Trade-Offs

Every time you hear someone say ‘there is no need to trade-off….A vs B’ be absolutely sure they are advocating a trade-off and very suspicious that the one on offer is not likely to be one you like. There is absolutely a trade-off between the education (with all associated benefits) of young people and the protection of older people during this crisis. The idea we can solve this with some catch-all ‘curing the disease is better for everyone’ is at best wishful thinking and more often a cover for preferencing some rights over others.

The healthcare industry has a sophisticated set of metrics for trade-offs, for example the QALY (a quality adjusted life-year) in the NHS is valued at £20,000 in the sense that an intervention costing less than that is deemed effective. To be clear by that when someone gets sick aged 70 and therefore might lose(for example) 18 years of life expectancy, adjusted down to 12 because they will likely be sick for several of those then unless the treatment costs less than £240,000 then it is judged not worthwhile. You probably feel as uncomfortable reading that paragraph as I do writing it, trade-offs are not all ice-cream vs cake, sometimes they are heart-breaking. The other thing is that trade-offs are unavoidable, not making a decision is itself a decision usually in favour of some status quo or existing preference and it is (again) wishful thinking to believe you didn’t make a call.

Politicians and perhaps specifically our (UK and US) governments are almost pathologically averse to confronting trade-offs and want you to believe in their ‘have cake – eat cake’ policies. The trade-offs are usually hidden by making the benefits immediate and obvious and the costs diffuse, complicated and later. That is not a necessarily ‘wrong’ approach but it often offloads costs onto the young and the poor since they have less political power than other groups.

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