Several years ago, I wrote, Putting a Price on Mental Illness. In it, I responded to an article by The Economist detailing studies showing that treating mental illness provided a net financial benefit. The thrust of my post was this. It is great treating mental illness is profitable, but what would be the implications if the study showed it was not? Is life only valuable if it is financially viable?
In another post, I discussed the different forms rationality can take. Studying to see whether treating mental illness is profitable is an application of economic rationality. This form of rationality seeks to maximize utility. It is a means-ends assessment. Those applying economic rationality are asking one of at least two questions:
- What is the most economic way to achieve the desired goal?
- Is the goal we achieve worth the effort?
Rationality, however, has no direction without values. Economic rationality explores the profitability of pursuing a goal, but it does not establish what goals we find worthy.
We seldom think about values. Despite that, values drive our motivations, often unconsciously. When considering a study assessing whether there is a net financial benefit to treating mental illness, I think you will agree that there are values implicit within this study. The central value I see is what one might call sustainability. The value of sustainability maintains that any action a society takes should be self-supporting over time. That is, if we put resources into an activity, then that activity must produce measurable outputs of equal or higher value. We want to see a bang for our buck.
Sustainability is a critical value. If a society’s activities are not sustainable, then that society will collapse. Sustainability, however, is not the only value civilization needs to flourish.
Consider what it would mean if that economic analysis of mental illness determined that treating it was unprofitable. What then? If easing suffering is unprofitable, are we willing to allow people to suffer? Does life only have value in its ability to contribute to GDP, or does it possess a purpose beyond economic considerations?
By asking these questions, I’m introducing the value of public interest, under which I include things like alleviating suffering. If you are going to perform economic analyses, you need to consider what a negative result implies. In the case of mental health or any health-related issue, a negative economic analysis is going to pit sustainability against public interest.
This is not a hypothetical issue.
A real-world example
Years ago when I worked in the biotech industry, I worked for a company developing a novel technology to diagnose certain cancers earlier than current methods. Earlier detection led to earlier treatments, reducing the severity of medical intervention and improving survival rates. We sold this device in the USA (a profit-driven healthcare system) and Canada (a socialized healthcare system).
In the US, our marketing efforts had to convince doctors that using our product was profitable. We had to forecast the costs and revenues of our system and then establish it would provide a net financial gain. The impact it had on profits outweighed the effect it had on patients.
In Canada, however, we had a very different challenge. Canada’s healthcare is socialized, meaning its costs are borne by taxpayers rather than patients. Consequently, the Canadian medical system focuses on cost reduction.
Doctors bill the government, not the patient. The government chooses what it will pay for, but it must do so thoughtfully. After all, they have a budget to manage. We had challenges establishing our product in Canada because by detecting cancer earlier, the government feared the duration of the treatment period would increase, thus raising costs. Though lives might be saved, governments were unwilling to adopt the technology unless we could show that doing so lowered overall costs. The impact it had on costs outweighed the effect it had on patients.
I understand the importance of sustainability. An unsustainable system is a failure. Still, I feel unsatisfied with these trade-offs.
Deepening the pool of values we pursue
I would like to expand the discussions in our society beyond, “Does treating mental illness–or any form of suffering–yield a net financial benefit?” Such questions emphasize only one value, thereby introducing conflicts between that value and others.
Societies need a multitude of values to flourish. A better question, therefore, would be, “How do we treat mental illness sustainably?” Better yet, “How do we maximize the net benefits of treating mental illness?” These types of questions focus our minds on enhancing both public interest and sustainability.
What are some debates you see going on around you that are currently framed as “either this OR that?” How would you reframe them to become “how do we achieve this AND that?” I would enjoy reading your thoughts in the comments.
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