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Thursday, July 15, 2010

On choice

Choose life. Choose a job. Choose a career. Choose a family. Choose a big fucking television. Choose washing machines, cars, compact disc players and electric tin openers. Choose good health, low cholesterol and dental insurance. Choose fixed interest mortgage payments. Choose a starter home. Choose your friends. Choose leisure wear and matching luggage. Choose a three-piece suite and higher purchase a wide range of fucking fabrics. Choose D.I.Y. and wondering who the fuck you are on Sunday morning. Choose sitting in a large couch watching mind-numbing spirit-crushing game shows stuffing fucking junk food in your mouth. Choose rotting away at the end of it all, pissing your last in a miserable home, nothing more than an embarrassment to the selfish fucked-up brats you've sworn to replace yourself. Choose your future, choose life. But why would you want to do a thing like that? I chose not to choose life. I chose something else. - Trainspotting by Irving Welsh (Screenplay by John Hodge)

For the last 20 years or so politicians have been keen on offering us choice, my message is "I don't want choice"!

Choice of schools is something of an academic question for me since I don't have any children but I grew up in rural Dorset and there the offer of choice would have been hollow. There were two primary schools in my village : one Roman Catholic and one Church of England, following that we went to the local "Middle School" one mile away - next nearest offering five miles away, followed by an upper school five miles away and the nearest alternative 10 miles and above away (to be honest I don't even know where the alternative would be)... and this in an area with a rural transport system, not an urban one. A great deal of effort is expended in trying to rank schools, there's evidence showing this process is not very accurate - the vast majority of schools are statistically indistinguishable. And who says schools are so important for education? My educational success is down, in large part, to the support of my parents but no-one seems to mention that. No one wants to say: actually your child's education is very much down to you.

We get choice in medical care these days too but how am I supposed to judge the quality of a doctor or a hospital? Set some bright people a target and they'll do a fine job of hitting it but is the target really representing the thing you want? People are actually quite keen to go to the hospital that's close to them. Do we really expect patients to make an informed choice of which hospital is best for them from a medical point of view. I'm pretty sure I couldn't make an accurate choice of the best hospital for medical care. Best hospital for me is easy: it's the one about half a mile from my house. And what's the message you're sending when you're offering a choice of hospital or doctor and providing data that purports to represent quality?:
"Here's a bunch of hospitals - make sure you chose the best one. Do you feel lucky?"
I'd much rather you made sure that it didn't matter which hospitals I went to.

People don't actually like lots of choice, academic research on jam shows that consumers are more likely to buy jam from a choice of 6 types than from a selection of 24 types, too much choice confuses and causes unhappiness. This chimes with my experience, to a large extent I've given up being a rational economic agent, live's too short to sweat over a choice of 100 different TVs.

This problem of ranking difficult to rank things is quite general, I experience it myself at work in my targets. I've come to the tentative conclusion that for people working in areas without clearly quantifiable outputs (number of strawberries picked, widgets sold, football games won), ranking really amounts to three buckets: sack, ok, promote. Your sack and promote buckets should really be pretty small. Yet we expend great effort on making more precise gradings. More interestingly I remember as I sat through an interminable college meeting discussing with an English fellow the marking of students. Normally for degree courses there's a certain amount of second marking, in physics where there are definite answers second marking works fairly well but for my colleague in English one marker could mark a First and the other a 2.2/3rd, for the same essay!

Don't give me choice, give me uniformity!


Nora Lumiere said...

I love "Trainspotting", such good writing. (That was when Danny Boyle still make proper movies.)
I've often thought the same thing myself: I can't pick a dentist or a doctor from a website and I can’t interview them either. There’s only word-of-mouth and one man’s doctor is another man’s quack.
Too much choice inspired the scene in “Hurt Locker” where the soldier stares at the vast array of cereal boxes and just takes the nearest one with an ulcerated look.
People are less fearful of making a bad decision when there is little or no choice.

drop4three said...

I'm like you. I'd like to choose the hospital closest to me. End of decision. If that gives a poor service to me and all others that it's the closest for, then we ensure the problems are tackled and rectified. How was a problem ever cured by people walking away from it? By this group effort, initiative, unity, we ensure our choice provides a service we want, to ur standards, not to some random targets that the service fudges to meet anyway and means nothing to those using the service.

Jon Butterworth said...

I think patients should be able to set up their own hospitals. They could hire doctors they like, form a dynamic partnership with local business, follow the bizarre medical orthodoxy of their choice, and re-elect a new governor every time one of them gets better or dies.

Anne said...

Don't want choice - want quality!

innerbrat said...

that section is verbatim fromthe book, and so should properly be attributed to Irvine Welsh.

SomeBeans said...

Seems I have struck a nerve ;-)

It's funny because I'm sure if you ask people if they want choice they say "yes" (which is in part what politicians pick up on). Politicians have also run with the idea that choice = competition which, in *ideal* economic markets leads to efficiency.

@innerbrat - cheers, I didn't have a copy of the book and didn't remember whether it was in the book from reading it a long time ago.