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Showing That You Care The Evolution of Health Altruism. Robin Hanson George Mason University Public Choice 2000. Talk Overview. Medicine low marginal health value Idea: loved ones push, to show care Theory approach seek few assumptions explain much evolutionary psychology

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Showing that you care the evolution of health altruism

Showing That You CareThe Evolution of Health Altruism

Robin Hanson

George Mason University

Public Choice 2000


Talk overview
Talk Overview

  • Medicine low marginal health value

  • Idea: loved ones push, to show care

  • Theory approach

    • seek few assumptions explain much

    • evolutionary psychology

  • Non-obvious results inform policy


Rand health insure experiment
RAND Health Insure Experiment

  • 2000 families ‘74-’82, random vary copay

  • Free care (vs. pay) gave

    • MORE spending (25-30%), glasses, fillings, “restricted activity days,” appropriate visits

    • SAME deaths, general health index, physical functioning, physiologic measures, health practices, satisfaction, appropriate therapy

    • LESS blood pressure? (mortality: ~1% = 7wks)


Contrasting magnitudes
Contrasting Magnitudes

3617 adults, die in 7.5yrs [Lantz et. Al. JAMA 6/3/98]


Evolutionary psychology
Evolutionary Psychology

  • Our preferences, behavior adapted to hunter-gatherer environment

  • Illuminates mating, parenting …

    • eat too much fat, sugar, salt

    • women live longer than men


Old ways to show allegiance
Old Ways to Show Allegiance

Groom, gossip, share food, visit, host visitors, adopt customs, make home, wedding/funeral, war, revenge kill, injury care, ...

  • Many signals lost, substitution hard

  • Evolved focus on long-term signals


Analogy christmas fruitcake
Analogy: Christmas Fruitcake

  • Nice if tasty, but goal is to show care

  • Size from exclude uncaring, not hunger

  • Mainly shared quality signals matter

  • Difference: hard to customize medicine


Assumptions explain phenomena

Ally Concern

group = correlated allies

status = more better allies

Private Info

want long-lasting allies

want appear high status

Altruism for show

Medicine low value

esp. high status

Neglect quality info

unless publicly accepted

Assumptions Explain Phenomena


Assume more explain more

Status healthy

Health paternalism

Esp. for low status

Placebo effect

Rich same care as rest of us

Assume More, Explain More

Allies protect

from stressful

crisis events


Two types of signaling

help?

A

B

q

p

G

Two Types of Signaling

Charity

Social Solidarity

Person

to

Group

Group

to

Person

“I care, so keep me.”

“We care, so calm down.”


Politics of social solidarity
Politics of Social Solidarity

  • National wars induce “Nation as Tribe.”

  • National health care to “Show Solidarity.”

    • First to calm worker unrest in Europe/Japan, late 1800s.

    • Altruism not extend beyond borders.

  • Votes as signal, collectively or to associates.

  • More when deeper wars, more homogeneity.

    • E.g., more in Europe, less in U.S.

    • E.g., more after WWII.


Policy implications
Policy Implications

  • Need commonly-visible quality signals

  • Insure min/subsidy helps if signal risk, but hurts if signal concern (w.r.t. gene prefs)

    Data: no risk signal [Cawley/Philipson AER 9/99]

  • Need review all allegiance signals

    • care no longer reveals long-term allegiance



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