Saturday, February 04, 2023

Institutional self-preservation

I was just at my Al Anon meeting, one which I've been going to for probably a decade now. I shared about how I've been reading a lot of non 12-Step program stuff as part of my program and mentioned that the program readings had gotten a little stale for me over time. AA meetings are generally well geared towards this kind of thing, Al Anon is a little more fragile, perhaps because it operates at a smaller scale. Other members gently stepped up to talk about how alive the program is in their lives.

All institutions seek to preserve themselves. This can be problematic. It's broadly recognized, for example, that US healthcare spending is a little excessive at 18% of GDP, far above the OECD average of 9.5%. Since COVID mortality was far highest amongst those with chronic diseases (diabetes, heart disease, etc) and treatment of those with chronic diseases makes up a disproportionate of US healthcare spend, you'd think that COVID should over time bring down US healthcare costs. But that's not what we're seeing. Fundamentally that's because healthcare institutions seek to preserve themselves. They are big enterprises and they want to retain payroll and grow earnings.

Pretty much all industries are the same. Finance should be the same way. If we believe it is not essential but exists to facilitate other activities, it should seek to shrink. But all the individual businesses within it seek to grow. Even Vanguard, which has been amongst all institutions perhaps the purest of heart. Ironically, in some sense Vanguard's laser focus on lower costs have caused it to not focus on developing a broader range of services and improve its platforms, so that it actually has constrained its ability to serve people better, forcing them to go to other vendors to get things they need, thereby increasing the footprint of finance on their lives.

Life is complex. On with the day.

No comments: