Thoughts in Brief: Vet Fees, Religious Freedom and Fractional Soul Trading
An occasional series for shorter thoughts
Why are people so upset about high vet fees?
Speak to anyone who’s used a vet recently, and there’s a good chance you’ll hear them lament how much they had to pay. But what’s really causing the problem?
As a preamble, yes, the Competition and Markets Authority has recently completed an investigation which concluded there were some problems in areas such as transparency and competition. Various remedies are to be enacted, such as requiring practices to publish a comprehensive price list for standard services. These are good things to do - but as many vets have pointed out, it’s not going to cause prices to plummet.
The fact that some countries in Europe (with similar GDP/capita levels) have cheaper vet fees than us for similar procedures suggests that some of our regulation is likely to have driven up costs in order to obtain higher animal welfare standards / staff ratios / safety than they accept in other countries.1 Given this has been a feature of almost every area of British society - from house-building to childcare to industry - it would be remarkable if this was not the case. But again, while reversing this to lower prices, it’s not the crux of the problem.
Last year, we sadly had to make use of a vet, after a kitten we acquired sadly took ill. It had been a rescue kitten and, sadly, had congenital FIV,2 upon the heels of which came a host of other infections which ultimately carried it away at around six months old.
We had excellent care and found each of our interactions with the vets professional and dedicated. The prices for routine treatments - check-ups, antibiotics and the like - were perfectly reasonable. But overall, the process gave me a new insight into what the real problem is - and it’s not the fault of vets, of the market or of regulation.
We decided to get a blood test, which told us the full extent of the problems. At this point, we are offered an advanced treatment, which would cost £6,000 - £8,000 over several months involving regular (daily?) injections and similar. Over this period, the kitten would have been in considerable discomfort - and the chance of success was only 25%.
The vets didn’t pressure us, or try to guilt-trip us, and were entirely open about the costs and the chance of success. The issue is not their behaviour - it is that the treatment exists at all.
In our case, we declined. While of course one would do this for a human3, we are both of the view that pets are not people, and that this is not something we would do for a pet. But even so, it felt hard.
And our society encourages people to feel that way4 - and even if it did not, it is natural to love a pet, and for many it may be their primary source of companionship. We are all far removed from the rhythms of the farm and field. So it is understandable that many will choose to pay - or else feel guilty that they will not, or cannot. What of those for whom such a sum is not merely large, but the house deposit they’ve been saving up for years, or their only buffer for a rainy day, or who choose to go into debt? What of those who feel no choice in the moment but to pay - and who then regret what it has cost them?
The range, sophistication and complexity of the treatments available have expanded dramatically since the days of James Herriot - or even since the 1980s and 1990s. Veterinary medicine has advanced, just as human medicine has. Advanced drugs, blood tests, MRI scans and more. They exist - and they are not cheap, for animals any more than for humans.5
There is simply no good solution to this. To ban them would be perverse. Banning an effective treatment that could save an animal’s life, and that someone was willing to pay for? People who wished to, and could afford to, pay would understandably be outraged.
About all that can be done, if one is a pet owner, is to think about it in advance, and - if relevant - to discuss it with your partner. What do you think about such matters? Are you both on the same page? At least, this means that any decisions can be made with forethought, and with less agonising, than if confronting them for the first time in the heartache of the moment.
In the meantime, we can and should see if we can make the market work better, or if every bit of regulation is needed. Every little helps in bringing down prices at the margin. But it will not obviate the central cause: that veterinary medicine continues to advance.
Religious Freedom
A couple of months ago there was a row over Muslims celebrating Eid in Trafalgar square6, after an MP, Nick Timothy, described it as an ‘act of domination’. This was widely criticised by a wide range of people who accused him of singling out Muslims. Some of his defenders tried to muddy the waters, arguing that his criticism had not been based on Islam, but that the event had been ‘against British values’ because it had been gender segregated, or ‘exclusionary’; before Nick, helpfully, used a follow-up column to clarify that his critique had explicitly been based on ‘Islamic domination’.
I don’t intend to relitigate the issue, on which many column inches have already been expended. Rather, I’d like to note that the debate showed that many of both his critics and defenders appear to have a minimal understanding of what both religion, and religious freedom, really mean.
It was notable that the criticism of Timothy’s comments was not just unusually severe, but included many who do not usually care about religious freedom; indeed, some who on other occasions have criticised religious institutions such as faith schools, practices such as Halal/Kosher slaughter, or supported restrictions on religious expressions, such as buffers around abortion clinics. The issue for such people was not Muslims’ freedom to pray, but the singling out of Muslims as a specific religious group. The issue was discrimination and uneven treatment, not a concern for religious freedom.
This is, of course, a valid thing to be concerned about! But there are two implications.
First, one should not mistake this as demonstrating any upswell of support for religious freedom more broadly. Some may, of course, hold both views. But to assume those criticising Timothy would be willing to actively defend religious practices, freedoms or institutions they disagree with - provided any prohibitions were applied impartially across all religions - would be a mistake.
More significantly, those who see religion as essentially equivalent to skin colour have a sorely lacking understanding of religious faith. The real world is not Civilization IV, where all religions are identical, with just a different colour, emblem and religious building.7 Religions are different: and for those who take their faith seriously, will shape their morals, values, actions and lives. It is absolutely possible that a religion - or to be more precise, a manifestation of a religion8 - may have values and manifestations that are opposed to those of liberal democracy.9 By refusing to even see that Timothy’s specific criticisms are worthy of engaging with, too many of his critics reduce religion to the realm of window dressing.
But if that is his critics, the statements of some of his defenders are even more inimical to religious freedom.
The suggestion that ‘there is no God but Allah and Muhammad is his prophet’, in itself, is unacceptable in a public place, would seem to cause severe problems for both the first commandment and John 14:6, ‘I am the way and the truth and the life. No one comes to the Father except through me.’ I have certainly seen the latter outside many churches! The logical implication is that only polytheisms should be permitted to worship in Trafalgar Square.10
The defences that rest upon gender segregation being ‘against British values’ are even worse. There was at least one occasion when a person advancing this was flummoxed when it was pointed out that some Orthodox Jews worshipped in this way, and did he wish to ban them too? And what of Catholicism, in which only men can become priests? This is the same perversion of ‘British values’ that saw Ofsted repeatedly fail private Jewish primary schools for not teaching LGBT content.
A religious liberty that depends upon the religion conforming to all of the current secular society’s mores is a shallow form indeed. It leaves no space for any but the most ‘progressive’ religions in public life. If that’s the goal, say so - but don’t hide behind religious freedom.
Defending religious freedom doesn’t just mean standing up for happy celebrations of diversity, such as celebrating a festival in public. It means defending the right of people to do things you fundamentally disagree with and think are actively bad.11 There can be limits, of course - FGM would be an example of something beyond those limits for me - but if those limits are not well beyond what things that you personally think are good, the amount of real toleration you are displaying is zero.12
Fractional Soul Trading
Selling your soul to the devil is a mug’s game. No matter how much money, power and sex you get, it’s not worth a lifetime of eternal torment.
So while Faust is a great story, the number of people willing to make such a deal will be highly limited. There is therefore a strong incentive for the devils to make such deals more enticing.
One option explored in literature13 is the concept of a get-out clause if one passes a test, or challenge. The sort of person who believes they can strike a good deal with the devil is probably also the sort of person who thinks they can beat this sort of test. But this is a bit complicated and not that scalable.
In a world in which deals with the devil exist and the devils are as portrayed - powerful, intelligent, evil, hungry for souls and incapable of breaking explicit deals - sooner or later, either the devils or the humans are going to invent fractional soul trading.
In fractional soul trading, rather than trading their soul, a person trades a fractional probability of their soul - for example 10% - in exchange for proportionally lesser rewards. Multiple deals over a lifetime would be possible. Upon death, with probability equal to the amount that is owned by the devil, the devil takes custody of that person’s soul; if not, it goes to its normal destination.14
While the expected value of such a deal is still negative infinity, for any given individual, it looks rather different. Yes, they have a 10% - or 5%, or 20% - chance of damnation, but a 90% chance of an improved life, with no negative consequences at all. That is a bargain that many people, sadly, would take.15
Different people might take different approaches. Some might trade 15% or 20% for something they really wanted, such as great wealth, or the perfect partner. Others might trade 1% every few years, for small but significant boosts throughout their career. Those who abjured from such deals would rapidly be left behind.
Unfortunately, this would rapidly become a Molochian situation. Once some begin participating in such pacts, the higher levels of success in politics, in business or the arts could not be obtained without it. It would be the doping scandal in cycling writ large. In any zero sum game, others would be forced to do the same - or abandon any hope of success. The fractions of a typical soul traded would gradually edge up until the probability became too much for people to stomach - and yet each person’s chance of success would be no better than before fractional soul trading was invented.
A good nation would, therefore, prohibit such deals.16 But one can equally see a darker fate. A nation that institutes a draft, in which draftees are forced into fractional soul trading for the good of the nation. Inevitably this would go beyond wealth and infrastructure, to success in military matters, continuing the Molochian arms-race on an international scale, fuelled by the unwilling souls of the partially damned.
A devil’s deal, indeed.
Indeed, if you look at what regulations have been passed over the last 30 years you can see this.
The cat version of HIV.
And as a small digression, having lived in a developing country without universal healthcare, where poor families are every day forced to make these heartrending choices on behalf of sick family members, is why I believe universal healthcare is an absolute non-negotiable of any wealthy country with pretensions to civilised status. We can debate how best to provide it - whether by a European-style insurance system, or a direct public service such as the NHS - but universal coverage is a must.
Talk of fur-babies and the like.
Even for humans, though our willingness to pay is rightly much higher, healthcare is taking an increasing share of national GDP, and NICE must put limits on what treatments are affordable.
This was not a spontaneous act of prayer, but an event for which permission had been granted by the Mayor of London, as part of a series of religious and cultural celebrations.
And, for some reason, providing vast amounts of money. The Colonization model, where greater religious freedom gave you more colonists, at least made the attempt at relating to reality.
Religious expression is not fixed and cannot simply be derived from looking at its Holy Book or other documents. The Christianity in Alfred the Great’s Wessex, in Philip II’s Spain, of a 19th century Evangelical and a 21st century Quaker are all very different.
Indeed, the history of Britain involves a renegotiation of the settlement with Christianity precisely to ensure that it is, from the revocation of privilege of clergy, to blasphemy laws, to battles over the screening of A Life of Brian. One useful test today, when considering what we should permit other religions, is ‘would we accept this of Christianity?’
Nick himself argues that ‘Christianity holds a different place to other religions in Britain' and that Islam has a particular history of domination. There is also a coherent argument, more aligned to the French concept of laicite, that no religion should be allowed to worship in Trafalgar Square. Agree with them or not, either of these positions are self-consistent, unlike the more generic critiques of ‘exclusion’.
As in Scott Alexander’s timeless essay, I can tolerate anything except the outgroup.
You keep your word when it benefits you? You stand by your principles when they lead to good outcomes? You tolerate things that you agree with? How beneficent of you.
Asimov’s ‘Gimmicks Three’, for example.
The devils, being perfectly lawful, can be trusted to administer this probability accurately. It is, indeed, in their interests to do so, for if people knew they weren’t they would stop making these deals.
Hence my suggestion that it could as easily be a human, rather than a devil, that came up with this in the first place.
Though they would no doubt continue in secret.
Re 10, the Church of England DOES have a different position but this tends to get glossed over
Living in France we have found vet's charges to be near half those in the UK with, if anything, a greater level of care. Having had several dogs over the past 50 years we have a pretty good idea of what a good vet looks like. Our local practice here has around 8 full time vets but we choose to see the same one all the time as he came to know our dog well and we believe he treated her as though she were his own. He is married to a vet (not in the same practice) and occasionally discussed our dog with his partner.
Typically, when blood tests are recommended, all but the most complicated are analysed in-house and results delivered 20-30 minutes later. Where human medicines are suitable and are cheaper he wrote a prescription for them, to be filled in our local pharmacy. When she suffered acute kidney failure recently (age 17) he advised that keeping her going would not be kind and we accepted his advice.
Our daughter in the UK has had starkly contrasting service from a local private equity controlled veterinary practice, rarely seeing the same vet twice and with bills that are positively eye-watering by comparison. We discussed the proposed treatments with our vet here and some procedures would be a third of the cost she has been quoted, to the point we are now considering bringing her dog here for treatment and thereby saving £000s.
Is this due to lower standards in France? I really don't think so, and the French are hardly noted for their lack of bureaucracy either. When we told our vet here about the consolidation of veterinary practices in the UK he was shocked and it seems it is at least rare in France, if indeed it exists at all.