PHILOSOPHY: What I am calling "philosophy" in this series is perhaps really "moral" or "metaphysical" philosophy. (According to the Oxford English Dictionary, at least.) That is, it has to do with the fundamental assumptions or beliefs about the nature and causes of things. In the political and social context, I'm particularly talking about what we believe about the fundamental causes of human behavior. To put it simply, what are my beliefs about what makes people do what they do?
IDEOLOGY: A "system of ideas or a way of thinking" that forms the "basis for an economic or political theory or system." Ideology, says the Oxford English Dictionary, is what justifies actions, and is "maintained irrespective of events."
In Part 2 of this series I talked about the generally-agreed-upon idea that in order to successfully deal with the scourges of vaccine-preventable and other infectious diseases we will need "innovative federal policy." Then I pointed out that most of the ideas we ever hear about this have to do with giving corporations some sort of "incentives" (i.e. money) to do the job. "Can't we do better than this?" I asked, and answered my own question by saying "Yes, we can."
The way to do it is, first, to understand that the very unimaginative--and ineffective--ideas that seem to be the norm in this culture in recent years are based on a certain philosophy and the ideology that goes with it. This philosophy and ideology have been consciously and systematically promoted and reinforced for over 40 years. (For more on this, see my "Website of the Week" in next week's Notes.)
The second way to do better is to begin working toward a general acceptance of a different philosophy, and the ideology that goes with that. This social transformation is what I'm talking about this week. Mysterious? Maybe, but give me a few minutes, and I think it will be a lot less mysterious.
What I said last week is that the philosophy that is currently the "conventional wisdom" in this country is egoism, and the ideology that goes with it is what I have called "Individualist and Competitive," or IC. "Egoism" says that society is composed of individuals who each are primarily concerned with their own individual welfare. IC ideology forms the basis for capitalism, which is the system within which the U.S., more than any other country, provides health care, which is the example that I am focusing on to make my point in this series.
People Are Selfish... AND They're Not
What I want to suggest this week is this: If one has a different philosophy--one which says that people are basically or mostly "good," meaning they are motivated at least in part by moral standards like compassion, empathy, altruism and the desire to make a positive contribution to their community and their society--then the task of public policy suddenly is not about providing "incentives" at all. Instead, the task becomes to figure out how to liberate people to act consistently with their highest values and principles. Or, perhaps, to reward people when they do act in accord with their highest values and principles--principles to which the society has committed through a democratic process.
So, if the philosophy that is currently the "conventional wisdom" in this country is egoism, or selfishness, what would be a different philosophy? One idea is that it would simply be some sort of "opposite," which in this case would be selflessness, or altruism. But I don't believe that most people act purely out of altruism most of the time. Instead, I believe that egoism is in fact a part of what motivates human beings to do what they do, and that altruism is ALSO a part of the equation.
So, what I'm left with as an alternative to an egoist philosophy is a philosophy that says that human beings are complex creatures, with complicated motives that are almost never a clear choice between "A" and "B." Or between "us" and "them." Or--dare I say--between "good" and "evil."
Why do I believe that human beings are complex? Is that simply the way I would like the world to be? No, actually there is all sorts of evidence that people behave in different ways in different times and places. People certainly act in selfish ways at times, in ways that apparently are aimed solely at serving their self-interest. But people also act in what might be called "prosocial" ways, in ways that do not benefit them personally, but that make life better for the group, whether it is the family, the neighborhood, the city, the watershed, the nation, or the world. There's even research now which indicates that human beings might have something called an "altruism gene." (I'm not going to go into that here, but there is an interesting group in Australia that is looking into this sort of thing, called the International Institute for Prosocial Behavior and Altruism Research. Check them out at http://www.iipbaar.org/ )
So, based on my belief that human beings are complex and have the capacity both to act in their own self-interest / and / in the interest of others, I subscribe to an ideology that I call a "Social and Cooperative" ideology. Some of the values that are at the core of this ideology include the values of Solidarity, Justice, Compassion, and Democracy. If this ideology were to form the basis for an economic or political theory or system (as ideologies do), then we would end up with something quite different from the economic and political systems we now have. And, even before we create an entirely new system, such a philosophy would lead us to very different policies as we try to deal with current issues under the current system.
REALLY Innovative Public Policy to Protect Public Health
I started out this series by talking about bird flu, and regular flu, and vaccine shortages, and needless deaths all over the world. I said that everyone agrees that effective solutions exist which are inexpensive and easy to provide, that those who currently have the means to provide those solutions are not providing them, and that we need to come up with some "innovative public policies" to deal with this reality.
Given the constraints of the dominant IC philosophy and ideology, the "innovative" policies put forward are all about "new incentives" aimed at "making the infectious diseases market more attractive to industry."
Now, twist your mind around and let go of one of the key ideas in the IC ideology: the idea that it will only be "attractive" to someone to save millions of lives if they can make a profit doing so. Just think about it, and think about the fact that it is PEOPLE--not corporations--who actually do the work of public health. That is, it's PEOPLE who figure out how diseases work, PEOPLE who do the research that gives us vaccines, PEOPLE who drive the trucks that deliver the vaccines, PEOPLE who actually give the shots, PEOPLE who build the clinics where the shots are given, and on and on.
Think further, about the people you know. What would you have to offer them in order to give them the "incentive" to make malaria vaccines, or bird flu vaccines, rather than Viagra or Botox? I suggest that some of the most basic things that people want are security, the means to feed and clothe themselves and their families, and the opportunity to do meaningful work. So you wouldn't have to offer a lot more than that to most people to get good things to happen. To corporations, on the other hand, you can and must offer only one thing: money.
Here, then, are a few examples of starting points for developing the "innovative public policies" that could make it possible for people to do the work necessary to meet the needs of society when it comes to public health:
1. Take, or keep, the public health infrastructure out of the hands of corporations;
2. Forbid the patenting of needed medicines, as they "belong" to everyone;
3. Set up a system for providing secure jobs to people who want to work at providing for the public's well-being;
4. Develop a democratic means for gathering the resources together that these people will need in order to address public health needs;
5. To back up the moral incentive, allow for PEOPLE to profit to the extent that they solve problems or improve quality of life. (As opposed to allowing corporations to profit from meeting the market demands of affluent consumers.) That is, the people who work hard to produce socially useful things get paid more, rather than people making money simply because they bought the most profitable stock.
We're far away from ideas like these right now, I realize. But next week, in what I think will be the last part in this series, I'll talk about one particular idea--the owning of ideas themselves--and hopefully show that we are perhaps not as far away as it may seem at the moment.