments intended to improve public health.

    Some of the ill effects have been proven. Others are only suspected and may not actually be problems. We really ought to figure out which of those things in our food, air, and water actually are deleterious and figure out how to eliminate them. I don’t pretend that that would be an easy task, and it will be actively opposed (as it already is) by large corporations and our governments, as long as government of the corporations, by the corporations, for the corporations does not perish from the earth.

    And that last bit is, in my opinion, the fundamental problem: Corporate capture of governments just about everywhere in the world. I have a feeling we cannot solve the other problems without solving that one, and I have little hope that anyone will ever have a solution for that one.

    See why I want to be anon?

  4. Jim Tubman says:

    Are health and long life signs of moral rectitude? Consider the Rat Pack:

    Peter Lawford (September 7, 1923 – December 24, 1984) – 61 years.
    Sammy Davis, Jr. (December 8, 1925 – May 16, 1990) – 64 years.
    Dean Martin (June 7, 1917 – December 25, 1995) – 78 years.
    Frank Sinatra (December 12, 1915 – May 14, 1998) – 82 years.
    Joey Bishop (February 3, 1918 – October 17, 2007) – 89 years.

    They drank like fish, smoked like chimneys, caroused like sailors on shore leave, and three of them lived to very respectable ages.

  5. Joe Goldthwaite says:

    I’ve always contended that the reason health insurance is so expensive is because health care is ridiculously expensive. As an illustration, here’s a bill for a burst appendix; It’s a whopping $76,574.85.

    My daughter spent three days in the hospital for a skin infection. There was no surgery. Just three days on an intravenous antibiotic. The cost? $12,000.

    Health insurance is part of a feedback loop that contributes to the price increases. If no one had health insurance the market for expensive procedures would be restricted to what people could pay. With health insurance the prices are free to rise because they do so independently of the individuals ability to pay. And they’ve risen across the board. The medical industry is pumping the revenue stream at ever step: $7 disposable diapers, $10 tylenol tablets and on and on.

    I think the solution is to increase competition in the health care industry. This isn’t very easy to do in a culture where we all expect to be protected from our own decisions but if we could give up on that a little and accept the responsibility for our own individual decisions.

    For example I wouldn’t mind going to my vet for medical care. She’s trained in it. I consider myself one of the great apes. She might have to do some additional study to learn a little more about ape treatment since she doesn’t have much opportunities to work with apes right now but she’s very sharp and I’m sure she could pick it up fairly quickly. I would be willing to sign away any rights to sue. After all, I’m the one making the decision. She might make a mistake but as long as she’s doing her best, that’s all I can expect. No one’s perfect.

    Now lets look at the potential savings. First of all, I don’t need an appointment. I can just drop in. A visit costs less than $30. If I need a hip replacement, I can get that for $4,000 to $5,000. That’s how much a vet charges for a dog hip replacement. A human doctor charges and average of $39,299. That’s a pretty big difference for what is basically the same procedure.

    If the market were working correctly, the human procedure should actually cost less since they are done in much larger volume than dog hip replacement.

    Another idea is to allow the health insurance companies to offer off-country plans where they would fly you to a different country where the costs are much lower. Again you would have to give up your right to sue and you couldn’t force someone to purchase that plan but if you feel like it’s worth the savings why not have the option? Everyone who purchases that sort of plan would be putting downward pressure on the costs of the domestic health insurance providers. They would have to lower costs to compete.

    I think these sort of changes would actually fix the root cause of the current health care crisis. The direction the government as gone with the Obama health care plan just adds fuel to fire. You’re seeing this now with the huge increases the health insurance companies are imposing. It’s not going to be pretty.

  6. Rich Rostrom says:

    Jim Tubman: The plural of anecdotes is not data.

    Joe Goldthwaite: If I need a hip replacement, I can get that for $4,000 to $5,000. That’s how much a vet charges for a dog hip replacement.

    If the vet screws up and the dog dies, or is severely crippled, what are the damages? If the surgeon errs, and the human is damaged, what are the damages? It’s not just a matter of monetary liability. We (including the providers) will not tolerate a significant rate of failures with humans, and six-sigma quality has costs.

    Jeff: There are many health problems that can strike out of the blue, or are genetically driven. There are others that are definitely driven by the person’s behavior. Very few non-drinkers develop cirrhosis of the liver. (And the Rat Pack didn’t actually drink that much – it was mostly a pose.) AIDS is almost entirely a consequence of risky behavior. Again, the plural of anecdotes is not data.

    Also, see this abstract on “Million Dollar Murray”:

    1. Jim Tubman says:

      Rich: I absolutely 100% agree that the plural of anecdote is not data. Those five guys would not have made an ideal control group in any kind of health study. My observation was basically for amusement.

    2. Joe Goldthwaite says:

      “We (including the providers) will not tolerate a significant rate of failures with humans, and six-sigma quality has costs.”

      What you are actually saying is that you and society will not tolerate me and my Vet getting together and making our own arraignments and our own informed decisions in the matter. Decisions that should not affect you in any way. It’s the growth of the nanny state.

      Granted if you’ve got a system that is going to pay to take care of people who make the wrong decision then you’ve got at least some right to object. That just illustrates how allowing the state to take care of everyone also allows them the justification to remove everyone’s freedom. I object to that system and would like to opt out. I’d like to be able to make my own decisions and take my own chances.

      In the system we have now, the state grants a monopoly to licensed providers of medical care. It controls how many people are allowed in and what they are allowed to do once they are licensed. This all purported to be for the public good but it’s not.

      There’s still no guarantee that a hip replacement will not be screwed up. In fact, the information that might help you make an informed decision on what doctor’s have the best record of success is restricted. That’s due to lobbying of the American Medical Association who doesn’t feel like the consumers are qualified to understand that sort of information and letting it out would be unfair to doctors.

      We have a system where there are no price constraints because the bulk of the medical processes are covered by the deep pockets of either the government or a health insurance company. The information that consumers might use to make better decisions is restricted. The supply is controlled by a state granted monopoly. That monopoly is itself controlled by the industry itself – the AMA. The AMA will always work in the best interest of the doctors and hospitals. It has never nor will it ever take actions to increase competition or reduce costs.

      That system will never lead to lower costs. Costs are going to keep increasing until they get so high that people will start calling for the government will take over the industry. That will swap one lousy system with another. In the first, care is good but very expensive. In the second, the cost of care is controlled but probably through rationing.

      It’s too bad the heath care industry can’t see this happening and take steps now to increase competition. Instead they helped write the current legislation that requires everyone to purchase insurance. That just floors the accelerator. They’ll ultimately be responsible for their own demise.

    3. Alas, the plural of anecdote is data…the problem is that people draw conclusions from too few data points. I’m doing a separate entry on this, gathering medical anecdotes from my close-in family and circle of friends, to see how many I consider lifestyle-related. Will present in a few days.

  7. Mike Bentley says:

    People do occasionally need medical treatment, no argument there. For thousands of years, effective treatments for most medical conditions did not exist at all. Now that we have ways to effectively treat more medical conditions, lots of people say that some treatments are absurdly expensive. I wonder: compared to what, exactly? The same treatment in India?

    People in India seem to generally afford a whole lot less than folks in the US, so clearly there’s some truth to the suggestion that the medical profession will charge what the market can bear. But the whole Indian economy is tuned much differently than the “one” here in the US. Would you be charged $76,000 for treatment for a burst appendix in India? Probably not, but I wonder what they would charge for it? How much do top-rated doctors make in India?

    Most people I know do not spend any time whatsoever delving into prices for any medically-related subject. They have no idea what drugs cost. They have no idea what xrays, cat scans, or MRIs cost, in any way. How much does it cost for an IV of whatever to enhance the visibility of the medical condition? They have no working knowledge of how to deal with hospitals, doctors, accounts payable, specialists and specialty clinics, or insurance before they get sick.

    $76000 is a big number. But “a burst appendix” is a nasty condition. To truly understand the nature of the treatment you have to look into the details in the bill, and the history of that treatment, including the costs involved to create it.

    Many of these treatments did not exist ten years ago, the R&D may not yet be paid for, the ingredients may cost a fortune, and maybe the market may bear a high price.

  8. […] too willing to ascribe their health to moral superiority, and bad health to bad behavior. (This is a phenomenon I’ve dubbed “Higgsism,” from the hero of Butler’s Erewhon.) Almost everyone is still repeating Ancel Keys’ […]

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