We need to be spiteful to defeat spite

A couple of days ago I wrote about a disturbing situation in Polish public healthcare: The government can only pay for some number of certain medical procedures, a number which is lower than the demand for these procedures. This means that some patients can't get them in a timely manner--they have to wait in line. Now the curious thing is that scarcity only exists on part of the government funding these procedures, not hospital capacity. The hospitals have the necessary equipment, and the doctors have the necessary time, to actually perform all procedures that are demanded--if only someone paid them for it. The government can't afford it, but some of the patients can. However, those patients are not allowed to do so, because public hospitals and doctors working for them are forbidden by law to accept any payments on behalf of the patients. Some politicians favor changing the law so as to allow waitlisted patients to pay for their procedures.

The stunning thing is that some (perhaps most) major politicians are against such a change. Why is this so hard to believe? Because allowing patients to pay would create one of those extremely rare situations that economists and ethicists call "Pareto-improvements." Pareto-improvement is a change in the social status quo such that no one is worse off, and some people are better off, than they were under said status quo. A Pareto-improvement means there are no losers, only winners (though it doesn't necessarily mean that everyone wins). Allowing waitlisted patients to pay would be a Pareto-improvement because doctors would be paid more than they are right now, and more patients would be treated than there are right now. No one would be less happy than they currently are, and some people would be happier. Ethically speaking, this really should be a no-brainer. And yet many politicians oppose it.

I think speaking out against Pareto-improvement is always profoundly immoral. Why? Because those who do so reveal that they are prepared to act on spiteful moral preferences. They want to help people they like, sure; but they also want to see people they don't like hurt--even if doing the latter means doing less of the former.

One of the ways in which societies remove immoral behavior is through social punishment. There was a time when it was quite all right to be overtly racist in speech and actions. It isn't anymore. (I realize this is a huge oversimplification but, as often, I am talking about what's true on average.) You can still have racist preferences, sure, but you can't really act on them, as this usually leads to unpleasant consequences in terms of your social standing. I wish acting on spiteful preferences would be ostracized this way as well. Here's a paradox though: one of the reasons we humans even have spiteful preferences is to ensure evolutionary stability of social punishment. In order for the society to be able to punish thieves, for example, most group members have to be ready to punish those that stole not only from them, but also from other people, even if such punishment entails costs to themselves. And that is a form of spite.