The Common Good and Individual Self Interest have oftentimes been portrayed by modern-day academics, politicians, and media experts as being on opposite ends of the political and economic spectrum.
History dating back to the ancient Greek Philosophers and up to the Fathers of the Enlightenment and through the Industrial Revolution and attempts to redefine the relationships between labor and capital, have always proven that those trying to exploit class difference and who have a vested interest when proceeding on this false assumption, are wrong. Always. When individuals proceed in their own individual unselfish interests, all of society economically and politically benefits.
Since antiquity and the Hippocratic Oath, the Doctor-Patient relationship has been sacrosanct. Beyond duties of fiduciary, physicians have always put their own patients above everything else including their own ease and comfort and especially above the needs of “the commons” all of society. If I were a patient with a complex medical or surgical problem I would certainly want my physician to counsel me on what is best for me and not what is best for society. In many medical schools today the Hippocratic Oath is no longer recited at graduation and its underlying philosophy is being replaced with an agenda of “the common good”.
I went to medical school in the early 1970s at The Ohio State University on a Navy scholarship. As a condition of the scholarship, I was required to serve 3 months of active duty every year at a Navy hospital away from The OSU. My 3 months were served on medical and surgical rotations, but in order to conform to University Standards, they were counted as Public Health Rotations. I was then required to write several public health papers and participate in several forums on public health. Very early on in my career, I was able to compare a socialized medical delivery system military medicine, and private systems and networks. During several interactions with my public health proctors, I became acutely aware that the needs of individual patients were oftentimes compromised when the “greater good” superseded their best interests.
There is no question that public health has made great contributions to the wellbeing of everyone. Clean water and food, sewage, and sanitation all meet the strict economic criteria of being a common good (non-exclusivity, jointness of consumption, and neighborhood effects). But when assigning common good strategies to the care of individual patient’s bad things begin to happen.
I saw this when I visited Cuba on two occasions in 1977. Patients with TB, polio, and hundreds of patients with mental illness were put in “sanatoriums” where they were isolated and quarantined from the general population. The cost of treating individuals was too high and the good of the group was best served by just placing these patients in a location where they would not put well people in harm’s way. Cheaper sure, but if you were a patient in such an asylum or sanatorium was that best for you?
Socialism is always about the group and not the individual and many times by placing the group first, everybody suffers. When people like John Kerry and Hilary Clinton touted the quality of the Cuban health care system when compared to ours I could only look back at my own experiences in Cuba to realize they weren’t talking about the care of individual patients, but rather about “public health” and the common good.
As we are working through the Covid-19 pandemic there are certain places where strategies very different from those recommended by “The Experts” in Washington and Boise are being practiced. Today’s Wall Street Journal reported on The Villages in Florida a retirement community of 52,000 adults all over the age of 65. They have tested 1580 people and 42 have tested positive. They have had 19 deaths in the tri-county Florida area surrounding The Villages there have been 6000 positive patients many from a State Prison and over three times the deaths. Living conditions at The Villages are very different from those found in many senior living facilities. Individuals and couples live in their own homes that are separated from each other. There are wide-open spaces and people spend many hours a day outdoors.
Until Governor Desantis closed down the State all those living at the Villages were under their own recognizance. The outlying county shut down two weeks earlier. Even though the average age of those living in the Villages is 69 and the tri-county area is 42, the disease seems to be affecting those outside the retirement community at a higher and faster and more deadly rate.
It seems obvious to me that the contributing factors that allow the Covid-19 Virus to be so problematic are what need to be addressed. The Ro factor the spread from one person to another is greater when many people are living in confined quarters when they have Comorbid factors, and when they use public transportation. Age over 70 is a risk factor, but maybe people living an active life with a rigorous exercise routine have an advantage.
At the risk of being graphic but still being scientific, maybe social isolation is not as big a factor in affecting the transmission of the virus as we might have thought. It has been well known that The Villages has one of the largest rates of STDs reported infections in the country. The rate has not changed since March 15th! hmmmm. And again the Covid-19 transmission rate in the Villages is lower than the surrounding counties or the rest of the country.
Is there a Public Health Master’s Degree candidate somewhere that is willing to assess the importance of social isolation vs exercise in the elderly population as comparative risk factors for Covid-19 transmission and infectivity? Or vice versa?! We won’t know until we do the testing. And we will certainly need lots, and lots, and lots of tests. Only “The Experts” and God know there can never be enough tests.
It seems to me that as the curve begins to flatten in Florida, Idaho, and the rest of the nation answers to these questions will begin to emerge. One last thought about choices. The decisions we make every day that sometimes seem to be little decisions, in the end, may be the biggest decisions of all. Choosing to live in a city instead of in an open area may be the biggest factor of all when the final analysis are in. Using public transportation and foreign travel are also big decisions. Working out and staying in shape are big decisions. What kind of food we eat and not being too heavy and not smoking and drinking are all little decisions that are important and need to be put in proper context regarding Covid-19.
A question I haven’t seen addressed by the experts and I can guarantee that they have asked and answered this question themselves, is what is the risk of a person who smokes vs a non-smoker surviving Covid-19 associated pneumonia? The reason this isn’t made public in my opinion is that if you have chosen not to smoke in your lifetime, your risks of complications are many times lower than those that have made such a decision. By identifying this fact alone, mitigation strategies of stay in place would be much more difficult. Maybe quarantining smokers or former smokers would be more efficacious than what we are doing today?
These are decisions we make for ourselves and that government cannot make for us just like decisions about eating out in public or going to church or getting a haircut. I know what is best for me and you know what is best for you, and by allowing each of us to make those decisions in our unselfish interest all of us benefit. If I want to get tested which I did fine. If not fine. In the end, testing is not of great significance when compared to the little decisions we make every day-decisions only we can make for ourselves.