The fine print

Perhaps the biggest policy skeleton key of them all has to be single-payer, free-at-the-point-of-purchase (that is, paid for by strangers) national health insurance / social security.

This is, let us be frank, a new experiment. The first test subjects are still alive, and the future sustainability of these nice entitlements is far from guaranteed. What we do know is that they are getting more expensive, due to the pretty pagoda-shaped population pyramids popping up all over the place; the practically infinite elasticity of demand for health care and life extension (what kind of a monster could put a price on life? – ah, who indeed?) and the inconvenient fact that better health care and life extension developments comes with increasing costs and diminishing returns (in terms of how much extra life the extra investment buys us).

These three short points speak to real constraints, and constraints mean bureaucrats with calculators trying to balance budgets which cannot be balanced without either reducing services to some or rationing services to all. Which is where the skeleton key part comes in. If the collective is paying your health bill, the collective should, very rationally, have a say in managing your risks that result in extra expenditure, either by limiting your risk, or, again, by limiting your access to the common risk payment pool. Only fair, the one who pays the bills should have a say in your behaviour that influences said bills And risk management, of course, requires surveillance. It also justifies cybernetic control of risk.

Control of what risk? Unfortunately risk is a slippery word, it’s somewhat subjective and not always easy to quantify, so the sensible state planner would err on the side of caution.

Furthermore, unfortunately, when it comes to accident, illness, injury and, well, let’s face it, death, there is just about nothing that does not impact your risk level one way or another. What you eat, how your sleep, who your sleep with, where you travel, how you travel, what you watch (mental health is a real risk factor) – everything. There is no choice you make that does not impact your risk to the collective purse (and that’s just risk to yourself! we have not even mentioned the risk you pose to others in terms of spreading illness, causing accidents, or resulting in the risk of harm to another’s mental wellbeing…), and therefore given enough time, our warm fussy social safety-nets are perfectly justified in squeezing just a little harder and demanding juts a little more personal data, and enforcing just a few more rules, until the warm embrace of social solidarity becomes a straight jacket. There is practically no policy in terms of control and surveillance that cannot be justified, very reasonably – and definitely in the interests of the greater good – using this logic.

Dr Ian Pearson’s futuristic (yet perfectly plausible) ANTS scenario paints a creepy picture of how the control can be enforced automatically, even with consensus of the governed.

(Of course, we know from history past and present, that disagreeing with consensus (not to be confused with consensual) policy is proof of mental illness. Neat, isn’t it?)

In other words, if the service is free, you are not.

Now, in a competitive market, riskier people could opt out of risk management and surveillance. In an enforced, government mandated monopoly, of course it’s not quite so easy to escape the mind, body, and soul dragnet...

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