Pssst, I’ve got a sure thing …

When I hear something like this, I pretty much figure someone’s about to take me for a ride. Same as when I hear a bookmaker telling the viewing public they know what punters want, when it’s pretty clear what the bookmaker wants is for the punter to keep handing over money under some sort of illusion that the bookie is really trying to provide the inside info to help them get ahead (but that’s another rant, for a different blog, attached to a quiet wish for a plague of moths to be visited upon the bookmaker to devour their expensive suit right off them).

But then, there’s a bunch of different things which have a really good chance of major payoffs that we are all guilty of ignoring, because sometimes we have the collective vision of a naked mole rat. Well, that’s not entirely fair, because we’re not that well hardwired to choose the future payoff over the immediate reward. That use of the collective term “we” is also directed just as much at the political class, as society as a whole.

I remember encountering this reality repeatedly in medical school. In that setting we were most commonly discussing the challenges of preventive health. The simple example I recall from the first year of the undergraduate degree, was that of blood pressure management. Most of us know that high blood pressure isn’t great for us. Leaving your blood pressure free to realise it’s full upside potential will fairly certainly increase your chance of cardiovascular disease and the associated sequelae strokes and cardiac disease. We also know we can keep blood pressure lower with medicine, but we need to take it every day. Yet trying to ensure compliance with the medicine that will potentially save your life is one of the greatest challenges of general practice.

The problem is that is if the treatment goes well, you’ll only know because you’ll feel about the same as now for the next 10 years. You won’t be better looking than now, smarter than now or made rich and powerful by your blood pressure medication. The pay off is that you won’t have had that bad thing happen that might have happened otherwise. It’s that damp squib of a payoff that probably explains the 50% compliance rate described by the WHO back in 2003. The gratification in a prevention setting is not only delayed, it’s a fizzer of a party when we arrive and everyone slouches by, wearing ironic party hats to say “congratulations, you didn’t have a stroke.”

Health isn’t the only area where delayed gratification comes up. The psychology experiment described here changes the setting to a financial conundrum, but similar behaviour is on display. The interesting thing here though is that study participants were more able to revert to the rational decision (“I’ll make the decision that gives the bigger payoff, even though that means waiting a bit”) the further removed the person they were making the decision for was. So, they were more likely to choose the instant giddy surge of financial payoff for themselves or their relatives than the stranger, who gets the big pay day. If we’re not personally invested, we have a better chance of letting reasoned thought rule the day, not our desire for instant joy.

And this is where I get ranty about politicians (yep, just here, absolutely nowhere else). You’d hope they could sometimes be the tiniest bit rational (and I’m not trying to be overly idealistic, nor do I believe in unicorns thanks very much). Every day you see some uninspiring individual banging on about how interested they are in “our future”, while splashing a bit of money that will hit the bank just after the election, or promising to protect a payment to a whole section of people who take it as a bonus payment when they have no need for it (but who’s absence would be the greatest threat to aspiration of our time).

What I rarely recall seeing is the politician or sober economic commentator talking about how they’ll invest in something with a return of 117% on capital, that will nevertheless require us to wait for the payoff, and know that part of the payoff will just be that we’re paying less than we would have otherwise in the future (there’s that damp squib again). Where did I pluck 117% from? That’s the return on investment referred to by the McKeon review into Health and Medical Research (the money bit I’m referring to is around the bottom of page 10 to the top of page 12). Can you imagine how excited you’d make an accountant if you offered that return? They’d snap an abacus in excitement. The thing is some of that return is in the form of less health expenditure than we otherwise would have reached, and that’s hard to feel good about now.

What about early childhood education and intervention? I heard coverage today discussing the benefits of early education (thanks very much A.M. on ABC Radio) or just as importantly the problems created by not getting that education (with Australian data suggested to show that if you can’t read by 2nd grade, you’re probably not going to catch up – here’s the link to the transcript). So what would be the benefit of early education in economic terms? The RAND Corporation suggested in their review anywhere between $1.80 to $17.07 for each dollar invested. Again though the payoff will be later, and we’ll never know what the other side of the “sliding doors” moment would have led to (*shudder*, can’t believe I just alluded to that movie).

So, if you’re a politician and you’re not talking about investing in things that will actually pay off majorly down the track, like enhanced investment in preventive health programs, proper support for general practitioners to provide patients access to primary healthcare, or the support that single parents need to stay engaged in the workforce and their kids’ lives, I say “Bollocks!” to your protestations of being all about the future (and my own interest in brevity, it seems). You see, if I was the type to be duped into thinking that a short term pay off from a politician was actually the one pokie machine in the world that would lead me to a better long term future, I’d just go and throw money at one of those annoying blokes on the TV pretending to be a commentator. At least that way someone gets an expensive suit.


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