# Do people know best what's "in their own self-interest?" **URL:** \ **Category:** Great Debates\ **Created:** [October 22, 2017, 6:55pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576 "2017-10-22T18:55:03Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [October 25, 2017, 4:25pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/81 "2017-10-25T16:25:27Z")
> [@Bone](#): > > I want dysfunction in government. So good? Not really. A dysfunctional gov’t isn’t in anyone’s best interest. Well, criminals and anarchists, sure. But the economy doesn’t do well under a dysfunctional gov’t, the justice system isn’t just under a dysfunctional gov’t, and so on. How can that possibly be in anyone, including your own, best intersts? > [@](#): > > But yes, if a person says they acted against their best interests, I’ll believe them. And if the are shooting heroin into their veins, will you still believe them when they tell you that? ---
**Author:** ![HurricaneDitka](https://avatars.discourse-cdn.com/v4/letter/h/96bed5/32.png) [@HurricaneDitka](https://boards.straightdope.com/u/HurricaneDitka)\ **Post date:** [October 25, 2017, 4:45pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/82 "2017-10-25T16:45:52Z")
> [@k9bfriender](#): > > Not really. A dysfunctional gov’t isn’t in anyone’s best interest. Well, criminals and anarchists, sure. But the economy doesn’t do well under a dysfunctional gov’t, the justice system isn’t just under a dysfunctional gov’t, and so on. > > How can that possibly be in anyone, including your own, best intersts? > > And if the are shooting heroin into their veins, will you still believe them when they tell you that? I read [an article by John Tamny](http://www.realclearmarkets.com/articles/2017/10/24/lets_end_the_pretense_the_republicans_are_not_cutting_taxes_102939.html) yesterday that I think illustrates a fairly common (and relevant to this discussion) conservative perspective. The key bit that relates to dysfunction / gridlock would be this: > [@](#): > > So while Republican voters would be wise to wake up to the tax-cutting ineptitude of their Party, all is not lost. Indeed, gridlock is – after good policy meant to actually reduce the burden of government - the next best friend of economic growth. The silver lining to a Republican Party incapable of reducing government burdens is that’s it’s also one incapable of doing all sorts of other damage legislatively. The trick now is for Republicans to change their brand. As opposed to being the tax cutting Party, let’s say they were put on this earth to ensure that nothing of legislative importance happens in Washington. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [October 25, 2017, 4:58pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/83 "2017-10-25T16:58:56Z")
> [@k9bfriender](#): > > Not really. A dysfunctional gov’t isn’t in anyone’s best interest. Well, criminals and anarchists, sure. But the economy doesn’t do well under a dysfunctional gov’t, the justice system isn’t just under a dysfunctional gov’t, and so on. > > How can that possibly be in anyone, including your own, best intersts? This is super meta. I’m telling you exactly what I want - and you’re saying there’s no way I could want that. Who do you think is better suited to determine what I actually want? Surprise, I say it’s me. [Here](https://www.wsj.com/articles/SB10001424052748703787304575075503388049196)are a [couple](http://www.slate.com/articles/news_and_politics/politics/2014/08/gridlock_is_good_when_the_house_gop_stands_in_the_president_s_way_it_means.html) of [examples](https://www.washingtonpost.com/opinions/lawrence-summers-when-gridlock-is-good/2013/04/14/8bfeab9c-a3c3-11e2-9c03-6952ff305f35_story.html?utm_term=.085f31cf025f)of [articles](https://www.huffingtonpost.com/deepak-chopra/why-gridlock-is-good-if-youre-a-progressive_b_2160193.html)[about](https://www.usatoday.com/story/money/markets/2016/10/05/stocks-election-senate/91484082/)[why](https://www.cato.org/publications/commentary/would-divided-government-be-better)[gridlock](https://www.wsj.com/articles/SB122117691244025843)(dysfunction) in [government](http://www.twincities.com/2010/11/01/kevin-hassett-divided-washington-is-what-u-s-economy-needs/)is [good](https://www.csmonitor.com/Commentary/Opinion/2010/1101/Divided-we-make-money-Why-the-stock-market-wants-a-Republican-victory). > [@](#): > > And if the are shooting heroin into their veins, will you still believe them when they tell you that? No idea what point you’re trying to make with this. I’m in favor of legalization of all drugs though, so there’s that. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [October 25, 2017, 5:53pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/84 "2017-10-25T17:53:45Z")
> [@HurricaneDitka](#): > > I read [an article by John Tamny](http://www.realclearmarkets.com/articles/2017/10/24/lets_end_the_pretense_the_republicans_are_not_cutting_taxes_102939.html) yesterday that I think illustrates a fairly common (and relevant to this discussion) conservative perspective. The key bit that relates to dysfunction / gridlock would be this: There is a difference between being deliberative, being in gridlock, and being dysfunctional. It’s good if bills don’t get passed through knee jerk reactions, and instead require the input of lots of people with different ideas who can see different flaws and fixes to a bill. Gridlock is annoying, but it means that there are large changes that some of the legislators want, but they can’t get enough on board to make those changes. Not a terrible thing for the country, but frustrating to those who want to see the legislation go forward. Dysfunction is when the congress critters are no longer responsible to their constituents, no longer represent or vote on the things that the people who elected them wanted. [quote=“Bone, post:83, topic:799576”] This is super meta. I’m telling you exactly what I want - and you’re saying there’s no way I could want that. Who do you think is better suited to determine what I actually want? Surprise, I say it’s me. [quote] Right, and this is a great demonstration of exactly what we are talking about. You say you want dysfunctional government. I believe you. I do however, think that if you actually had dysfunctional government, you would be far worse off than you are now. What you want, and what is in your best interest, are at odds with each other. > [@](#): > > [Here](https://www.wsj.com/articles/SB10001424052748703787304575075503388049196)are a [couple](http://www.slate.com/articles/news_and_politics/politics/2014/08/gridlock_is_good_when_the_house_gop_stands_in_the_president_s_way_it_means.html) of [examples](https://www.washingtonpost.com/opinions/lawrence-summers-when-gridlock-is-good/2013/04/14/8bfeab9c-a3c3-11e2-9c03-6952ff305f35_story.html?utm_term=.085f31cf025f)of [articles](https://www.huffingtonpost.com/deepak-chopra/why-gridlock-is-good-if-youre-a-progressive_b_2160193.html)[about](https://www.usatoday.com/story/money/markets/2016/10/05/stocks-election-senate/91484082/)[why](https://www.cato.org/publications/commentary/would-divided-government-be-better)[gridlock](https://www.wsj.com/articles/SB122117691244025843)(dysfunction) in [government](http://www.twincities.com/2010/11/01/kevin-hassett-divided-washington-is-what-u-s-economy-needs/)is [good](https://www.csmonitor.com/Commentary/Opinion/2010/1101/Divided-we-make-money-Why-the-stock-market-wants-a-Republican-victory). And here you call for gridlock, which is a bit annoying to some, and can slow down progress, but is not the same thing as dysfunction. > [@](#): > > No idea what point you’re trying to make with this. I’m in favor of legalization of all drugs though, so there’s that. Do you believe that doing heroin is in a person’s best interest? ---
**Author:** ![HurricaneDitka](https://avatars.discourse-cdn.com/v4/letter/h/96bed5/32.png) [@HurricaneDitka](https://boards.straightdope.com/u/HurricaneDitka)\ **Post date:** [October 25, 2017, 6:45pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/85 "2017-10-25T18:45:13Z")
> [@k9bfriender](#): > > … Dysfunction is when the congress critters are no longer responsible to their constituents, no longer represent or vote on the things that the people who elected them wanted. … This is actually an interesting parallel to this thread. Do you think you know best what “the people who elected them wanted” or do those people know best? If the people feel like the congress critters are no longer responsible to their constituents or doing what they want, then the people can vote them out. That’s apparently not the case in most situations, so perhaps the problem lies with your understanding of what the people who elected them wanted. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [October 25, 2017, 6:46pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/86 "2017-10-25T18:46:26Z")
> [@k9bfriender](#): > > Dysfunction is when the congress critters are no longer responsible to their constituents, no longer represent or vote on the things that the people who elected them wanted. Maybe we’re using the term differently then. As I note in the parenthetical that you quoted, I am using the two as synonyms. Here’s an example from [the Economist](https://www.economist.com/blogs/democracyinamerica/2014/09/political-gridlock). Note the title: “Political gridlock Unprecedentedly dysfunctional”. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [October 25, 2017, 6:56pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/87 "2017-10-25T18:56:33Z")
> [@Bone](#): > > This aspect relies on the person not knowing what their actual goals are. No, it does not. In my analogy the driver has a pretty good idea of where he wants to be but he has no idea where the roads go, can’t read the signs, and is clueless about navigation. You’re trying to advance a tortured semantic argument that says that ignorant voters electing ignorant and self-serving politicians – the proverbial blind leading the blind except that some of the blind leaders are also crooks and liars – is somehow a beneficial state of affairs. > [@Bone](#): > > I want dysfunction in government. So good? Are you sure? I’ve tried to respond to that below. > [@Bone](#): > > This is super meta. I’m telling you exactly what I want - and you’re saying there’s no way I could want that. Who do you think is better suited to determine what I actually want? Surprise, I say it’s me. > > [Here](https://www.wsj.com/articles/SB10001424052748703787304575075503388049196)are a [couple](http://www.slate.com/articles/news_and_politics/politics/2014/08/gridlock_is_good_when_the_house_gop_stands_in_the_president_s_way_it_means.html) of [examples](https://www.washingtonpost.com/opinions/lawrence-summers-when-gridlock-is-good/2013/04/14/8bfeab9c-a3c3-11e2-9c03-6952ff305f35_story.html?utm_term=.085f31cf025f)of [articles](https://www.huffingtonpost.com/deepak-chopra/why-gridlock-is-good-if-youre-a-progressive_b_2160193.html)[about](https://www.usatoday.com/story/money/markets/2016/10/05/stocks-election-senate/91484082/)[why](https://www.cato.org/publications/commentary/would-divided-government-be-better)[gridlock](https://www.wsj.com/articles/SB122117691244025843)(dysfunction) in [government](http://www.twincities.com/2010/11/01/kevin-hassett-divided-washington-is-what-u-s-economy-needs/)is [good](https://www.csmonitor.com/Commentary/Opinion/2010/1101/Divided-we-make-money-Why-the-stock-market-wants-a-Republican-victory). Gridlock is not the same as dysfunction, at least in the sense I meant the word, which is incompetence resulting from ignorant and misguided voters electing politicians who are either ignorant and/or have ulterior motives. Gridlock is more like an extreme version of the argument sometimes made in parliamentary systems about minority governments being better than majority ones. Except that the minority-government argument says that such governments tend to produce more balanced and less ideological legislation, whereas gridlock tends to produce nothing at all. I don’t agree that this is beneficial since governments have to function, but we can disagree on this point of ideology as it has little to do with what I meant. We are at opposite ends of the spectrum regarding the beneficence of government and that’s fine, but that’s a different argument. In the context of ignorance, what I mean by dysfunction (and there might have been a better word for it) is the governmental equivalent of bad management in an organization. It is surely foolish – not to mention a semantic head-scratcher – to believe that bad management is good! An employee who wishes for bad management had better be careful what he wishes for. Dysfunction – or bad management – is random and unpredictable in its effects, like a monkey wrench thrown into delicate machinery. An employee may believe that it will give him more freedom and less supervision, but it’s just as likely to give him oppressive micromanagement by an idiot and then get him fired for stupid reasons. I can understand that libertarians like to see minimalist government and see gridlock as a contributor, but even libertarians acknowledge the need for minimal essential government services and presumably want these to function. In dysfunctional governments even the essential stuff gets broken. And dysfunctional governments get you things like irresponsible spending and soaring national debt, inequitable taxation, stupid and unnecessary wars like Vietnam and Iraq II, and the economic and housing collapse of 2008 – things that the majority of voters surely never signed up for. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [October 25, 2017, 7:32pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/88 "2017-10-25T19:32:59Z")
Just a lexical side note. Out of curiosity I actually looked up “dysfunction” in a dictionary – when all else fails, RTFM! 😃 The word can be construed to have multiple meanings and unfortunately when applied to government is often used to mean the same as “non-functional”, which would be the same as “gridlock”. But it does also have the meaning that I intended, implying bad organizational management, which is expressed in the following example (an example actually cited by Merriam-Webster): [A probe revealed a hospital where patients were endangered by rampant organizational and managerial dysfunction.](https://www.washingtonpost.com/local/dc-politics/head-of-dc-veterans-hospital-fired-after-new-inspector-generals-report/2017/08/02/98616dce-77aa-11e7-8839-ec48ec4cae25_story.html?utm_term=.d3df9a59407b) I don’t think anyone would reasonably say that this sense of “dysfunction” in any organization or government is desirable. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [October 25, 2017, 8:17pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/89 "2017-10-25T20:17:19Z")
> [@Bone](#): > > Maybe we’re using the term differently then. As I note in the parenthetical that you quoted, I am using the two as synonyms. Here’s an example from [the Economist](https://www.economist.com/blogs/democracyinamerica/2014/09/political-gridlock). Note the title: “Political gridlock > Unprecedentedly dysfunctional”. That title itself demonstrates that they are not synonyms, but rather, the gridlock has become so bad, that it has descended into something worse, dysfunction. There is a difference between when legislation is slow, and doesn’t change very quickly, that’s gridlock, and when the government is not capable of governing, that’s dysfunction. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [October 25, 2017, 8:25pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/90 "2017-10-25T20:25:51Z")
> [@wolfpup](#): > > Just a lexical side note. Out of curiosity I actually looked up “dysfunction” in a dictionary – when all else fails, RTFM! 😃 The word can be construed to have multiple meanings and unfortunately when applied to government is often used to mean the same as “non-functional”, which would be the same as “gridlock”. But it does also have the meaning that I intended, implying bad organizational management, which is expressed in the following example (an example actually cited by Merriam-Webster): Non-functional means when you go to the zoning office, there is no one there to help you get your building permits. Non-functional means that there are no judges in the courtrooms. Non-functional means that the police don’t come when you call them. I do not see how gridlock and dysfunction can be synonym. They are both issues you can have in a gov’t, but one is just when it takes a long time to get a law passed, and the other is when laws don’t get enforced. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [October 25, 2017, 9:23pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/91 "2017-10-25T21:23:00Z")
> [@Shodan](#): > > Group 2 includes federal taxpayers, so the notion that “the federal government pays for it so it won’t hurt you” doesn’t work. Since much of this got funded by increasing taxes on the very rich, for most taxpayers it worked just fine. > [@](#): > > Plus, it’s the same problem as always - now people don’t have insurance, so I have to pay for their care thru increased charges for hospitals and doctors. Put them under Medicaid, and I have to pay for their care thru increased taxes. So either Medicaid patients get less care than they do now, and I will save money. Or they get the same level, and I don’t save anything, or they get more (or the demand increases) and I pay more. They will go to the doctor more often, but with any luck they will catch expensive diseases and problems before they get to the very expensive ER, so it can be a win-win. Also the extra hospital cost is often borne by hospitals in poorer areas who can least afford it, so spreading it out over everyone is more efficient and helps those hospitals. > [@](#): > > And, as mentioned, increasing the number of people with coverage did not reduce costs for the rest of us. Obama said it would, but now that we [know that he didn’t mean it](https://www.washingtonpost.com/opinions/marc-thiessen-thanks-to-jonathan-gruber-for-revealing-obamacare-deception/2014/11/17/356514b2-6e72-11e4-893f-86bd390a3340_story.html?utm_term=.83ab64085609), it is that much harder to believe that it will this time. > > Regards, > Shodan The marketplaces are certainly a mess, and getting worse. But ACA could reduce costs in the long run, through evidence based medicine and more information on costs published to allow better decisions. In the short term all it could do was reduce the rate of increase, which did happen for a few years at least. And my Medicare copay costs are going down next year, so not everyone is seeing a gigantic increase. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [October 25, 2017, 10:24pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/92 "2017-10-25T22:24:39Z")
> [@Shodan](#): > > Plus, it’s the same problem as always - now people don’t have insurance, so I have to pay for their care thru increased charges for hospitals and doctors. Put them under Medicaid, and I have to pay for their care thru increased taxes. So either Medicaid patients get less care than they do now, and I will save money. Or they get the same level, and I don’t save anything, or they get more (or the demand increases) and I pay more. Which of those options do you advocate? What recourse do you propose for those who need medical treatment beyond their ability to pay? ---
**Author:** ![kaylasdad99](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kaylasdad99/32/3398_2.png) [@kaylasdad99](https://boards.straightdope.com/u/kaylasdad99)\ **Post date:** [October 27, 2017, 2:29am UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/93 "2017-10-27T02:29:42Z")
> [@](#): > > =Voyager;20555826]A perfect political example is when those who are on government programs that benefit them vote for politicians sworn to cutting those programs. > Plenty of people act against their economic self interest viewed narrowly - like anyone donating to charity - so you have to view self interest more widely. The 401K example I gave is pretty pure. _If those on Medicaid who vote against Medicaid said that they were willing to suffer to keep Democrats out of office I might say that is not against their broader self interest, but I’ve not seen much evidence they’ve thought through the implications of their vote._ That’s more an example of them having competing interests (and demonstrating a piss-poor level of ability to prioritize them). ---
**Author:** ![kaylasdad99](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kaylasdad99/32/3398_2.png) [@kaylasdad99](https://boards.straightdope.com/u/kaylasdad99)\ **Post date:** [October 27, 2017, 3:23am UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/94 "2017-10-27T03:23:57Z")
> [@UltraVires](#): > > Well, nothing’s perfect and _sometimes_ people will _unwittingly_ act against their own self interests. > > Allowing people to make these decisions anyways is preferable to allowing others who will _often_ and _intentionally_ act against the self interests of these people do so. So…allowing people to vote for Republicans to policy-making positions is preferable to allowing Republicans to make policy decisions? Ummm, o-kaaaayyyy. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [October 27, 2017, 4:09am UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/95 "2017-10-27T04:09:06Z")
> [@kaylasdad99](#): > > That’s more an example of them having competing interests (and demonstrating a piss-poor level of ability to prioritize them). Only if they accurately computed the cost and benefits of each option. Which people don’t. Your sure they know they are on a government program? Or is Medicaid for _those_ people, and I am not one of those people, so I can’t be on Medicaid. There are countless examples of this. The effective interest rate people demand to delay something good happening, like getting money, varies wildly with the amount and the time to get it - far more than can be explained rationally. People are willing to drive long distances to save $10 on a $20 purchase, but not to save $10 on a $100 purchase. One of these must be against the best interest of the person, depending on the value of their time. Both can’t be right. Many people are really into that they and others always make rational decisions. The Nobel Committee and the evidence say they are wrong. ---
**Author:** ![asahi](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/asahi/32/8693_2.png) [@asahi](https://boards.straightdope.com/u/asahi)\ **Post date:** [October 27, 2017, 1:31pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/96 "2017-10-27T13:31:14Z")
> [@Velocity](#): > > - > > (Despite using Trump voting as the example, this thread is not about Trump/Trump-voters specifically - it is about the overall broader question of whether people know what’s good for them on a particular issue - abortion, sexual orientation, political candidate, etc. - or not.)\* > > One common refrain about Trump voters is that “Trump voters voted against their own self-interest.” > > I’m not a Trump voter, but I would like to challenge this on two grounds: > > 1. Usually, people who make this claim, do so purely on the basis of economic grounds. (i.e., Democrats might bring jobs back to the Rust Belt better than Trump, or Democrats would provide better healthcare and a social net, or Democrats understand that the Rust Belt’s heyday is over while the GOP doesn’t.) But they don’t take factors like psychological pleasure into account - for instance, many Trump voters, undoubtedly, get a powerful dopamine kick of schadenfreude out of seeing Trump win the presidency - not just on Election Night 2016, but also every day that he’s in the Oval Office and Hillary isn’t. Indeed, some Trump voters may enjoy that psychological pleasure so much that it, to them, outweighs whatever economic drawbacks they may suffer from Trump’s policies. If that is the case, then weren’t such Trump voters, in fact, indeed, voting for their self-interest when they elected Trump? > 2. It’s usually argued that a pregnant woman knows what’s best for her and her uterus (i.e., abortion,) or that people know what’s best for them on their sexual orientation, etc. If we go by the “Trump voters voted against their own self-interest,” then what’s the rebuttal against someone who claims that “Women who get an abortion do so against their own self-interest because abortion causes psychological trauma,” or “If gay people knew what was best for them, they’d seek gay-conversation therapy, since they’d be happier off straight than gay?” My assumption is that all voters vote for their own interests, including me and including my own. It’s a matter of how an individual voter defines and perceives voting in his/her interests. Some links between voting and interests and imagined outcomes are obvious, such as the businessman who votes for a candidate who promises to lower taxes on business income by 20 percent and slash regulations. Conversely, a poor person whose income is largely from the state would not be blamed for voting for a candidate who promises more generous entitlements. However, the businessman who votes for lower taxes might end up voting against his own interests in the long run if he ends up voting for someone whose monetary policies end up creating a boom to bust economy that results in bank failures and the crash of his stock portfolio. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [October 27, 2017, 2:30pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/97 "2017-10-27T14:30:43Z")
> [@Voyager](#): > > Since much of this got funded by increasing taxes on the very rich, for most taxpayers it worked just fine. Much of it got funded by increased taxes on those who didn’t buy healthcare, so it would not be in the interest of the rich nor of those who did not have healthcare insurance. > [@](#): > > They will go to the doctor more often, but with any luck they will catch expensive diseases and problems before they get to the very expensive ER, so it can be a win-win. ER visits went up as Obamacare was implemented even with more people covered, and preventative care does not, in general, decrease health care spending overall. So it was supposed to be a win-win, but didn’t work out that way. > [@](#): > > Also the extra hospital cost is often borne by hospitals in poorer areas who can least afford it, so spreading it out over everyone is more efficient and helps those hospitals. Cost-shifting isn’t efficiency. Either I pay it thru increased costs at hospitals, or I pay it in taxes. > [@wolfpup](#): > > Which of those options do you advocate? Everyone should get less health care. But that is true no matter what kind of health insurance is implemented. The US is over-doctored and over-treated. The way to address excessive health care costs is to spend less on health care, and that means delivered less health care. Simply swapping payers around doesn’t address the issue. To be clear, I am not aware of any Republican plan that will address the issue either. We need to ration care, and both sides of the aisle recoil in horror at the prospect. The standard liberal rejoinder is that we ration care now, based on ability to pay. Which is true, as far as it goes. But we as a society are approaching the limit of what we can pay. So we as a society need to ration based on ability to pay as a society. We could implement something like Medicare for all. On average, doctors and hospitals lose money on 65% of their Medicare patients, and make up the difference on everybody else. The hard question is “what do we do when there isn’t everybody else?” Regards, Shodan ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [October 27, 2017, 4:01pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/98 "2017-10-27T16:01:15Z")
> [@Shodan](#): > > Everyone should get less health care. That makes no sense. The rational answer is that everyone should get exactly the full amount of medically necessary health care they really need. If that sounds like a pointless truism, it isn’t. It’s the basis of health care provision in every civilized country in the world, and the rational enabler for it is the doctor(s) responsible for your care. Specifically and very importantly, it’s the doctors together with the patient making clinical decisions, and not insurance bureaucrats making profit decisions, that determine medical treatments. > [@Shodan](#): > > We could implement something like Medicare for all. On average, doctors and hospitals lose money on 65% of their Medicare patients, and make up the difference on everybody else. The hard question is “what do we do when there isn’t everybody else?” That’s only true in the present economic model of health care where a glance at any chart of health care costs show the US as an enormous outlier. Costs are high for all the reasons related to the the mess of private insurance that I’ve described many times. Your question is meaningless because you assume the same cost dynamics under UHC as under the mess that exists now, whereas the whole purpose of UHC, besides the moral basis of providing health care for everyone, is to fundamentally change those cost dynamics. This gets us back to the discussion of self-interest. No doubt that there are some voters who oppose UHC from an informed basis that opposes it on principle, which principle argues that everyone must be financially responsible for their own health care. These voters presumably accept the unpalatable consequences of people suffering and dying just because they don’t have enough money to pay for health care. But I maintain that such voters are in a small minority. The lack of support for UHC I believe arises from decades of propagandizing by the health insurance lobby and by the AMA and related organizations, typified by the intense lobbying against Medicare in the early 60s, which warned that it would bring on the darkness of statism and socialism and the loss of basic freedoms. In today’s political hysteria and vast networks of shadowy channels of disinformation, such efforts to poison the dialog are more potent than ever, and I very much doubt that Medicare would have a hope in hell of being enacted today. And thus so many voters are persuaded to foolishly vote against their best interests that the US remains the only advanced country in the world without UHC, and seemingly doomed to remain so. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [October 27, 2017, 5:08pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/99 "2017-10-27T17:08:12Z")
> [@Shodan](#): > > Much of it got funded by increased taxes on those who didn’t buy healthcare, so it would not be in the interest of the rich nor of those who did not have healthcare insurance. Of course it is not in the interests of the rich - but they are tiny fraction of taxpayers. (And they have insurance.) The tax on those who are uninsured isn’t nearly as much as the tax on the rich (not enough) and can be seen as a prepayment for when they choose to become insured when the odds turn against them. > [@](#): > > ER visits went up as Obamacare was implemented even with more people covered, and preventative care does not, in general, decrease health care spending overall. So it was supposed to be a win-win, but didn’t work out that way. The cost of prevention is seen right away - the benefits will be spread over years or even decades. And we can’t just count the cost of medical care for illness, but also social costs like lost work. Vaccination costs more upfront also - I trust you are not against that. > [@](#): > > Cost-shifting isn’t efficiency. Either I pay it thru increased costs at hospitals, or I pay it in taxes. Hospitals with financial issues are likely to cut corners and give worse care, including more readmissions which drive up costs. Plus increased costs for the insured drives them to other hospitals, leading to a death spiral for medical care in poorer areas. > [@](#): > > Everyone should get less health care. But that is true no matter what kind of health insurance is implemented. The US is over-doctored and over-treated. I’m not sure people in rural areas would agree. In rich urban areas, perhaps. Some people are over-doctored, but many are under-doctored. The attempt of ACA to use evidence based medicine was at least an attempt to address over-doctoring. But if you read the articles in the New Yorker on this issue, you’ll see it is not an easy one, since a doctor will naturally worrying about missing something without one more test. Breast cancer screening shows that even when there is evidence that more tests hurt, consumers want them. Over-doctoring is a natural consequence of our free market system. > [@](#): > > The way to address excessive health care costs is to spend less on health care, and that means delivered less health care. Simply swapping payers around doesn’t address the issue. No, the way is to be more efficient. Do 5 hospitals in a 10 mile radius all need expensive MRI machines? In a free market they do for competitive reasons. Does each small doctors office need an insurance specialist? Our results are not so great as it is - let’s not make them worse. Other countries have better results with less cost, but not just from cutting spending. It is from doing it a different way. > [@](#): > > To be clear, I am not aware of any Republican plan that will address the issue either. We need to ration care, and both sides of the aisle recoil in horror at the prospect. _cough_ death panels _cough_ Let’s not blame Democrats for that one. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [October 27, 2017, 5:11pm UTC](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576/100 "2017-10-27T17:11:43Z")
> [@asahi](#): > > My assumption is that all voters vote for their own interests, including me and including my own. It’s a matter of how an individual voter defines and perceives voting in his/her interests. Some links between voting and interests and imagined outcomes are obvious, such as the businessman who votes for a candidate who promises to lower taxes on business income by 20 percent and slash regulations. Conversely, a poor person whose income is largely from the state would not be blamed for voting for a candidate who promises more generous entitlements. However, the businessman who votes for lower taxes might end up voting against his own interests in the long run if he ends up voting for someone whose monetary policies end up creating a boom to bust economy that results in bank failures and the crash of his stock portfolio. Warren Buffet calling for more taxes on him is an example of someone voting against his best interests rationally, since he feels the interests of others take precedence. Do you think someone sending money to a Nigerian prince is working for his best interests? He thinks so, of course, but does it count that anyone with a shred of sense should know it is a scam? [Previous page](https://boards.straightdope.com/t/do-people-know-best-whats-in-their-own-self-interest/799576.md?page=4)