The road paved with good intentions

Those of you familiar with Less Wrong may already be familiar with the torture-vs-dust-specks controversy. It asks one to imagine someone going through 50 years of severe pain. Then imagine the smallest possible hurt that still registers as pain (such as a speck in the eye, or a stubbed toe), and imagine a number of humans so inconceivably vast that if they were ALL to experiences that tiny hurt, the total pain would still add up to much, MUCH more than the 50 years of severe pain for one person. The question is raised – which is preferable? Greater total pain spread out, or far less total pain concentrated on one person?

I used to be solidly on the pro-dust-specks side. Spread it out!

A year and a half ago, I injured my knee while skiing. I went to see my doctor and based on various manipulations and questions he said that I most likely had a slightly torn meniscus. If I stayed off of it for a month, did some basic exercises daily, and was extremely gentle with it for six months, it should heal up after about a year.

Of course there was the miniscule probability that it was something more serious, which would require surgery. If that was the case, waiting until this was apparent really wouldn’t make the situation worse. But I could get it checked immediately by getting an MRI. At the time I had minimal insurance, so it would cost me between $1,500-$3,000 out of pocket. Given the tiny probabilities involved, I was comfortable not paying all that money. That’s a good fraction of the down payment on a house.

Nowadays I have pretty decent insurance. My back was bothering me, my doctor thought it was no big deal, but went ahead and ordered X-Rays for me. I paid almost nothing and was told “Yup, looks like normal wear due to aging.”

Now, X-Rays are much cheaper than MRIs already. But my knee issue was much more serious, and if I could have gotten an MRI for $100ish dollars, I very well might have. And in fact, this seems to be what everyone does. When someone else is paying for most of the bill, you buy a lot more of something than you otherwise would, and you get what we have in the USA – a completely dysfunctional health system. Healthcare costs have been rocketing for decades, always growing faster than the general economy, so that now Healthcare spending is almost 1/5^th of ALL spending in the USA. It’s projected to keep going up.

One could imagine a world of a nearly-infinite number of skiers who hurt their knee like I did. Out of this vast number, there is one person who really did have a hidden but very serious injury, which will be made much worse if he doesn’t get into surgery immediately. He will suffer from 50 years of extreme daily pain in his knee. Basic daily functions will be nearly impossible, and excruciating. His life will be awful until the medical tech is created which allows him to get a cloned knee replacement, a very costly and also painful surgery with several years of recovery. All this could have been avoided if he’d simply gotten an MRI. This is the “torture” world.

On the other hand, we can give an MRI to every injured skier with only a nominal copay (as I would have gotten if I’d had “health insurance”). For all but one person this will be a trivial waste, but that one guy will be really happy. This is the “dust speck” world.

This is also pretty close to the world we actually have right now. The world where vast overuse of medical care, due to the off-loading of the cost, has led to such high inflation that now many people can’t get care at all. We all know the horror stories, but for many people suicide is preferable to getting life-saving healthcare because they cannot afford it. The aggregate effects of us as a society choosing dust-specks over and over have added up fairly quickly.

Let’s face it – not getting the MRI was the correct overall choice at the time, regardless of whether I had insurance or not.

I think I’m starting to be swayed to the very-unfortunately-named pro-torture side.