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The moral hazards of healthcare

Deepest thanks to David Farrer for linking to this fascinating article by Dr Raj Persaud in the Scotsman.

Could your political beliefs determine how long you live? New research from sociologist Dr William Cockerham and colleagues from the University of Alabama in the United States has found that differences in attitudes to looking after your body and your health are predicted by your political allegiances.

It seems those who believe the state should take responsibility for most aspects of life also tend to eschew personal responsibility for taking care of themselves. As a result, they are more likely to engage in lifestyles hazardous to their health, including drinking to excess and not exercising.

The just-published research was conducted among Russians, comparing those who longed for a to return to the old-style Soviet system with those who preferred the free-market approach to the economy.

Personal interviews with almost 9,000 Russians found significant differences in how much they looked after their own health depending on where they placed themselves on the political spectrum.

David says that this reminds him of Glasgow, another great bastion of socialist intellectual self-abuse, and bodily self-abuse by other more enjoyable but equally destructive means. But Dr Raj Persaud doesn’t seem to have heard about Glasgow.

The old divisions between socialists and capitalists may have largely disappeared in modern Britain but elsewhere in Europe, particularly in the old eastern bloc countries, the political conflict between socialists and capitalists remains. These countries have experienced unprecedented upheaval since the collapse of the old Soviet systems and it is still not clear to large sections of the electorate that abandoning the old centrally-planned economies has brought any real benefits yet.

But the Russian plunge in life expectancy began several decades ago, so the capitalism they’ve been having over there lately can hardly be blamed.

Russian male life expectancy stood at 64 years in 1965, but steadily decreased to around 62 years by 1980. Male longevity improved during Gorbachev’s brief (1984-87) anti-alcohol campaign, reaching almost 65 years in 1987, and then entered a period of accelerated decline – centred around the fall of the communist regime – in which life expectancy fell to a modern low of roughly 58 years in 1994. The most recent figures for 2000 show Russian males living 59 years, on average some five years less than in 1965.

Things have improved a tiny bit, in other words, but not nearly enough to take Russians back to the good old days before the system so many of them yearn for began its final collapse.

Persaud ends his article with what can only be called a philosophical attack on the whole idea of collectivised medicine.

The dilemma in politics is that some kind of safety net for those unable to look after themselves seems desirable, yet if the net becomes too extensive it may act as a disincentive for fostering individual personal responsibility for looking after one’s own health.

Solving this dilemma is an urgent requirement of modern politics because it could even determine how long we live.

“Solving this dilemma” sounds an awful lot like “squaring this circle” to me. This is our old friend moral hazard, a sadly familiar concept to all too many providers of care or help. You help someone who’s down, to get him back on his feet, and he uses your help to make staying down more comfortable, and when you finally give up with helping him, he’s lost the trick of walking. The Welfare State sets up a trampoline, and it turns into a swamp.

18 comments to The moral hazards of healthcare

  • Chris Josephson

    My opinion is that *all* government backed safety nets are a “disincentive for fostering individual personal responsibility for looking after one’s ” anything. Why work when the government will take care of you? Why take care of your health when the government is there to look after you?

    I’m concerned his choice of research subjects, Russians, may not prove his point. What about other countries that have socialized health care?

    In order to draw the conclusions he has, he should include other nations that also have socialized health care.

  • Kevin L. Connors

    It’s been shown repeatedly that, absent government intervention, people of all incomes are more than willing to give a substancial portion of their wealth to charity. The problem, in today’s world, is for those in need to find those willing to help.

    Just as government has a legimate role in facilitating markets for commerce. so to should it take the role of facilitating a market for charity.

  • Johnathan Pearce

    Brian, good article. Another thing occurs to me: if you look at how the old Eastern Bloc countries treated things like sport and fitness, it was essentially seen as a way of glorifying the State. Remember those old Olympic Games where those muscled men and women of East Germany often trounced their “decadent” Western opponents? But of course these super-fit folk were only a tiny fraction of the total population.

    Meanwhile, in the capitalist west, one of the big growth industries in the past 20 years or so has been the gym and related health business. It is now a major contributor to GDP in the UK, for instance, not to mention the US. The whole self-help movement in health and related matters has also been a significant cultural and economic event here over that period.

  • Anti-globalizers like to go on how capitalism has cut Russian life-expectancy short, but of course they didn’t have capitalism in the early 90s, just cleptocrarcy.

    Btw, the Economist wrote some years back that freed male slaves experienced a similar decline in life-expectancy after 1865.

  • Guy Herbert

    The suggestion is interesting, but in the Russian study the causation might just as well work the other way round: the more sickly you are, the more you yearn for socialized medicine, subsidised food, etc.

    A differrent set of facts relating to the same issue that can also be interpreted both ways: the proportion of working days lost to sickness in the UK in the public sector is much larger than that in large private-sector firms, where it is in turn larger than that in small firms, which is larger than that among the self-employed.

    Would the same person be more often ill with less direct responsibility? Or do people gravitate to such posts because they know or suspect they need an easier ride? Does the same level of illness stop people in large firms more easily than those in small? My guess: all of the above.

  • Jonathan and Guy raise important points. The causation on this study might well work in reverse: sickly people yearning for free healthcare.

    Also, since I’ve lived in Eastern Europe for some years I have to disagree a bit with Jonathan. Young East Europeans are very fit and slim, and are obsessive consumers of fitness clubs and fitness equipment. But this is largely down to vanity competition among young women, since they are on average a lot prettier than West Europeans and need to try harder to attract and keep men.

    This suggests to me a slightly different pattern from the state-versus-private model. In parts of Europe where a larger proportion of young people are good-looking (the Mediterranean, the East), then they compete for mates, but become fat, bald etc once the marriage contract is signed and a baby or two has been born. Biologists call this the “disposable soma” philosophy (once you’ve mated and passed on your genes, you stop having a compelling reason to take care of your body).

    It could be reinterpreted though. Most people try to be fit to attract the opposite sex, not to be well in old age, and so reaching the safe harbour of a marriage with children might be the equivalent of what libertarians see as sagging gratefully into the embrace of state healthcare and letting go.

    Almost everyone smokes and drinks compulsively in Hungary, Russia etc (apparently there has been a big shift in Poland in the 90s, however, towards Western habits of moderation) – and often those smokers and drinkers can run five miles without getting out of breath and have figures like lingerie models.

    My personal suspicion is that socialism thrives in cultures genetically predisposed to be short-termist about life, health and their futures (several centuries of getting pregnant in their mid-teens will easily ensure that) – not the other way round.

    So perhaps most Russians, Hungarians, Romanians, Serbs don’t care and have trouble seeing ahead further than the next drink and pack of cigarettes, and thus get one horrible political system after another as a result. They also tend to drop _everything_ else at any chance to fuck the next beautiful person they see, which helps to explain chaotic, handicapped societies with hordes of stunning-looking young people appearing every generation.

  • Guy Herbert

    So if you are good-looking and get to screw around with other beautiful people, smoke and drink, you’re unlikely to care about the state of the political system. The Joey Trebbiani approach top current affairs. Sounds eminently reasonable to me. I must get out more.

  • Lorenzo

    All of the above just seams to prove that you should never conclude from a single sample population. Which of course is the why statistics come last in the old saying “lies, damn lies and statistics”

  • mark holland

    Methinks that this is the good Dr Persaud author of the article above. And if so he’s got an excelent platform for spreading his anti-socialised medicine/personal responsibily views.

  • Jon

    For what it’s worth, I saw Persaud introduce a documentary on the making of “One Flew Over the Cuckoo’s Nest” at the ICA, in London. He spoke about the film for about 30 seconds, about his own work for a couple of minutes, and about Tony Blair’s apparent dementia and the derangement of George Bush for a good five minutes. He’s a woolly-headed, self-aggrandizing horse’s ass of epic proportions.

    The film, by the way, was disappointing…

  • Paul P


    How do you mean ‘facilitate’ and why is it justified?
    Government and business should be run at arms (no pun intended) length.

  • G Cooper

    Jon writes (of PerPseud:
    “He’s a woolly-headed, self-aggrandizing horse’s ass of epic proportions”

    He is, undoubtedly, a remarkable self-publicist. Reading the press and listening to R4, you’d have to assume his mobile phone number is in every news and feature editor’s contacts book.

    Sadly, his opinions on just about everything seem anodyne in all but (ironically) the medical sense.

  • A possibly relevant data point on comparing civil servants and private sector workers: in the U.S. civil servants have far more generous sick leave and vacation (holiday) benefits that people working in the private sector. And, as you might expect, civil servants take more sick leave than their private sector counterparts. Unfortunately, what all too often happens in the private sector is that people come into work too sick to actually accomplish much. But hey, the statistics on sick time look better.

  • By the way, I didn’t mean to suggest people should smoke, drink and screw around lots, any more than they should be thriftily sensible and save up for an old age of vigorous hill-walking and gardening.

    Only that there are at least two versions of “fit”: fit to live to a healthy, ripe old age – and fit to mate.

    Darwinian ideas collide a little with free-market ideas here. If you think being fit to mate matters more, you might actually freely choose to damage your health now (for example with liberal use of steroids, tanning and overexercising) in order to look very fit and attractive in the short term and mate with as beautiful a partner as possible, soon.

    Drinking and smoking are part of the mating game – research suggests that being ostentatiously careless with your health while young is a way in several species (people included) to show off just how young and fit you are to potential mates.

    Could this be-moderate-now-&-save-up-for-your-own-sickness-later prudence explain why libertarianism does not have a young, hip image, as discussed in previous threads here?

  • Ken

    I wonder if we can be sure that Russian life expectancy dropped after the fall of Communism. The Soviets were notorious for lying their asses off at every possible opportunity. I’d say that the confidence we can place in any statistics provided by the Soviets is exactly zero.

    Our estimates of statistics pertaining to the Soviet Union were not much better. Our government consistently overestimated the economic and military strength of the Soviet Union.

    So where do our numbers come from to support the assertion that the end of Communism brought a drop in life expectancy?

  • Good point Ken, Russian statistics about falling life-expectancy under capitalism are hard to trust.

    Mind you, I seem to recall vodka became much harder (obviously not impossible, but perhaps it moved out of regular affordability for most Russians) to obtain during the Gorbachev’s “dry” presidency. Given the massive size of the Russian alcohol health problem, I can imagine that a return to freer availability – or even just a reduction in price – for alcohol in the 1990s was sufficient alone to suddenly kill off a swathe of semi-recovered alcoholics, for example every fifth male over 50.

    That alone could have done it.

  • Brian Micklethwait

    The point about the big fall in life expectancy in Russia is that it happened during the collapse phase of communism, and was a huge part of that collapse. It makes no sense to interpret the numbers as resulting from the mere ending of communism.

    The reason I personally trust these figures as being a bit more meaningful than steel production figures is that (a) there was a dramatic change during the communism period, and (b) the change was very bad news for communism. In fact I do believe that these numbers were one of the big reasons why Gorbachev and co decided that communism had no future.

    However, I agree that the sharp decline that is said to have occurred during the late eighties and into the early nineties could have been partly a sharp increase in the willingness of Soviet/Russian decision makers to face “unhealthy” facts rather than lie about them, and it could be that the sharp decline began somewhat earlier and somewhat less abruptly than the late eighties.

    But the point is, the decline is not claimed to have begun in the early nineties, or not by the people basing their argument on the numbers that Persaud is referring to.

    Even Soviet steel production figures mean something. They mean the amount of useless crap produced by the USSR and either used semi-“efficiently” to make more useless crap, or else left rotting in piles beside the road or in marshalling yards or in big sheds.

    It’s my udnerstanding that GDP numbers in the west are less bogus, but similarly polluted by the useless crap factor.

    My recent reading obsession Terence Kealey points out that growth rates in all advanced countries are remarkably steady. This fits. The amount of stuff that piles up each year is steady, but what is not steady is what good it achieves.

    Getting back to the original point, these life expectancy figures are rather different. They actually measure something changing, and changing for the worse. I think they’re suspect, of course, but still somewhat meaningful.

  • Metaphor alert! The trampoline turns into a swamp? Hey, maybe that should be a quagmire. Heh. Depressing topic, too. I fear that Russia will take generations to get out of its, uh, morass.

    The theory of political allegiance linking with personal responsibility doesn’t fit my experience. I know prudish leftists who take great care of themselves, even though they think the U.S. should adopt a national health plan. I also know some irresponsible libertarian drunkards.