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Showing That You Care The Evolution of Health Altruism. Robin Hanson RWJF Health Policy Scholar U.C. Berkeley/San Francisco (8/99: Economics, G.M.U.). Think different. Talk Overview. Medicine low marginal health value Idea: loved ones push, to show care Theory approach

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Showing that you care the evolution of health altruism

Showing That You CareThe Evolution of Health Altruism

Robin Hanson

RWJF Health Policy Scholar

U.C. Berkeley/San Francisco

(8/99: Economics, G.M.U.)


Showing that you care the evolution of health altruism

Think different.


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)


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, 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

  • Shared quality signals mainly 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


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.”


Predictions

Predictions

  • More care by insecure individuals with fewer other ways to signal.

  • Little effect of quality info unless commonly publicly accepted.

  • Spending increases not depend on technology, but on cohort changes.


Policy implications

Policy Implications

  • Need publicly accepted quality signals

  • Insure min/subsidy helps if signal risk, but hurts if signal concern

  • Need review all allegiance signals

    • care no longer reveals long-term


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