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Saturday, February 19, 2011

What is more important - Money or Lives?

I am reading a very entertaining book, "Packing for Mars" by Mary Roach. It touches upon a host of issues impacting space travel and the ongoing efforts to simulate in flight scenarios on earth. It contains a great mix of fascinating scientific observations and bathroom humor.

The chapter I am reading now is focused upon the development of escape technologies to facilitate survival of space travelers in the event of catastrophic capsule breakup either on the way up or the way down. It never occurred to me prior to reading this chapter but the issues being addressed by NASA regarding the space shuttle (and future space vehicles), are not unique. If we are going to spend large sums of money to engineer escape technology for a vehicle that flies only rarely, why not invest comparable or larger sums to deploy the similar technologies to protect the hundred of thousands of airline travelers who occupy our skies every single day?

Granted there are serious engineering challenges to creating separate and distinct deployable oxygen sources for each seat on an aircraft which will need to be also equipped with an ejection device and a parachute. These challenges are substantially less than what will be required to provide protection for travelers on a vehicle entering or leaving space. Why don't we have the technology built into aircraft that will guarantee my survival if something happens to the plane at 30,000 feet?

The answer is actually very simple. It's all about the money. While technically possible, it is financially impossible. Does that mean we value money more than lives? Of course not. If we were to mandate such technology, it would simply have the effect to make airline travel unavailable, shunting people to other forms of transportation that are slower and more dangerous.

I think the lesson from this is not that we need to look at decisions using the filter of lives or money, but the perspective of lives and money. Short term perspectives create a false choice. Money is a proxy for resources which can be deployed to improve the human condition. Fewer resources means tougher choices as to where to deploy them and likely lives lost. The most publicly visible product of the engine which creates resources to better human conditions on earth is wealth, which for a number of reasons has been colored with an unflattering brush.

However, to me it is clear. Wealth means additional resources which are deployed to make lives better and to save lives via a myriad of mechanisms. For those who are fixed in the mindset that the world is a zero sum game, that anyone's gain must be linked to someone else's losses this is a hard concept to grasp. Paul Rubin has written about this in his paper on "Folk Economics"  (http://papers.ssrn.com/sol3/papers.cfm?abstract_id=320940).

Decisions are made every day regarding deployment of scarce resources which impact the lives of people. We do not deploy survival systems on airplanes and because of this people do die. However, scarce resources which might have been less usefully deployed to create safer airline travel are deployed elsewhere which greater overall impact on human life.. or at least we hope.

In medicine, we really have not come to grips with this concept. No intervention, no matter how expensive, no matter how futile, can be withheld when the primary justification is cost. Even if we bankrupt the system for future generations by unwise deployment in the present at the potential cost of thousands if not millions of lives, that appears of little immediate concern. Potential impact on lives now trumps availability of resources for future generations. However, we can basically be certain that fewer resources and less wealth means more lives lost.

As I have written before, a major reason for this quandary is the architecture of resource pooling. Using our own resources, we make trade offs every day. You might purchase the used car without the side impact air bags or the subcompact which save gas but provides less protection in an accident. Not everyone pays the Whole Foods premium for organically grown food. Many of us travel faster than the speed recommended for safest travel in our autos, but we value the time saved and enjoy the thrill of higher speed travel. I could go on and on (but I won't). These are all personal choices made with individual resources.

This simplicity comes to complete halt when resources are commonized and what was once simple becomes difficult bordering on impossible. Increasingly common resources appears to drive their deployment to marginally less and less useful use and that waste means that lives will be lost. It is not about money or lives, it is money and lives. Sticking to rules which create more wealth and resources means saving lives.

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