Against Having it All

(Originally, this flowed out of healthcare: I thought that it deserved its own post) 

It is extremely challenging in this world that chants 'you can be anything' and 'you can do anything' to make decisions and have discussions about trade-offs, opportunity costs, and the fact that you can't have it all.

I think the 'have it all' outlook has been, and continues to be, incredibly damaging to individuals and the health of society. Paradox of Choice, by Barry Schwartz, articulates the problem incredibly well (and then beats it into you after the first 20 pages with interminable examples). You cannot, in fact, have it all. You have to make choices, and this includes eliminating options, i.e. not having it all. You can't be a doctor, a lawyer, an astronaut, a Hollywood superstar, a mom, an author, a politician, an artist, a teacher, a businessman, a friend, sister, cousin, daughter, reader, and long walk taker. Or at least not all at once. Which means you have to make a decision, eliminating some choices, at least for now, and committing to others. Yet with the 'have it all' outlook, we have deprived ourselves of systems for making decisions, by claiming them unnecessary, and the supports for following through with decisions, once made. 

Where does this leave free will? A question for tomorrow, once well rested. 

Health Care: Brits v. Americans

I was quite impressed and inspired by an interesting NY Times article on drug costs and the British healthcare system, and the follow-up letters. The British healthcare system is almost alone in considering effectiveness data and costs in deciding which drugs and treatments to provide. 

These are conversations the US seems unwilling to have, taking an attitude that all drugs, no matter how costly, should be marshaled at the patient's request, never mind the costs to the health care system, that health care costs may now be out of reach for a low income family with a sick child. Can you imagine our government consulting a citizens group to decide whether a 75-year old should receive the same care costs as a 5 year-old? To say nothing of conversations truly denying the 'right' to million dollar medical care.  

No matter how hard it is to determine the value of a life--seeing a grandchild, or a child graduate--I very much agree with the reader who wrote in to say: 

In a world of limited resources, every choice has an opportunity cost -- we forgo the value of that on which the resource would otherwise have been spent. Extending a life by a year, for instance, might reduce other people's life spans, or educational opportunities. 

So, either implicitly or explicitly, we unavoidably place a value on a year of human life. Most of us prefer implicitly, so we don't have to face the fact that we're doing it. But this avoidance is inefficient; society pays for it in many ways, including life years. 

I applaud the British people for facing up to reality. 

I do also sympathize with the reader who points out how unappealing this is to Americans who have battled managed care, spending so much on preventing care and battling claims, to again set up a system that denies them some care. However, a system that involves citizen dialogue for setting limits and boundaries, and articulates opportunity costs, bring the problem and question into the public consciousness, rather than leaving such decisions up to purely profit-seeking business minds seems far more promising.