I think the best solution is to make charity cool again...
It doesn't matter if big problems are solved for profit or solved for charity. What matters is that they get solved.
I think a lot of problems can be solved using a for profit model. I think, overall, it tends to be for the best if you can find a for profit model that is viable for the problem in question. I think the problem is not that it is for profit, I think the problem is that some for profit models are just not well suited to solving certain problems.
This is an idea I have thought a great deal about. I have a serious medical condition. I have spent the last 13 years getting myself well when doctors claim it cannot be done. I have come to believe that one of the problems is that doctors make their money off of treating illness. They do not actually make their money off of keeping you well. The more your treatment drags out, the more money they make.
I have heard that in China, they put a doctor on retainer and only pay him when they are well. So doctors in China only make money if you are well. I do not know how accurate this is or how effective, but, as someone who is getting well in part by avoiding the medical establishment, I feel very strongly that our current "health care system" is very broken and one of the things wrong with it is not that it is monetized but how it is monetized.
I have thought long and hard about how to try to share information about what worked for me. Given the negative reception my story gets almost everywhere I go, it may not be possible to help anyone else. But one thing I am clear about: I do not want to be "a consultant" and monetize the information much the way doctors get paid. Doctors in the U.S. mostly trade short term gains for long term costs. I got well by trading long term gains for short term costs as much as I could. When doctors put people like me on strong drugs, the drugs have a long handout listing the horrible side effects. But then as people like me get sicker and sicker, it is blamed on our disorder, not on the drug side effects. I have no desire to join doctors in following this model that allows them to charge big bucks and claim credit for the short term improvements while blaming long term deterioration on my condition. I believe that is a failed system and I believe the way it is monetized is part of why it goes down like that.
I think charity also tends to fail. Think of the very negative connotation for the phrase "charity case." I don't think we help people that much when we first have to write them off as losers before we do anything for them. Given that I have been homeless for over two years and left the soup kitchens and most other homeless services as soon as I could, yeah, I think my opinion on that is informed and not merely pontification of an unclued privileged person trying to justify not giving money away.
I don't have an answer. I mostly cannot get people to even engage me in discussion on the topic (of how I got well). But I agree much more with your statement about solving big problems and not caring if it is for profit or for charity than I do with your idea of making charity cool again. I do not really want charity. Charity has helped keep me alive but it is not going to get me off the street or restore me to a middle class lifestyle. I need to be taken seriously as a competent professional to achieve that. Being viewed as "a charity case" is the opposite of the professional respect and business connections I would prefer to achieve.
Honest question: do you have a criticism of "charity" besides your own negative psychological reaction to derogatory uses of the term? I believe charity can be an empowering force if it helps people break out of the cycle of poverty. If anything, your criticism indicates that we need to work to reframe charity as compassion rather than some kind of condescending pity. But that seems like a problem to fix, not a reason to view charity as likely to fail.
> I don't think we help people that much when we first have to write them off as losers before we do anything for them.
I'm not really sure how to respond to this. Who's writing them off as "losers"? I'm pretty sure charitable organizations don't consider the people they help to be losers. If you're complaining that people look down on the poor, that's certainly an unfair stigma, but why does this mean charity isn't helpful?
Edit in response to your edit: I did not say "charity is not helpful". I said that other models typically provide superior solutions if you can work it out right.
Original reply:
Yes, I have a lot of criticisms of it. I was talking to my son the other day about something and he gave me the supporting example that a charity in Africa found that if it gave away mosquito netting to poor moms to protect their babies from diseases carried by mosquitoes, they typically sold it. But if they sold the netting for 50 cents, which was half a day's wages for these women, then proper use of the netting shot up from something like 10% to something like 80%.
Giving away things for free tends to undermine self esteem and self determination, tends to come with a lot of controlling conditions, and tends to be very poor quality. I left the soup kitchens as soon as I could in part because the food is terrible and it exposed me to concentrations of people who were often ill and actively smoking cigarettes next to me. Staying away from sick people and cigarette smoke and eating good quality food is part of how I stay out of the ER.
I could go on but I don't really see much reason to. I have a lot of very practical reasons. It is not merely some kind of negative psychological reaction. It is a very well reasoned position, based in part on having done a lot of volunteer work when I was younger and a lot of reading about such topics.
I don't think we should eliminate all charities but I do think that the more we can find other ways to solve problems, the better those solutions are likely to be. Charity tends to produce pretty bad solutions which keep people limping along and generally does not have a good track record of lifting people out of poverty.
Thanks for the response, your points make a lot of sense. I will say, however, that after searching for info on the mosquito net situation you described, I came across this article which seems to contradict your point:
I have heard that in China, they put a doctor on retainer and only pay him when they are well.
Since you indicated that you weren't sure if that is true, I can assure that it is not. Most doctors in China are paid formally by salary, and under the table by patients who can afford bribes on a fee-for-service basis.
Thanks. Let me clarify that my main point (in mentioning what I had heard about China) was that there are potential alternate paradigms for paying doctors which do not directly incentivize dragging out illness. In the U.S., one of the best hospitals we have also has doctors on salary. They make the same amount regardless of how many tests they order. They credit this with helping make sure the focus is on giving the patient the best possible care without any conflict of interest subconsciously influencing the doctor's treatment plan.
As I see it, there are only two fundamental ways to pay for health care: you can can pay for treatment as and when you need it, or you can pay a flat rate in exchange for treatment at no additional cost. Hopefully we can agree that the former option is barbaric, as you are effectively denying modern medicine to anyone not rich enough to cover it up-front, which is most people. The latter option is essentially health insurance. Paying the doctor a retainer only when you are well is tantamount to making your doctor a de-facto health insurer (and all of the horrible consequences that entails).
Insurance works off averages, so it works more efficiently the more people buy in. Logically then, the most efficient health insurance is where everyone buys in. Hence, the most efficient system is nationalized health insurance, which comes with many other benefits - for example, it lends massive bargaining power to the people for reasonable drug prices.
You state in your original comment "I feel very strongly that our current "health care system" is very broken and one of the things wrong with it is not that it is monetized but how it is monetized." This implies that you don't believe in socialized medicine. What in your opinion is wrong with it?
I'm from Germany. Once I was hit by a car on my bicycle. The driver wasn't looking and hit me. My hospitalization was paid for by a nationalized system of public and private insurers. A short trial was held for fault. I was awarded money that would cover replacing my bike and a few hundred more dollars for my troubles.
In the US, I probably would have gotten a large cash settlement out of the deal. But a nationalized system like that in most other first-world countries does not require tort-reform because effectively the commitment to your health, cradle to grave, is a given.
Paying doctors piece-meal, like assembly-line workers or auto mechanics, creates perverse incentives and only tangentially works towards good outcomes.
Please do note that I put "health care system" in quotes. That was not an accident.
I worked in insurance for over five years. They are not in the business of taking care of people. They are more like some version of Las Vegas but all the "winners" first have to lose an arm or get run over by a car. I am not a huge fan of insurance.
I was a homemaker for many years. I also was studying to go into urban planning when my life got derailed by divorce and health issues. Urban planners used to plan pedestrian-friendly spaces in part with an eye towards health of the community members. I have also read a fair amount about the differences between how Europe handles things and how the U.S. does. Europe is generally more family-friendly and people friendly, which is good for the health of it's people.
Medicine is not about making people healthy. Eating right, exercising and living right are what foster good health. Medicine is crisis management when things go wrong. Viewing medicine as "health care" is fundamentally fubarred. You cannot crisis manage your way to good health. It simply cannot be done. Good health is built over a long period of time, with every bite you put in your mouth, every time you fail to become a drug addict or alcoholic, every time you find a way to get your sexual needs met that does not expose you to high risk of infection from strangers with unknown personal habits, etc.
So when the U.S. reduces discussions of "fixing our health care system" to the question of "who should pay for it?", the situation is already essentially hopeless. It cannot be fixed from that starting point.
As for who should pay for medical care (which is not, in my mind, "health care"): The government. Insurance is not in the business of taking care of people. It is a numbers game and, like Las Vegas, in order for the house to even keep it's doors open, much less make the occasional big payout, there have to be a great many more losers than winners. It's simple math in that regard and the actuaries look out for that end of it like vigilant hawks. And when the actuaries decide the company is paying customers too much money for X benefit on X policy, the policy gets sent to the legal department and they "clarify" what the paragraph in question means and the claims department gets retrained to "pay this benefit correctly" and we start sending denial notices to the customer for things we used to cover. That will never, ever, ever, ever, ever make this country healthier.
And I worked for a good insurance company with a very ethical reputation. From what I gather, a lot of other insurance companies are far more gruesome.
Remuneration in the medical profession is fascinating and trying to properly align incentives whilst avoiding unintended consequences is very complicated. I am not sure there is a model that properly works yet.
I think a lot of problems can be solved using a for profit model. I think, overall, it tends to be for the best if you can find a for profit model that is viable for the problem in question. I think the problem is not that it is for profit, I think the problem is that some for profit models are just not well suited to solving certain problems.
This is an idea I have thought a great deal about. I have a serious medical condition. I have spent the last 13 years getting myself well when doctors claim it cannot be done. I have come to believe that one of the problems is that doctors make their money off of treating illness. They do not actually make their money off of keeping you well. The more your treatment drags out, the more money they make.
I have heard that in China, they put a doctor on retainer and only pay him when they are well. So doctors in China only make money if you are well. I do not know how accurate this is or how effective, but, as someone who is getting well in part by avoiding the medical establishment, I feel very strongly that our current "health care system" is very broken and one of the things wrong with it is not that it is monetized but how it is monetized.
I have thought long and hard about how to try to share information about what worked for me. Given the negative reception my story gets almost everywhere I go, it may not be possible to help anyone else. But one thing I am clear about: I do not want to be "a consultant" and monetize the information much the way doctors get paid. Doctors in the U.S. mostly trade short term gains for long term costs. I got well by trading long term gains for short term costs as much as I could. When doctors put people like me on strong drugs, the drugs have a long handout listing the horrible side effects. But then as people like me get sicker and sicker, it is blamed on our disorder, not on the drug side effects. I have no desire to join doctors in following this model that allows them to charge big bucks and claim credit for the short term improvements while blaming long term deterioration on my condition. I believe that is a failed system and I believe the way it is monetized is part of why it goes down like that.
I think charity also tends to fail. Think of the very negative connotation for the phrase "charity case." I don't think we help people that much when we first have to write them off as losers before we do anything for them. Given that I have been homeless for over two years and left the soup kitchens and most other homeless services as soon as I could, yeah, I think my opinion on that is informed and not merely pontification of an unclued privileged person trying to justify not giving money away.
I don't have an answer. I mostly cannot get people to even engage me in discussion on the topic (of how I got well). But I agree much more with your statement about solving big problems and not caring if it is for profit or for charity than I do with your idea of making charity cool again. I do not really want charity. Charity has helped keep me alive but it is not going to get me off the street or restore me to a middle class lifestyle. I need to be taken seriously as a competent professional to achieve that. Being viewed as "a charity case" is the opposite of the professional respect and business connections I would prefer to achieve.