Here's a scary thought – what if there was no way a government could ever create a health service that we felt safe and secure about.  If, no matter how much money, how much management expertise, how much research was lavished on it, it was inevitable we, as a society, would see the health service as failing us.

There's a psychological argument that suggests that this, is in fact, the case – we see the health service as failing, because we need to see the health service failing.  Why?  Because if we didn't think it was failing us we'd be faced with the horrible fact of our own mortality.  And nobody wants that.

Francois de La Rochefoucauld said that thinking about death was like staring at the sun – you can't do it (he said it rather better, and in French, but I'll just take the metaphor).  Thinking of the inevitability of our own mortality is a very uncomfortable thing and therefore we avoid it.  So much so that if someone who is close to us dies then most of us will seek out a reason and explanation.

Very few of us will be content with the idea that someone died because they were old and that's what old people do.  Or because they got cancer and there is simply a percentage change that any of us could develop cancer on any day, no matter what our life-style, diet or exercise regime.  Or they died because it was a risky operation and it just happened that they were unlucky.  Generally we need to find a reason – a specific reason, a specific reason why this particular person died in this particular way.  Therefore we come up with a theory, a story that tells us why.  We may put it down to their diet, the fact that they used to smoke, or… the fact that the health service let them down.  We can't just accept the fact that sometimes people just die – why?  Because if we accept it was something that 'just happened to them' then it's something that 'could just happen to us'.  And that's terrifying.

The fact of our inevitable death is very uncomfortable, so when we see the death of another person we may need to reassure ourselves that 'it didn't need to happen'.  We tell ourselves it could have been avoided.  We tell ourselves that it was someone's fault.  That if the health service was better run, or better funded, or if the managers were doing a better job our friend or family member wouldn't have died.  By doing so we are trying to convince ourselves that perhaps death isn't inevitable, perhaps it can be cheated when its our turn, perhaps if we complain and protest enough someone will come along and fix the health service properly so that we don't have to die.

None of this is to deny there aren't real problems.  Of course having a better diet decreases your chance of getting cancer, and quitting smoking decreases it a lot.  But it doesn't remove it entirely.  Cancer is just one of those things that happens, it's random and entirely unfair.  Likewise a hospital can be run better, doctors can improve the way they perform operations and managers can improve the efficiency and effectiveness of the organisation.  However, it'll never be perfect.

And perhaps we need to always see it as imperfect, as flawed.  Perhaps we always need to criticise the health service, and always feel a little bit let down by it when someone we know dies, so we can look at its imperfections and avoid having to stare at the sun.

[Sadly I can't claim this idea as my own.  It was mentioned to me at a party by a friend, but despite extensive googling I can't find out who the academic was who originally suggested this theory.  If you do know where it originates from do drop me a comment.]

In my previous post I was discussing the Ultimatum experiment, a simple but entertaining psychological experiment that suggests that if we feel we are being treated unfairly we are prepared to lose out ourselves in order to punish someone else.  The most recent experiment I have seen on this suggested that we punish others out of a sense of anger, rather than out of a strategic attempt to teach the other person a lesson.  It reaches this conclusion because drunk people still punish the other participant and drunk people are notoriously bad at thinking about long term consequences.

Personally I disagree with the conclusion that people are purely motivated by anger.  Poor though we may be at acting strategically when drunk (which is why a nights drinking is rarely rounded off with a rousing game of chess) I think the kind of action demonstrated in the Ultimatum Experiment is so deeply ingrained in our psyche that we don’t need to think it through, we instead ‘feel’ what is the right thing to do.

Man, as the cliché goes, is a social animal.  We function as a part of a society – that’s how we survive and that’s how we prosper.  But societies are tricky things, and to be a successful member of a society we have to strike an interesting balance, a balance which we simply call 'being fair'.

We thrive in societies because we receive more through being a part of them than we could get on our own.  By sharing responsibility for collecting food, producing goods, building shelter and defending what is our own, we can achieve far more than if we were each individually responsible for completing those tasks.  But being in a society is really just being involved in a whole series of individual relationships, relationships we must maintain.  Maintaining the relationships we require to make a society exist relies acutely on our sense of fairness.

What is the ideal kind of person to share a society with?  Clearly a person who is generous, shares their resources and generally acts for the good of others.  But what is the best type of person, from our own self interest, to be in a society?  Initially we may think, from a purely selfish point of view, being a freeloader – a person who takes from society but doesn't give back.  That way we gain benefits from society and get to keep our own resources as well.  But of course, sharing ones own society with freeloaders is the very worse situation to be in – they take from us but don't give back.  So whilst purely selfishly we might want to be a freeloader, we must be on guard to protect ourselves from freeloaders that are close to us.  If we spot a freeloader in our society we should do our best to either punish them so that they behave better in future, or push them out of our society all together.

But this, in turn, suggests that actually being a freeloader ourselves isn't our best strategy – if we are seen as being a freeloader then others will attempt to punish us or push us out of society, and we lose all of the great benefits of that that society was bringing us. We have probably seen this drama played out on a smaller scale in friendship groups over the years – I remember being at primary school and the accusation that 'you're a user' was one of the most vicious that was used.  An accusation that could lead to a child being ostracised from a social group for days at a time (seemingly a lifetime when that young).

So we strike a balance – a balance between being selfish enough that we get good benefit from our own resources, but not so selfish that we are seen as being damaging to society and so rejected from it.  This balance is what I think we instinctively recognise as 'being fair'.  We also constantly monitor the actions of those around us to make sure that they are being fair. If we come across people acting in a way that we don't think is fair we will generally react strongly – we will feel angry and may wish to punish them in some way.  But this isn't necessarily coming from a vindictive angry place – it may come from our need to protect our society.

I believe our instinctive, emotional, response to what is fair and what is not is deeply rooted in our emotional selves because it is necessary to maintain our society.  Like most human qualities what an individual person considers 'their fair share' probably exists on a bell curve – some of us instinctively feel we deserve more than others, some are naturally more pushy towards keeping more whilst others are more naturally generous.  But what I feel the Ultimatum Experiment demonstrates is that even when our intellectually faculties are clouded – by alcohol say – we still feel very strongly when a another individual is treating us unfairly, and will act in a way designed to demotivate that behavior – even if it costs us personally.  It's necessary because ensuring others act fairly is necessary to keep society functioning and that society is much more important in the long term than the short term loss of some money.

Next – what the Ultimatum Experiment suggests about our attitudes to public services, or why so many people complain about benefits so much.