The sanctity of market solutions and business culture are at the heart of our health care system’s problems and our failure to reform it in any meaningful way. Oddly enough, our commitment as a society to market solutions and business culture have also been at the heart of maintaining practices and products outside those approved by the official health care system—that is, access to vitamins, herbs, and practitioners of alternative healing arts in the various traditions of natural health.
It’s a shame because the magic of the market we so cherish is to a very great degree antithetical to our biological inheritance. However you paint it, market solutions and business culture are the realm of self-interest and “More!”. The philosophy of this realm is, as a character in Kurt Vonnegut’s God Bless You Mr. Rosewater puts it, “Take much too much or you’ll get nothing at all.”
Yet the pursuit of self-interest seems the very bedrock of human nature. After all, hasn’t our success as a species been the result of survival of the fitness, the competition of each against each in the market of who passes on their genes to the next generation?
In my view, self-interest as the defining characteristic of success is a philosophy we’re taught, one we are conditioned to accept as human nature. A number of anthropologists and psychologists tell a very different story. Careful study has shown, for example, that human children exhibit a high degree of cooperative behavior that is independent of either overt training or rewards. For example, very young child will spontaneously offer help, share things they value, and give information when doing so has no benefit for them. It is only later in childhood, as children are taught the mores of their family and culture, that they learn the efficacy of self-interest, mine versus yours, us versus them.
About now, those of you with children will disagree with me. We parents have seen our share of appallingly selfish behavior by our children. But what the researchers see human children doing as compared to other primates and other social species is a basic instinct that motivates them to acts of empathy and cooperation. The fact that we recoil from our children’s selfish acts suggests that some of that instinct persists into adulthood.
In fact, I’d argue that our basic instinct for cooperation does remain with us, far more pervasively than we recognize. What happens is that our biology is overpowered of the ideology of self-interest, what our social structure and business culture condition us to accept as “human nature.”
For example, a piece of research from last week that started me down this path has the title “A theory of the evolution of other-regarding.” The researchers accept altruism as a human characteristic in need of explanation as a biological adaptation that confers greater success in passing along the trait to the next generation—that is, success in evolutionary terms. What these researchers do is construct a model of adaptations and their effects based on humans as individual goal seekers—that is, self-interested actions. Because the human strategy is a collective one, altruism contributes to individual success at achieving self-interested goals.
Here is where ideology is in plain sight. What goal is served when a three-year old picks up a pen I’ve dropped or shares a piece of fruit with me or tells me where I misplaced my glasses? What goal is served when you open the door for a stranger, give money to a panhandler, or stop to give someone the time of day or directions to their destination? We can concoct self-interested explanations about the goal of seeking pleasure through giving, but that’s thin and unconvincing. What’s going on is that empathy and cooperation are things we want from life for their own sake, in spite of how much effort is put into sanctifying self-interested, goal-seeking behavior.
That the ideology of the market finds its way into the very science of cooperation itself is not new. Herbert Spencer, upon reading Darwin’s Origin of Species, coined the concept “survival of the fittest,” a recasting of Darwin’s concept “natural selection”—the driving force of evolution. The ideology represented by “survival of the fittest” was intended to justify British racial superiority and British imperialism, entirely missing what Darwin argued—namely, that organisms and their environments adapt to one another over time, evolving together. However, even Darwin caved to Spencer’s degradation of his work: in the fifth edition he equated the two concepts.
Humans are much better at adapting their environment than other organisms—for good and for ill. We have great capacity and opportunity for both enabling and thwarting that basic instinct for empathy and cooperation. So what we really need to ask about health care reform is not the mechanical issues that have pre-occupied legislators but the fundamental ideological question: are we a society in which everyone has a right to health care? Then we can ask how to adapt our environment so that health care is what we get from life, something given for its own sake. Otherwise, we’re left with the survival of the fittest, with those who take much too much leaving the rest of us with crumbs and excuses.
In this regard, an emerging movement has responded to the recent Supreme Court ruling that effectively removed all control over corporate spending in politics. This piece of mischief and many more springs from the legal fiction that corporations have the same rights as natural persons. This movement is now calling for a Constitutional Amendment that eliminates that fiction. Information about the movement and its petition are at movetoamend.org.
These issues are discussed further in our book Too Much Medicine, Not Enough Health.