Opinion: Good behavior

POSTED: 01/29/14 11:30 AM

How do you change people’s behavior? That question has hunted politicians all over the world forever. And based on results, they still have not found the answer. This has something to do with the way politicians view people.

In the socialist vision all people are good. This has in the Netherlands for instance for years resulted in massive social benefits fraud.

In the liberal (read: Mark Rutte) vision all people are bad. So they have to be punished.

Those two world views clashed dramatically when the Rutte-cabinet presented its income-dependent healthcare premium plan: it hit hard working middle class citizens in the solar plexus.

Psychologist Bram Bakker analyzed this drama: if you want to change people’s behavior you have to reward good behavior, he wrote in his Volkskrant-column. Spreading the cost based on income without looking at the nature of these costs and at those who cause them is a little bit stupid, he remarks.

Bakker refers to a comparison Arnon Grunberg made recently between Islamic fundamentalists and those who have turned maintaining the level of purchasing power a religion: “To the purchasing power fundamentalists I say: your purchasing power is a fabrication, your purchasing power does not exist, your purchasing power culture is a backward culture.”

Bakker picked up on what seemed to be a columnist’s joke. Purchasing power effects resulted last week in the fact that the new cabinet has annulled its intended healthcare measures. That a part of the population would lose purchasing power met with so much resistance that the decision makers quickly changed their minds.

That these plans did not make it because of the costs is in itself not a problem, Bakker wrote. But the most important reason that these plans were not good had to do with healthcare itself and not with the financing.

Bakker makes a comparison with road tax: A similar decision would be to base road tax no longer on the type of car or the amount of CO2 its emits, but on the owners level of income. Within the shortest amount of time everybody who makes more than $100,000 will buy an environmental unfriendly four wheel drive “PC Hooft tractor” (we figure this is Dutch slang for Hummer – ed.). Big earners will reason: if I have to pay that much, I want to profit from it to the max. Money carries more weight than the environment.

With health it is no different: if you have to pay hundreds of dollars without ever seeing a doctor, there will be hardly any restraint to go to a doctor after three days of fever, just because you pay for it anyway.

The incentive to drive an economic, environmental friendly car and the temptation not to go to a doctor too quickly are in a large part comparable. Except in intended political policy.

Every first-year student psychology learns that punishment does not work and that desired behavior has to be rewarded the government works on plans for healthcare that many experience as a punishment.

For starters, Bakker argues, people who were supposed to pay a high healthcare premium ought to be happy, because this means that they are doing economically well. But if they spent a lot of money on staying fit and vital they are not rewarded. On the contrary: it discourages them to continue with such efforts.

Healthcare costs are increasing every year. In part that is due to better but more expensive treatments of diseases we have known for a long time, like cancer. For a much larger part this is due to an unhealthy lifestyle that makes that we consume ever more healthcare until we die. If this trend continues we will also start to die earlier, due to a lack of motivation and discipline to take care of our own well-being.

Most people consider their health their most precious possession. People who heard that they have an incurable disease often spend their last dollar on the search for a treatment that might work. They are busy to survive, not with maintaining their level of purchasing power. Many ailments that cost us our lives are due to an irresponsible lifestyle. Not everybody understands that, or is able to understand that.

The political policy ought to be focused on explaining the need for all to spend more efforts on keeping healthy. The people who are unable to do that deserve our solidarity, and that could be income-dependent. Those who saddle the community willingly and knowingly with high healthcare cost should pay for it substantially, even if this goes at the expense of their purchasing power. Those who do not consume a lot of healthcare have to pay little by comparison.


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