After the philosopher Daniel Dennett was rushed to the hospital for lifesaving surgery to replace a damaged aorta, he had an epiphany:
I saw with greater clarity than ever before in my life that when I say “Thank goodness!” this is not merely a euphemism for “Thank God!” (We atheists don’t believe that there is any God to thank.) I really do mean thank goodness! There is a lot of goodness in this world, and more goodness every day, and this fantastic human-made fabric of excellence is genuinely responsible for the fact that I am alive today. It is a worthy recipient of the gratitude I feel today, and I want to celebrate that fact here and now.
To whom, then, do I owe a debt of gratitude? To the cardiologist who has kept me alive and ticking for years, and who swiftly and confidently rejected the original diagnosis of nothing worse than pneumonia. To the surgeons, neurologists, anesthesiologists, and the perfusionist, who kept my systems going for many hours under daunting circumstances. To the dozen or so physician assistants, and to nurses and physical therapists and x-ray technicians and a small army of phlebotomists so deft that you hardly know they are drawing your blood, and the people who brought the meals, kept my room clean, did the mountains of laundry generated by such a messy case, wheel-chaired me to x-ray, and so forth. These people came from Uganda, Kenya, Liberia, Haiti, the Philippines, Croatia, Russia, China, Korea, India—and the United States, of course—and I have never seen more impressive mutual respect, as they helped each other out and checked each other’s work. But for all their teamwork, this local gang could not have done their jobs without the huge background of contributions from others. I remember with gratitude my late friend and Tufts colleague, physicist Allan Cormack, who shared the Nobel Prize for his invention of the c-t scanner. Allan—you have posthumously saved yet another life, but who’s counting? The world is better for the work you did. Thank goodness. Then there is the whole system of medicine, both the science and the technology, without which the best-intentioned efforts of individuals would be roughly useless. So I am grateful to the editorial boards and referees, past and present, of Science, Nature, Journal of the American Medical Association, Lancet, and all the other institutions of science and medicine that keep churning out improvements, detecting and correcting flaws.
Indeed. And because the supply of thankfulness is not fixed, it will not depreciate the value of Professor Dennett’s sentiment to add a word of thanks not just for goodness but for greed—the greed that inspired generations of inventors and investors, laborers and capitalists, doctors and nurses, technicians and scientists to envision and perfect such a thing as an artificial aorta, to educate themselves in the healing professions, and to show up for work every day. For the most part, they did it to make a buck.
We can be thankful too for the system that channels all that potentially destructive greed into life-sustaining brilliance. But we might temper our gratitude just a bit with a moment of wistful regret for the lives lost because of unnecessary imperfections in that system. As a society, we spend far too little on basic research in health care, largely because breakthroughs are under-rewarded. For one thing, our reliance on third-party payers (with the attendant loss of control over our own health care choices) makes us willing to pay handsomely even for relatively ineffective treatments, which diminishes the incentive for innovators to make treatments more effective. (This compelling observation comes from a paper by the economists Kevin Murphy and Robert Topel; I’ll be blogging on their work in more detail in the near future.)
For the sake of future Daniel Dennetts, I hope our legislators have the goodness and wisdom to devise a health care reform package that strengthens the incentive structure instead of weakening it still further. When they fail, as they probably will, there will be plenty of time for outrage. Meanwhile, things could be far far worse, and there’s much to be grateful for on this Thanksgiving day.
It’s not just money-greed that has driven such beneficial behavior. Status-greed (or esteem-greed) has contributed as well. It’s closely related, and is often sublimated by some of the same institutions.
Incidentally, I’ve been wondering lately why some things — medical care, car repair — are billed approximately on a cost basis (or more nearly based on an itemized invoice), while most things are paid for at a prix fixe. Procedure-billing drives the excessive use of procedures, and eliminates incentives for medical providers to keep costs down; this is in addition to the effects of third-party payment. Car repair is a less distorted market, and has ended up with the same system, though. The only reasons I’ve thought of are risk aversion (the auto shop doesn’t know well how much it will cost when they get the car — but shouldn’t I be more risk averse, on an absolute basis, than they are?) or information asymmetry (which, again, I would expect to work in the other direction, but I could conceive that the car owner would, a lack of expertise notwithstanding, know more about the situation than the garage). Or maybe there’s more something more complex — individuals want to signal that they have superior information, or enough of them do that any shop that tried to stick with an initial estimate would have an unbearable adverse selection problem. Any thoughts you can provide would be welcome.
Give thanks
For what you have –
It will be no fortunate coincidence
That it is all you said
I also have a question, I enjoyed your book, but I think I found an inconsistency. I could be wrong, but how do you reconcile the following:
On page 161:
The Headache Problem. A billion people are experiencing fairly minor headaches, which will continue for another hour unless an innocent person is killed, in which case they will cease immediately. Is it ok to kill that innocent person?
Your answers: Yes
On pages 192 – 193
Don’t take things that aren’t your. You conclude this section with “[b]ut taxation for the sole purpose of redistributing income is closely parallel to behavior that we admonish our kids for on the playground.”
Thanks!!
Clifford Nelson: I claim two things. First, this is not an inconsistency. Second, if it were an inconsistency, I’d be entirely cheerful about it.
“Taxation for the sole purpose of redistribution” means taking a dollar from Peter in order to give a dollar to Paul. But in the headache problem, I claim that you’re taking a dollar from Peter in order to give two dollars to Peter. That is, Peter suffers a one-in-a-billion chance of death (which he values at one dollar) to cure his headache (which he values at two).
So the headache situation differs from the redistribution situation in two important ways: First, you’re doing more good than harm. And second, that good comes back to the very same people you’re doing the harm to, not some other people.
That’s why I think this is not an inconsistency. Now as to why I’d be cheerful about it even if it were: I introduced the headache problem in the course of illustrating the application of cost-benefit analysis to public policy; I also argued that by and large, this approach to public policy is a good one. I introduced the playground analogy in the course of trying to apply our instincts about fairness to public policy. I think this is a good idea too. But when you’ve got two different good approaches, you can’t expect them to always point you in the same direction. (Of course this leaves you with the problem of deciding what you should actually do, and I haven’t solved that problem.)
Thanks for responding. BTW – remember that the yield curve inverts after one slice of pumpkin pie irrespective of whether you added whipped cream.
My understanding of greed is of an anti-rational and ultimately self-defeating drive, i.e. an economic bubble is driven by greed, but sustained economic growth is not. In fact, when I talk of the “work ethic” (an expression denigrated in The Armchair Economist), I mean little more than making a distinction between the two definitions of “greed”: mine, and that implied in this post.
I think it’s a mistake to call this “greed”. I don’t think that “greed” captures all that’s going on. Certainly they did it to make a buck. That’s true. But that’s not all of it.
In order to develop a profitable product or service, I can’t focus solely on myself. I have to also think about the needs of the other person. I’m going to trade with them my product/service for their money. And in order to get them to part with their money, I have to think about what they’re going to need. I’m not just focused on making a buck. I’m focused also on meeting their needs. I have to be, or they wouldn’t freely trade with me.
But if I were to simply call this “selflessness” because I’m focused on the needs of others, that would also not capture the whole of what’s going on.
It’s not greed. It’s not selflessness. It’s both. IMHO, it’s the practical experience of “love your neighbor as yourself”.