The Terrible Urge to Tear Down the Successful

Fairness and equality, much like communism, are concepts that pull at the hardwired nature of we humans. For reasons no doubt much to do with the evolutionary success of our ancestors, we instinctively seek to tear down those who have more than we do. Fairness and equality, again much like communism, turn into a race for the bottom when put into practice:

Creating "equality" by taking from the successful ruins the creation of wealth - very much a non-zero sum game - for all. It takes away the vital incentives and rewards for success. At the end of the process, as demonstrated by all that transpired in the Soviet Union, you are left with the same old inequalities, but now taking place amongst ruins, starvation and disease.

I noticed an exploration of one manifestation of this human urge today:

The fair innings argument maintains that for healthcare resources to be distributed fairly every person should receive sufficient healthcare to provide them with the opportunity to live in good health for a normal span of years. What constitutes a normal span of years is often defined as life expectancy at birth, but this criterion fails to provide adequate grounds for the equal distribution of healthcare across and between generations. A more suitable criterion for the normal life span is the idea that the human life span is biologically limited. Many current gerontological theories argue that the biological limit to human life spans is related to the ageing process. If technological advances in medicine can retard the ageing process by treating and preventing the diseases and disorders associated with it, human longevity will be limited only by the developments in and the successful application of medicine. In consequence, the fair innings argument will no longer be able to justify denying people healthcare resources because they have lived longer than the normal life span.

The very existence of the fair innings argument - the term coming from cricket, I imagine, refering to a decent time spent at bat, a good life lived, time to get out of the pool - is a terrible end manifestation of the urge to equality. That people talk about denying medical care to those who need it the most, and that they establish an idea of what length of life should be in defense of that aim, demonstrates that any attempt to impose equality is also a retreat from compassion and a refutation of progress.

An older paper runs along much the same lines and is open access: the basics of the fair innings argument haven't changed.

The fair innings argument (FIA) is frequently put forward as a justification for denying elderly patients treatment when they are in competition with younger patients and resources are scarce. In this paper I will examine some arguments that are used to support the FIA. My conclusion will be that they do not stand up to scrutiny and therefore, the FIA should not be used to justify the denial of treatment to elderly patients, or to support rationing of health care by age.

The whole debate has to be put in context, however. This is related to the operation of the universal health care system in the UK, a system that has long been in the doleful steady state of all such socialist, centralized systems: waste, terrible services, and - most importantly - rationing. Every taxpayer involuntarily funding this behemoth feels that they own a piece of it, and everyone has that tug on their human nature urging them to make sure that no-one gets more than they do. It's ugly, and it's why socialism fails. Along the way to failure, however, it produces dangerous ideas, such as "human beings have a fixed length of life, after which they should be cut off and left to die."

I much prefer the vanishing alternate path for health provision: a free market of competing service providers, and people taxed less, free to save and plan for their own medical needs. In that environment progress and longevity are welcome, and increased need for medicine is a market opportunity to excel in providing services.

I say if this were a privatized system, we would all say “gee it’s wonderful. All these people want more health care, this industry is thriving”. Let me put one other analogy. Suppose we made cars a government entitlement. Instead of cheering when auto production went up, we’d say, "Oh my God, we can’t afford this!". How you finance it may greatly affect the psychology and actually the freedom of the economy to take advantage of these new opportunities.

Sadly, freedom in medical choice is not the zeitgeist of this age. Worse looks more likely than better for the years immediately ahead.


There's no worse system than the US system that denies health care to everyone but the wealthy "elite" (who have gambled away our whole economy, but gosh darn it, they deserve the best).

Posted by: Name at December 23rd, 2008 2:18 AM

I like the reasoning in the Rivlin paper about the impossibility of determining a "fair" share. The cake analogy shows how faulty our commonly held concepts of value tend to be.

Posted by: shegeek at December 23rd, 2008 3:49 AM

rationing and otherwise restricting health care access is not socialism. In countries where so-called "socialism" failed they never had true socialism. A true socialism is where each citizen receives according to his/her needs. Health care is a basic human need and a human right which can be limited by available technology but not by ability to pay.
In so-called free enterprise system where only the rich can afford the best medical service, rationing is done by private companies by making health care unaffordable and inaccessible to the poor majority of people.

Posted by: nikki at December 23rd, 2008 4:35 PM

People fall thru the cracks in both systems, but in a universal system, few contribute to charities to help out, because they think the government has taken care of it.

If government healthcare makes good sense, then it would follow that a move to all government grocery stores, government housing, government transportation, government clothing stores, etc. should be the best way. Do you really believe the people responsible for the war on poverty, the war on drugs, and FEMA should be in charge of health care? I'm always curious as to how people get so "pie in the sky" about government services.

How well did cardiac patients fare in England when they had a 2 year wait for surgery? Or the people in New Zealand who were denied dialysis because they were too old? Those are examples of just one of the drawbacks of a universal system.

And you realize they refer to the NHS as the "post code lottery"?

Regardless of the approach, there are downsides, but IMO choice is a much better option than force.

Posted by: les moore at December 24th, 2008 7:41 AM

Definately horrible. I love the communism comparison.

Posted by: Tycio at March 2nd, 2009 7:20 PM

What about a mixed health care system that covers "normal" lifespan for everyone and then allows the existence of private companies that offer cutting edge, semi-experimental treatments for the oldies who can afford them? We are too used to black and white thinking.

Posted by: Barbara at October 10th, 2012 1:27 AM
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