Good discussion with Shelley this morning, after going to see a discussion in Seattle last night on constitutional law. The main reminder I got from the talk was that institutions need to be designed to work around the inadequacies of the individuals who operate them, so that they don’t fall apart when mishandled through incompetence or malice (the Presidency, the Senate).
Somehow we got to talking about health care, again, and the way insurance is the driver of health care reform in the US, a rather arse-backward approach, and I realized the insurance problem is a symptom, not a cause. The cause is pervasive lack of trust: between patients and doctors, between hospitals and staff, between the population and the judiciary they appoint to decide disputes. Doctors have to carry huge amounts of malpractice insurance, because they can’t trust that their patients won’t sue them for a bad result. Patients can’t trust that their doctors will do the right thing. People don’t trust their neighbors. Parents don’t trust their kids’ teachers to teach properly. So we build an industry based around the idea that we can start from a position of no trust, and have a mechanism to fix the problems that we expect will inevitably arise from people trying to screw us. And when that fails, we revert to trusting only our extended group, our tribe.
Trust is fundamental. It doesn’t need to imply that there won’t be situations where trust is violated. But trust needs to be the default case, or society doesn’t work.