Goals


In any complex system, a solution that best meets one goal will fall short in other areas. Computer programs to solve nearly any problem in the fastest manner will not be the algorithms that use the least memory. Solutions that can be written in the least amount of time will neither be the fastest nor the most memory-efficient. Solutions that are the best-performing by any measure on average are not the best performing in the worst case. And on it goes.

The same is true for public policy. So if you were to complete the sentence below, how would you?
"I think healthcare policy should be designed to achieve [outcome] for [group] at [timescale]"

Some options you might pick
Outcome:
- Longest life expectancy
- Best treatment weighed over all medical issues
- Greatest value for the cost
- Equality; accessibility of existing treatments to all
- Fairness; rewarding those who make choices that reduce cost (e.g. charging smokers or obese more, allowing those who choose not to have children to not pay for maternity care etc.)
- Most political popularity

Group:
- The poorest and least privileged in society
- The median or average person
- Those who work the hardest to live a healthy lifestyle

Timescale:
- Right now, or in the next few years
- Over the next few decades (or even for your forseeable lifetime)
- Over the next generations (e.g. for your children, theirs, ad infinitum)

As with any complex system, a solution that best meets one goal (say, least suffering for the poorest right now) will fail other goals (such as life expectancy for the average person over the next few decades). And no, you cannot have them all. Some, like equality and fairness, are polar opposites. I lean toward most desired outcome for the average person over the longest timescale, after all, if you have the choice of a policy that will cure the most, worst diseases and do not take it, does that not make you a cruel heartless person?

But I am honest enough to admit that the solution that provides the best treatments for the average person, for a variety of economic reasons, cannot possibly be the solution that will most evenly distribute treatments any more than the quicksort algorithm can be heapsort. And there are good reasons to believe that most people will be much happier in a system where everyone gets the best available treatment than in a system where the average person receives much superior treatments but not everyone can receive all available treatments. Maybe that is what we should work for instead?

Further complicating matters, policies that are most politically acceptable tend to be those that are focused on the most visible immediate results, nearly always causing harm over greater timescales against groups who have the least political voice now. So there are also legitimate reasons to advocate for a solution that is not the best now but does well in the short term if the best will not last in a democratic form of government. Furthermore, ample evidence exists that people pick a solution they feel emotionally best, then rationalize their decision later and reject any contradicting information, one reason political arguments often fail to admit any tradeoffs exist in policy discussions.

Anyway, the moral of the story is, take time to understand where the other side is coming from. Frequently the root disagreement is over deeper values; see if you can identify those and be willing to consider those different from your own.

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