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The traditional view of education is that it raises a student’s value via improvement—by taking in rough, raw material and making it more attractive by reshaping and polishing it. The signaling model says that education raises a student’s value via certification—by taking an unknown specimen, subjecting it to tests and measurements, and then issuing a grade that makes its value clear to buyers.
research is fairly consistent in showing that the extra medicine doesn’t help. Patients in higher-spending regions, who get more treatment for their conditions, don’t end up healthier, on average, than patients in lower-spending regions who get fewer treatments. These results hold up even after controlling for many factors that affect both medical use and health—things like age, sex, race, education, and income.
For each extra day in the ICU, patients were estimated to live roughly 40 fewer days.
“no evidence that improved survival outcomes are associated with increased levels of spending.”
Like in the RAND study, lottery winners ended up consuming more medicine than lottery losers.32 Unlike the RAND study, however, the Oregon study found two areas where lottery winners fared significantly better than lottery losers. One of these areas was mental health: lottery winners had lower incidence of depression.
Most scholars don’t see medicine as responsible for most improvements in health and longevity in developed countries.37 Yes, vaccines, penicillin, anesthesia, antiseptic techniques, and emergency medicine are all great, but their overall impact is actually quite modest. Other factors often cited as plausibly more important include better nutrition, improvements in public sanitation, and safer and easier jobs. Since 1600, for example, people have gotten a lot taller, owing mainly to better nutrition.
The problem is that marginal medical treatments are just as likely to do harm as good. Prescription drugs almost always have side effects, some of them quite nasty. Surgeries often come with complications. Staying in the hospital puts patients at higher risk of contracting infections and communicable diseases.
When we consume medicine for the simple, private goal of getting well, we shouldn’t care how much it costs or how elaborate it is, as long as it works. However, to the extent that we use medicine to show how much we care (and are cared for), the conspicuous effort and expense are crucial. Patients and their families are often dismissive of simple cheap remedies, like “relax, eat better, and get more sleep and exercise.” Instead they prefer expensive, technically complicated medical care—gadgets, rare substances, and complex procedures, ideally provided by “the best doctor in town.” Patients
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“More people die from medical mistakes each year than from highway accidents, breast cancer, or AIDS and yet physicians still resist and the public does not demand even simple reforms.”
If our goal is really “health at any cost,” then we should expect to pursue the most effective health strategies, whatever form they may take. If we’re using medicine as a signal of support, however, then we’ll provide and consume more of it during a patient’s times of crisis, when they are more grateful for support. And this is exactly what we find. The public is eager for medical interventions that help people when they’re sick, but far less eager for routine lifestyle interventions. Everyone wants to be the hero offering an emergency cure, but few people want to be the nag telling us to
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There are other ways to explain each of these phenomena, of course. But taken together, they suggest that we are less interested in “health at any cost,” and more interested in treatments that third parties will appreciate.
Religion. There’s perhaps no better illustration of the elephant in the brain. In few domains are we more deluded, especially about our own agendas, than in matters of faith and worship.
religions can be understood, in part, as community-enforced mating strategies.44
the value of holding certain beliefs comes not from acting on them, but from convincing others that you believe them. This is especially true of religious beliefs.
A good badge allows us to answer the central question about loyalty: Are you with us or against us?
On economic issues, for example, Bryan Caplan identifies a number of areas in which the average voter deviates from expert consensus: an antiforeign bias, an antimarket bias, a make-work bias, and a pessimistic bias (systematically underestimating the value of economic progress).14
When people are asked the same policy question a few months apart, they frequently give different answers—not because they’ve changed their minds, but because they’re making up answers on the spot, without remembering what they said last time.
Real voters, however, seem apathetic about practical details, and prefer instead to focus on values and ideals.
Most of us live quite happily in our political echo chambers, returning again and again to news sources that support what we already believe. When contrary opinions occasionally manage to filter through, we’re extremely critical of them, although we’re often willing to swallow even the most specious evidence that confirms our views.
The fact that we attach strong emotions to our political beliefs is another clue that we’re being less than fully honest intellectually.
when our beliefs serve non-pragmatic functions, emotions tend to be useful to protect them from criticism.
All of this strongly suggests that we hold political beliefs for reasons other than accurately informing our decisions.
We live in neighborhoods, cities, states, and nations; we work on teams within companies; and we worship at churches belonging to denominations of overarching religions. We’re also tied to a given race, ethnicity, gender, and sexual orientation. All of these groups compete for our loyalties;
Nevertheless, our hypothesis is that the political behavior of ordinary, individual citizens is often better explained as an attempt to signal loyalty to “our side” (whatever side that happens to be in a particular situation), rather than as a good-faith attempt to improve outcomes.
the desire to signal loyalty helps explain why we don’t always vote our self-interest
Political scientists often distinguish between “instrumental voting” and “expressive voting.” Instrumental voters use their votes in order to influence outcomes. They may be entirely altruistic (like a Do-Right) or entirely selfish, but regardless, they want their votes to make a difference. Expressive voters, however, don’t care about outcomes, but instead derive “expressive” value from the act of voting.
Thus the apparatchik is an expressive voter who is rewarded socially for expressing him- or herself at the polls.
contexts that reward loyalty are a breeding ground for self-deception and strategic irrationality.
The fact that we use political beliefs to express loyalty, rather than to take action, also explains why we’re emotionally attached to our beliefs, and why political discussions often generate more heat than light.
when you’re doing politics as a performance, like an apparatchik, you don’t care about outcomes as much as you care about the appearance of loyalty.
In such polarized climates, anyone who advocates for compromise risks being accused of insufficient loyalty.
What this and other realignments make clear is that the main political parties have not always stood firm behind fixed principles, but instead are a complex patchwork of (sometimes conflicting) agendas—strange bedfellows brought together by common interests and held together, in part, by the bonds of loyalty.
“Our virtues are most frequently but vices in disguise.” “We cannot look squarely at either death or the sun.”
Self-deception allows us to act selfishly without having to appear quite so selfish in front of others. If we admit to harboring hidden motives, then, we risk looking bad, thereby losing trust in the eyes of others. And even when we simply acknowledge the elephant to ourselves, in private, we burden our brains with self-consciousness and the knowledge of our own hypocrisy. These are real downsides, not to be
The next time you butt heads with a coworker or fight with your spouse, keep in mind that both sides are self-deceived, at least a little bit. What feels, to each of you, overwhelmingly “right” and undeniably “true” is often suspiciously self-serving, and if nothing else, it can be useful to take a step back and reflect on your brain’s willingness to distort things for your benefit. There’s common ground in almost every conflict, though it may take a little digging to unearth it beneath all the bullshit.
People who are able to acknowledge uncomfortable truths and discuss them dispassionately can show a combination of honesty, intellectual ability, and perhaps even courage (or at least a thick skin). And those who can do so tactfully, without seeming to brag, accuse, or complain, may seem especially impressive.