the best stats you've ever seen

This is one of the more surprising TED talks I've watched. Hans Rosling, a doctor and researcher of hunger diseases in Africa and international health generally, gives a dazzling presentation of data debunking our preconceptions of the developing world. Some of the points he proves using statistics throughout his 20 minute presentation:

1. We underestimate the tremendous change in Asia, which was social change before economic change.
   
   
2. There's no gap between rich and poor any more. It's a myth.
   
   
3. The concept of developing countries is extremely doubtful.
   
   
4. [T]he best projection from the World Bank is that [income will even out], and we will not have a divided world. We'll have most people in the middle.
   
   
5. Today we don't have to go to Cuba to find a healthy country in Latin America. Chile will have a lower child mortality than Cuba within some few years from now.
   
   
6. It seems [a country] can move much faster if [it is] healthy first than if [it is] wealthy first.
   
   
7. All countries tend to use their money better than they did in the past.
   
   
8. The improvement of the world must be highly contextualized ... we must be much more detailed.
   
   
9. It's as if the world is flattening off.

The end of the presentation explains why most people aren't aware of these statistics and how the internet is rapidly changing that situation. I was aware of some of this, but I wasn't aware of the extent to which it was true. Seeing the data presented graphically brought the point home more vividly than if I were just to read about it. I recommend you watch the video and not just read the transcript.

As statistics like these become widely acknowledged in North America and Europe, two things are going to happen. The first is that it will be possible to correctly diagnose the problems facing places like "Asia" or "Africa"—useless constructs for international medicine, health, politics, and economics, which Rosling is eager to demolish. The second is that the left's tale about the oppression and privilege inherent in "the system" will continue to lose credibility, as it has for over half a century now. I say this as a leftist, as a critic of capitalism, as someone whose worldview is deeply informed by Hegel and Marx, and as a humanitarian. Leftist political dogma since the 60s has been based far too much on moralizing about the oppressed and the privileged and not nearly based enough on theory and observation.

The reasons this is wrong are not complicated. American Marxists in the 20th century distilled the critique of capitalism down to one idea: capitalism is forever crisis-prone and will make your life worse in the long-run. When capitalism radically raised the standard of living over the course of the 20th century, the radical critics of capitalism no longer had a leg to stand on. (See Stephen Resnick and Richard Wolff for more.)

Marxism became equated in workers' minds with losing the real, substantial gains they had made. Those workers weren't "sold out" or "stupid. The problem is that Marxism was turned into a theory about oppression, which it never was in the first place.

The hangers-on insisted all the wealth the greedy, racist, sexist, etc., "western" workers (the real enemies!) were enjoying was being stolen from the "developing world". As Rosling's presentation makes clear, nothing could be further from the truth.

Rather than applying by rote what we learned from our liberal arts education—or cynically dismissing it—why not start instead with the actual trajectory followed by capitalism over the course of the last 200 years, with special emphasis on the past half-century? We start with the facts, we attempt to come up with a general law of development, and then we project it into the future and see where it's going.

What's the future of a high tech global capitalism in which the vast majority of individuals experience themselves as empowered individuals with control over their own lives? I believe that situation is far more dangerous to capitalism than a world divided into the privileged and the oppressed.

personal genomics and the future of health care

There was something else interesting in this Steven Pinker article I linked the other day. I don't typically find myself agreeing with Pinker because even while he admits there are problems with behavioral genomics, he sticks to his guns nonetheless in claiming that almost all our behaviors are inherited. The findings of geneticists leave me more ambivalent and agnostic with regard to such claims. Nevertheless, he's always thought-provoking, and I found the following suggestion very interesting:

"Depending on who has access to the information, personal genomics could bring about national health insurance, leapfrogging decades of debate, because piecemeal insurance is not viable in a world in which insurers can cherry-pick the most risk-free customers, or in which at-risk customers can load up on lavish insurance."

Since one of my hobbies is trying to make social and political predictions from technological developments, I got excited when I read this.

It's a plausible idea. Private health insurance in the United States is currently based on the idea that private insurance companies don't know what's going to happen in the future, so they spread their risk across a large pool and bet on an average outcome between sick and healthy. This necessarily means that if you have a prior condition, you're going to have a hard time getting coverage. All other things being equal, an HMO will take a bet on you, but if they already know you're going to get sick, that's a different story. It's also the reason why a health insurance mandate was part of one of the health care bills last year. It seems unfair to make people pay for health insurance, but assuming the system is left the way it is (with health care provided through the free market), then that's the only way to control costs. You need to have everyone in the same basic pool so that the sick and the healthy average out. That's also part of the reason why health insurance premiums are going up by 39% for so many people in California. If healthy people opt out of health insurance because they don't think they need it, that shrinks the pool and leaves more unhealthy people in it. So the premium goes up.

On the face of it, it seems like, given the parameters of the current system, making your predispositions toward certain illnesses public would be a horrible idea. HMOs already want to deny coverage to those who have conditions. If they're able to see that you're a bad bet, because you have a 30% chance of developing Parkinson's Disease or a kind of cancer later in life, they're not going to give you coverage even if you are perfectly healthy right now. They'd be able to cherry pick those they wanted to cover and leave the rest of Americans without any insurance whatsoever. A dual-caste system would develop. Like in the science fiction movie Gattaca, there would be "valids" (who could acquire health insurance and possibly other goods in life with ease), and then there would be the "invalids" (who would be denied all those things).

The other possibility—which Pinker alludes to—is that such developments would make the current system impossible. If insurance providers were able to cherry-pick who they wanted, then presumably the system would become so radically unfair that people wouldn't stand for it anymore. Many of those uninsured Americans would also be voters, and they would demand from those they elect a more rational response to these technological developments.

I think it's difficult to make a prediction here. If I understand Pinker's claim, it seems to rest on the idea that people wouldn't tolerate something so unfair and irrational as allowing HMOs to arbitrarily decide who gets health care and who doesn't. Except if you think about it, people already do tolerate that and a lot more in this country. The electorate doesn't just seem indifferent to the idea of the free market deciding who gets to live and who gets to die. Many of them feel that any alternative is actually evil. The shrill, persecuted tone of last year's protests and town hall meetings proves that. It doesn't matter to them that our neighbors to the north and our neighbors across the pond have a right to health care and haven't had to resort to howling at the moon and marrying snakes. People put up with and even seem to cheer on a lot of injustice already, even when there are rational alternatives. So I'm not comfortable with the argument that, given some technological development y, therefore social change x. You have to consider these (frankly weird) ideological factors that go into it, too.

Still, perhaps reality has a way of asserting itself after all. Good genes and bad genes are probably distributed evenly across the rich and the poor, the powerful and the disenfranchised. If a new technology has the power to impact not just those without power but also those who make decisions or can easily influence those who can make them, perhaps the irrationality of the system will translate into change in the real world. But the field of personal genomics in all likelihood will make just such a radical, all-encompassing impact. I think there are a lot of factors that will determine what the political and social upshot of all this is, but it's hard not to imagine it changing something fundamental in how we think about the distribution of health in our society.