A Game of Healthcare Law

A Game of Healthcare Law

Healthcare is a game of incomplete dominance. No one wins because no can win.

Whether we discuss gun control or abortion, the debates never end because no side is completely right. This is the nature of healthcare. All issues are multi-factorial, and that is the problem.

For the most part, we think of these issues in terms of sides, blue and red, for or against. But healthcare is less about one side, and more about relative perspectives. In game theory, we call this a multiple payoff game, meaning there is no one outcome that determines victory or defeat. There are only relative benefits and harms.

This is an apt analogy for healthcare. There is no one right or wrong decision on any issue, only relative benefits and harms. For the diabetic patient celebrating her daughter’s graduation, that piece of cake is well worth the sugar spike. In broader policy, the same applies.

There is no right or wrong perspective on any healthcare debate. Should we mandate health insurance for everyone? Well sure, if we want the overall quality of care to decrease. Healthcare is an opportunity cost, whether we view it from the perspective of the individual or in terms of broad policy. Everything is a payoff – because everything in healthcare has enough unique perspectives where any stance can be justified, in favor of or against.

Yet we insist on distilling healthcare solely into a narrative of either-or, and right or wrong. But when we do that, we take a multiple payoff game and turn it into a zero-sum game. Now we must have one winner and one loser. Despite multiple payoffs of relative benefits and harms, the game comes down to whomever has the greater payoff, relative as it may be; or whomever has the smaller harm, as negligible as it may appear.

This makes healthcare a game of incomplete dominance. A never-ending series of games played over and over in which relative benefits and harms are perceived to be absolute victories or losses. No side wins because the game never ends.

Take the issue of abortion. When Roe v. Wade was drafted by the Supreme Court, the Christian leaning right perceived it as a loss to the moral fabric in this country. They mounted a multi-generation campaign to fight back and nearly a half century later, they seemingly won. But alas, the game is not over. Now the left, more supportive of abortion rights, appears to be mounting its own campaign. And the game goes on.

This happens when the majority or prevailing opinion is not the dominant one. In game theory, often the majority opinion is the dominant opinion and the majority dictates the outcome of the game. And once that outcome is reached, the game is over. In healthcare, it is inverted; the majority opinion is the less dominant one.

In philosophical terms, we call this a dialectic, a ceaseless reverberation back and forth from one perspective to another. In game theory, we call this an incomplete preference. The payoffs vary based on the previous outcome of the game and change with the changing outcomes over time.

The moment a majority position is held in healthcare, it is no longer dominant. And conversely, the moment a particular view on a health issue becomes the minority position, or the legally disenfranchised position, it becomes dominant.

Herein lies the contradictory nature of healthcare. When a person is in the minority on a health issue, the payoffs shift. The margin between obtaining the desired outcome versus perceiving a loss grows, and the person is incentivized based on the widening payoffs to become more extreme.

Those in the majority, whose position on a health issue represents the majority or the current law of the land, hold less extreme positions because the relative margin between payoffs decreases.

Eventually, the margin between the minority position’s payoffs widens to where the upside payoff becomes dominant, and the game leads to an outcome favoring the most extreme payoff with the more dominant position.

It is a fascinating phenomenon in healthcare. It explains how the minority opinion prevails only to eventually fall to the previously held opinion – producing a dialectic of decision-making.

It is nothing more than an outgrowth of the belief that healthcare is a zero-sum game, that every health issue must have a winning side and a losing side. As a result, any opportunity for a nonzero-sum outcome, a game of compromise, is forsaken.

But if we were to reimagine healthcare as a compromise, a nonzero-sum game, the payoff structures would not inversely correlate with the dominant position. And healthcare would no longer be a game of incomplete dominance with a continual cascade of winners or losers.

We would have equilibrium. We would have peace.

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