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Showing That You Care The Evolution of Health Altruism

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

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  1. 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.)

  2. Think different.

  3. 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

  4. 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)

  5. Evolutionary Psychology • Our preferences, behavior adapted to hunter-gatherer environment • Illuminates mating, parenting … • eat too much fat, sugar, salt • women live longer than men

  6. 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

  7. 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

  8. 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

  9. 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.”

  10. 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.

  11. 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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