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和魂と洋才と医療の崩壊(上)

前回、ギルド社会で赤の他人を信用できるのは評判メカニズムのおかげであり、そしてその信頼関係は異分子の混入に対して脆弱なので、ギルド社会は本質的に排他的にならざるを得ない、ということを書いた。それこそが銭湯などでの「日本人は外人を差別する」というお約束の主張につながっていくのだ、という所で〆たわけだが、別に異分子とは外人に限らない。ギルド社会が機能不全に陥れば、誰だって異分子になってしまうのだ。今日はそんな話を。

人間社会と人間の意識、そして人間の選択

医療の話に入る前に、前々回のおさらいもかねて評判システムのメカニズムをもう一度確認しておきたい。とある社会に多くの人がいて、この人々は互いに協力しながら頑張って生きているとしよう。そして、世の中の常として、裏切りは少なくとも一時的には得になる。仕事をサボって相手に押し付ける、売上金パクって逃げる、などなど、挙げればきりが無い。

もし裏切られた場合、その人はギルドのメンバー(社会の人々)に「こいつが裏切りやがった」と伝えて回る。そうすると、「なんて奴だ」と全員がこの裏切り者を排除(村八分)する。裏切り者は一時的にはパクったお金で儲かるかもしれないが、もはや二度と雇ってもらえなくなるので差し引きマイナス。これが怖いから誰も裏切らないようになるのがギルド社会での人間関係であり、だからこその信頼関係だ。この仕組みが機能している社会では、他人を疑う必要が無い。相手が善人であることを前提に生活できるのである。これはまさに性善説だ、と前回書いた。

「自分の利益を出来るだけ増やそうとする人間の行動を考える(注1)」というのは経済学で一般的な仮定だが、これは社会学や哲学系の政治学をやっている人にはどうもお気に召さない考え方であるらしい。「人間はそこまで機械のように合理的ではない」「人間は自分のことだけを考えて生きているわけじゃない」などなど、似たような反論は山ほどある。要するに、経済学が考える人間の行動原理が間違っているというわけだ。そして、例えば「人間は生まれながらに性善説に従っている」ことを前提に社会を語ったりする(注2)。しかし、上の議論から出てくる結論はこれの逆をいく。人間は自分の利益を増やすためにギルド社会を形成し、その上で「他人は皆善人」と考えるようになるのである。社会学などでは性善説は理屈抜きの仮定だが、ここでは性善説は合理性から導かれる結論であり、現象なのだ

こう書くと、「でも私は他人に優しくするときに『村八分が怖いから』なんて考えてない。自然にそうしているだけだ」と反論されるかもしれない。だが、別に経済学では全ての人が「いちいち意識して」合理的な選択をしていると考えているわけではない。最適な選択に意識は必ずしも必要ないのだ。意識など無い宇宙の天体が、重力その他の要素を考慮した物理学の最適解に「従って」動いているように、我々もまた無意識のうちに最適な行動をしていると考えることは出来る。前回少し触れたように、子供のモノの感じ方は親や社会の影響を強く受ける。「他人に優しく」「わがままを言わずに我慢する」「相手のことも思いやる」というのは、長い時間をかけて練り上げられた日本社会を生き抜く処世術であり、それゆえに倫理となる(別の社会には別の倫理があるのは、システムが違うから)。我々のものの感じ方は社会の在りようから無関係ではいられないのだ。例え「理屈ではない心からの感情」を感じたとしても、その感じ方が「その社会を効率よく生き抜くための最適の感じ方」である可能性は考えておいたほうがいい。


救急システムの崩壊

話がそれた。タイトルどおり、医療の話に戻ろう。日本の医療システムが崩壊しつつある、というのは、ここ数年よく議論されるようになった。産科医療の崩壊の話はマスコミとネットを賑わせているし、救急車の問題も深刻だ。総務省の統計では、2002年までの過去10年間で救急出動回数は約65%増。こちらの地方記事では、高松市では本来救急車を呼ぶ必要の無い案件が4割あった、とのことである。こちらの記事では、平塚市では救急出動のうち軽症患者が7割とあるから恐れ入る。

この記事の中でも指摘があるが、日本の救急車というのは性善説を大前提にしたシステムだ。無料であり、しかも一度電話がかかってくれば必ず出動しなければならない。このようなシステムに異分子が混入すると悲惨なことになる。「全ての患者は正直に自分の容態を話し、本当に必要なときしか救急車は呼ばない」という前提で社会が回っている以上、例え嘘であろうとも救急隊員はその患者に全力を注ぎ込まざるを得ない。そして、彼らが頑張れば頑張るほど、その分のしわ寄せは他の正直な患者に回り、事態はどんどん悪化する。銭湯の垢が他の利用者に引っ付くように、問題は拡散していく。

何故ここ10年で増えたのか、をはっきりと説明することは難しい。高齢化のせいもあるだろう。だが、ひとつ断言できるのは、この救急システムはギルド型の観点からも洋才型の観点からも到底正当化できない代物だ、ということだ。

まずギルド型のシステムから考えよう。上で書いたように、評判システムが機能するには、社会全体、または裏切り者を処罰するのに必要な人たちに、「誰が裏切ったか」を迅速に伝える仕組みが無ければならない。そして、裏切り者を排除できなければ、村八分は完成しない。銭湯であれば、居合わせた人と番頭には瞬時に情報が伝わるし、番頭が出入り禁止を申し渡すことも出来る。出入り禁止にならずとも、同じ銭湯に通う人が銭湯の外でも会う可能性は高いし(銭湯に通う人の所得や生活スタイルは似ている可能性が高いため)、そうなれば恥ずかしい思いをするのは粗相をした人だ。

しかし、救急車の場合、裏切り者(軽症なのに救急車を呼ぶ人)の情報が救急センターで止まってしまう。地方の一戸建てならどこに救急車が止まったか分かるかもしれないが、夜のマンションなら裏切り者の特定は近所の人間にすら不可能だ。そもそも、都会では、同じマンションの住人は同じギルドのメンバーとは限らない。人間関係が無ければ、そこにギルドは存在しないからだ。違うギルドのメンバーに情報が伝わっても、裏切り者を処罰できるわけが無い。

そして致命的なことに、唯一裏切りの情報を持っている救急隊員にはこの自称患者を村八分にする権限が無い。例え常習者だと分かっていても、「万が一」のために駆けつけざるを得ない。例えそうすることで別の患者の命が危険にさらされることがあったとしても、性善説を前提にする限りはどうにもならないのである。このような状況では、日本人だからといってまじめに救急車を使う理由は無い。ギルド社会を統べる評判メカニズムが、救急システムでは全く機能していないのだから。

「なら何で今までは機能していたの?」というのは当然の疑問だろう。筆者が思いつく理由は二つ。まず、過去20年で地域社会のギルド的なつながりが薄れ、村八分の効果が薄れてしまったこと。顔も知らない人間に村八分にされても特に困らないのである。逆に、今でも社会的な立場がある人間は横紙破りはしない。

もうひとつは、もともと日本人は「みな善人である」と勘違いをしていたに過ぎず、現在はその勘違いが解けていく過程にあると考えること。上で、我々が無意識にギルド社会での最適な行動を選んでいる可能性について書いた。無意識に選んでいるということは、突然違う情況が与えられたときにその状況に即応できないということでもある。我々は評判メカニズムが機能する所(銭湯や、会社組織など)を見て、皆善人なのだと錯覚した。その錯覚は、評判メカニズムが機能している限りは正しいので問題にならない。しかし、その錯覚を評判メカニズムが機能しない救急活動の分野にも適用すると、その社会はゆっくりと綻んでいく。最初のうちはいい。救急隊員に負担がかかっても、救急隊員は必要以上に頑張ってしまうので問題は顕在化しない。上で書いたように、この裏切りの情報は第三者にはほとんど伝わらないので、例え患者が完全に悪いケースでも、治療に失敗すれば全く悪くない救急隊員が叩かれる可能性は十分にあるのである(第三者は、評判メカニズムが機能していると思っているので、患者が間違っているケースをそもそも想定しない。だからこそ救急車を叩くのである)。それを恐れる救急隊員は必死に働かざるを得ない。そして、彼らが頑張るほど「裏切り者が救急車を呼ぶメリット」は高まることになる。その結果、裏切り物の数は更に増える

当然、この状況では、裏切り者の数は緩やかに増えていく。そして、救急隊員の体力はどこかで限界に達し、社会問題として顕在化するその段階で上の錯覚が完全に消滅する。「なんだ、救急車って無料タクシーとして使ってもいいんじゃないか」と。その結果、救急車を自分勝手に使う人は急速に増加を始めることになる。善良なる読者の方は、「社会問題になったら行動を慎む人が増える」と思うかもしれない。しかし、その考え方自体がギルド社会的な発想である。評判メカニズムが機能している社会では、社会問題になるほどの事をやらかしたら大変なしっぺ返しを食らう。しかし、救急システムに評判メカニズムは存在しないのだから、しっぺ返しを恐れる必要は無いのである。馬鹿なのは「みんなでモラルを守ればうまくいくのに」などと甘い錯覚を後生大事に抱えている人たちであって、そんな人たちに付き合う合理的な理由はどこにも無い。

問題なのは、この問題を考える政治家やお役人は未だにこの手の錯覚を抱えて生きている可能性があるということだ。彼らは特殊な職業についているため、日本中どこでも評判システムが機能してしまう。その分、日本にもギルドが成立しない社会があることに気付けない。評判メカニズムの外で生きている「異邦人」な日本人が増えていることがわからない。その結果、最前線にいる人たちに向かって「もっと頑張れるはずだ」「つらいだろうが頑張ってほしい」などというコメントをしてしまう。上で書いたとおり、最前線の人たちが頑張れば頑張るほど、裏切り者の数は増えていく。「頑張れ」という言葉を安易に口にする政治家たち(マスコミを含めてもよい)は、この10年間で問題を更に悪化させてきたのである。

更に皮肉な見方をすれば、過去10年間、日本人は評判システムの外側で救急車をタクシーのように使う人を叩けないので、代わりにまだギルドのメンバーである医療関係者に「もっと仕事しろ」と鞭を入れることで、問題をかろうじて糊塗してきたとも言える。但し、こんなやり方は当然長続きしない。ギルド社会が社会として安定するのは、「和魂と洋才とユダヤの商人」で書いたとおり、「メンバーの全てにとってギルドに所属することが最適」という状況があるからである。このような機能不全に陥ったギルドからは、商人は少しずつ離れていく。医者になる人間は減るか、または海外に職を求めることになる。誰が悪い、ということを言いたいわけではない。無意識のうちに我々が行動を選んでいる場合、このような「負担の局所集中」は短期的には避けがたいギルド社会の現象なのだ。そして、長期的には、集中した負担は別の方法で解決されるか、ギルドそのもの(この場合は救急医療ギルド)が消滅することで解消される。


救急システムを救う3つの方法

この問題を解決する方法は2つある。ひとつは、評判システムを立て直すこと。例えば、「軽症であるにもかかわらず3回救急車を呼んだ場合、それ以降はブラックリストに載せて119番に対応しない」というやり方。救急システムから村八分にしてしまうのである。

こう書くと、「じゃぁその人が本当に病気になってしまったらどうするのか」と思う人は当然いるだろう。しかし、彼らオオカミ少年(むしろ中年や老年が多そうだが…)はきっちりとオオカミに食べられてもらわないと社会システムが成立しないのである。自力で病院までたどり着ければ良し、もし気力・体力・財力が足りないのであればそのままお亡くなり頂くしかない。後は村八分の掟に則り、しめやかに葬儀を執り行うことだけが社会の責任だ。

何を冷酷なことを、と思われるかもしれない。しかし、第1回で書いたとおり、ギルドの性善説的社会を維持しているのは「評判を落としたら大変なことになる」という恐怖心である。村八分が「大したこと無いじゃん」と思われてしまう社会では、誰が裏切ってもおかしくは無い。我々は裏切り者をとことん冷たく扱うことで、初めてそれ以外の人たちに優しくすることが出来るのだ

ただ、「救急車にブラックリストなんて納得できない」と思う人はそれでもいるだろう。そこで、全ての人を公平に取り扱う洋才的な解決法も紹介しておく。それは、救急車の有料化。出来れば完全前金制が望ましい。洋才社会では「社会の秩序を乱す悪者」をあらかじめ排除することが出来ない。そして、それを知っている利用者の側には自制する理由が無い。とすれば、金を払わせることで自制する理由を作ってやるしかない。この場合、救急車に載せる前が勝負である。担架よりも早くクレジットカード端末を差し出し、金が払えないのなら病人は放置して撤収すべきなのだ。後日請求にすると踏み倒す輩が出てきて余計なコストがかかってしまう。もちろん、「支払能力はあるけど手持ちが無い」という人を救うために後払いを認めてもよいが、借金の取り立てのコストの分だけ納税者は増税を我慢せねばならない。

もうひとつの洋才的解決法は、法律で「救急車は適正に利用すべし」と規制をかけること。こちらの記事を見ると、度を越したケース(救急隊員に暴行を働くなど)では刑事告発も行われているらしいが、「救急車の適正利用」を明文化することはなかなか難しい。想像もつかないような不正利用があったとき、裁判所では当然揉める。時間も金もかかるし、その結果として社会的に望ましい判決が出る保証も無い。むしろ、「何が適正か」の判断を救急隊員に任せる評判メカニズムの方が、まだうまくいく可能性は高いように思う。もちろん、これは救急隊員にかなり大きな政治力を持たせることになるので、彼ら隊員自身も「評判メカニズム」の監視の視線に耐えて自らを律せねばならないが。

さて、救急医療はとりあえずの解決策がありうるとしても、実は産科医療はこれよりも更に難易度が高い。長くなったので、その辺りは次回に軽く説明しておきたい。


本日のまとめ

評判メカニズムで大切なのは、裏切り者の情報が適切にギルド内に伝えられること。

我々は必ずしもいつも「意識的に」最適な行動を取っているとは限らない。無意識にでも、その社会で生きていくために最適な行動を取るよう教育されていることはありえる。

無意識に行動を選んでいる場合、何らかの理由で評判メカニズムが機能しない場合でも、それと気付かないまま同じような行動をとり、そして相手にも同じ行動を期待することはありえる。その結果、評判メカニズムが機能していない場所でも「あたかもそれが存在するかのように」見えることがある。

この錯覚が、一部の裏切り者の悪事を一時的には覆い隠す(裏切り者がいても別の人が更に頑張ってしまう)。しかし、これは結果として問題を更に悪化させ、いよいよ社会問題として顕在化したときに、錯覚は消滅してこのギルド社会は崩壊へと向かい始める。

注1:ここでは敢えて「合理的」とは書いていない。合理的というのは幅広い概念で、「他人に尽くすことが自分の使命」と思っている人も合理的になってしまう。他人に尽くすことから自分の幸せを得ているのだから、彼・彼女は自分の幸福を最大化する合理的な人間なのだ。ここでは、もっと利己的な人でも「他人を信頼する善い人間」になれるという話をしている。

注2:社会学とかは全く知らないので、実際にこういう議論があるかどうかは知らない。ただ、社会学や政治学を勉強した人には、この手のイデオロギーを不可侵の前提条件として話す人が多いように思う。これが引き起こす問題はこのシリーズの後のほうでもう一度考える予定。

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Comments

このギルド型、洋才型は山岸俊男「安心社会から信頼社会へ」が述べる安心社会、信頼社会に当たるように思います。
上記は社会心理学の本で、洋才型は「人間、特に理由がない限りそうそう悪いことはしないものだ」という多くの人が考え行動するから成立する、を社会心理学ならではのエグい実験の数々から定量的に明らかにしています。そしてギルド型社会に暮らす日本人は、そうした他者への信頼が弱いことを。
他にも学歴と他者への信頼が見事に比例すること、他者を信頼する人間は裏切られると反撃が厳しいこと、その逆も成り立つこと、等々。山岸先生の主張は私の生活実感に合っておりまして、本稿の脱線の中で経済学と社会学の人間観が述べられていますが、どちらも極端に過ぎるように思います。

Posted by: forsterstrasse | December 02, 2007 at 07:17 AM

馬車馬さま

少し例が悪いように思います。救急医療に限らず、日本の医療の問題点はお金の問題ではないでしょうか。たしかGNP比で先進国最低だったと記憶しています。そして医療崩壊を起こしているのは実は公的医療制度の先輩(というか先生)である英国にも共通しています。

救急車の問題ですが、こういった不埒な人間がある程度出るのは仕方ないのでは?むろんここ数年でやたら増えたというのであればそれは大きな問題ですが、そうでもないように思います。

Posted by: SLEEP | December 03, 2007 at 08:30 PM

ギルド型、法規制型の中間として、
"会員制"が考えられます。
違反行為等が明文化されたギルドを
自前で用意するイメージになります。
救急医療の場合公的な側面が強い為、
保険診療・受け容れ能力の査定など
法的な調整が必要になりそうですが、
銭湯程度なら問題ないように思います。
レンタル業(故意でなくても裏切りが発生しやすいサービス)や
ウェブサービス(社会的な村八分が行えないサービス)では、
会員制の業態が多いようです。

Posted by: Tezooka | December 05, 2007 at 10:33 PM

救急搬送はかつて事故を対象としたもので、
病気は含まれていなかったんです、、、
それが病気も搬送対象とするようになり、
それから年数もだいぶ過ぎたので

呼ぶのが当たり前のようになった面もあるかもしれません
高齢者は有病率が高いので、高齢化による数の増加も
無視できないようです。

ただ現場にいるものとしては

ご指摘のように、
歯が痛くても呼んだり

あるいは飛行機の時間が迫っているので、飛行場方面(40kmくらい離れている)に向うように救急車に要請し、その途中でもっともよい病院に連れて行ってくれと依頼されたり

その間、、、地域には救急車空白の時間が生まれ
ほんとうに緊急性がある場合に対処できないことになります

ということで、あるひとりのわがままな人によって、他の助かる命が奪われている可能性があるんです。

Posted by: ossanpower | December 08, 2007 at 04:56 PM

forsterstrasseさん、コメントありがとうございます。

その本は読んだことが無いのですが、字面だけから考えると安心社会が第1段階の血縁重視(理屈度外視)、信頼社会が第2段階のギルドであるようにも思えますね(法制度が完備しても信頼社会は成立しますが)。

日本人は他者を信頼しない、というのは興味深い結論ですが、そもそも著者は信頼をなんであると定義しているのでしょうね。状況に一切左右されない無原則な行動原理なのか、それとも暗黙の社会契約のことなのか。法制度に支えられた明示的な信頼関係なのか。また、無意識そのものが社会の中で内生的に決定される可能性を考慮しているのかどうか。その辺りが分からないとちょっと何ともいえない気がします。

相手の学歴が高いと相手を信頼しやすいのはギルド社会では理解しやすい現象だと思います。それは、「村八分にされたときに失うものが大きい」からだと解釈できます。自分の学歴が高い場合、その交友関係もまたある程度学歴が高い、又は学歴以外でも失いたくない何かを持っている人が多いでしょうから、平均的に相手を信頼しやすくなるとは言えるでしょうね。

信頼が深いほど裏切ると手ひどい反撃を受けるのはこのエントリーで書いたとおりです。むしろ、手ひどい反撃を前提にしているからこそ、深く信頼できる、と考えるわけですね。

極端だというのはおっしゃるとおりだと思います。そもそも、最近は社会学も政治学もゲーム理論やネットワーク理論を使った数理的なものが随分増えているそうですし(アメリカでは最早そちらの方が主流なのだそうです)、社会学全体を一くくりにするつもりはありません。注で書いたとおり、イデオロギーを前提で語る人たちに向けて、「その考え方は的外れかもしれないよ」と書いているに過ぎませんので。まぁ、極端に書いたほうが分かりやすいからということもあるのですが。

Posted by: 馬車馬 | December 08, 2007 at 11:19 PM

SLEEPさん、コメントありがとうございます。

お金の問題だというのはおっしゃるとおりで、効率的な社会システムを考えることとどれだけのコストをかけるかは別の問題です。これは次回もう少し詳しく書くつもりです。ただし、このエントリーで書いたような構造がある限り、2倍のコストをかけても効率は改善されず、むしろ問題は悪化すると思います。

それから、エントリーの最初のほうで書いたとおり、救急車の出動回数がここ10年で急増しているのは事実のようですし、それに対する対策が必要なこともまた事実です。SLEEPさんがおっしゃるとおり、そういう人が出るのが仕方ないことであるなら、それを前提にした社会システムを構築すべきだと思います。

Posted by: 馬車馬 | December 08, 2007 at 11:30 PM

Tezookaさん、コメントありがとうございます。

個人的には、会員制は会員のみに排他的にサービスを提供する業態という意味でギルドの一種ではないかと思います。ギルド型社会というのはバリエーションがたくさんあるのだと思います。次回少し違う形のギルド社会を紹介するつもりです。歴史的にも、洋才型社会へと過渡期のモデルとして認知されているものです。

Posted by: 馬車馬 | December 09, 2007 at 12:10 AM

ossanpowerさん、コメントありがとうございます。

救急搬送が事故のみを対象としていたというのは初めて知りました。急病を含めるというのは社会的な要請としては正しい方向だとは思うのですが、やはり本来の目的とは違う使い方をするとどっかにほころびが出来るもですね。

日本の救急医療は、「全ての患者に誠意を持って全力を尽くす」という原則のせいで、不心得者の数が少数でも、救急スタッフが彼らに振り回されてしまうせいで問題が加速度的に悪化する(増幅される)点にあるように思います。このシステムを維持するのであれば、やはり患者の選別は何らかの方法で行わざるを得ないと思います。過去の行動で選別するなら評判メカニズム、「どれだけ金を払えるか」でどれだけ切羽詰っているかを選別するなら有料制。そろそろ厚生労働省も真剣に動かないと間に合わないような気がするんですが、デリケートな問題でもあるので政治家が動かないとどうにもならないかもしれませんね・・・

Posted by: 馬車馬 | December 09, 2007 at 01:31 AM

二次救急の現場の実感としてこの論説が正しいということは理解できます。現場でいろいろ文句を言う患者は急増しましたが、それはマスコミと弁護士が医療はとことん注文をつけてもよいサービスである、と海外の一部病院を例に周知徹底したおかげでしょう。国内の大衆食堂で海外の高級レストランなみのサービスを要求させるのは詐欺ですが、たしかに海外で一般保険で病院にかかる人は少ないので、詐欺で回る国内マスコミの実態をふまえると、幻想は解消されないでしょうねえ。実際には受け入れる病院側も、ある程度ブラックリストを作成していて(薬物依存・精神的な不定愁訴のリピーターリストもあるんですが)それに応じて対応の優先度を決めているのですが、本人に対して表だってペナルティを宣言できないと本人も不利益を自覚できず、行動に変化が生じないでしょうね。宣言すると応召義務違反で共産党や公明党が地方議会でやり玉に挙げるか、マスコミの餌食になるかですし。厚生労働省みたいに全体に受診抑制を宣言すると、生真面目な人は手遅れになるまで受診せず、とほほ患者は受診を繰り返します。所得と、とほほ度に相関はないのか、金銭的なハードルはあまりとほほ率を下げないですね。軽症だけれど昼間は仕事で受診できない層が、救急車こそつかわないものの、夜間救急にくるようになったのもこの数年でしょうか。視聴・購読に依存するマスコミ、投票に依存する政治家、大衆を味方につけたい弁護士、なにかとネガティブな形でしか取り上げられず人気回復を必要とする警察、という評判依存産業(実は結構広いですね)の人たちにとって大衆相手の糾弾は致命的であり、比較的少数の医療集団に責任を押しつけるのは短期的に見れば合理的です。しかも大衆側も短期的利益に反応する朝三暮四状態なので、なんだかなあ、ですね。応召義務撤廃は現場では言われてはいるんですが、Tit For Tatをよしとしない外交・防衛での国民の反応を見ると、とほほ患者にペナルティを与えることについて、過半数の賛成は得にくいでしょうね。

Posted by: ぷー | December 11, 2007 at 11:26 AM

モラル(Moral)対ギルド?

モラルが高く、歴史のある国は比較的法律が緩い気がします。移民も多く、国家のモラルが結成されてない、又は国民が自国に対し自信を失っている時、法律という名の紙面上/ルール上モラルが必要になる気がします。

個人的意見ですが、今の日本には宗教がなく、国民に全く自国愛がない気がします。戦時中のように天皇万歳な時代に戻れとは言いませんが、最近中国で儒教を見直す動きがあるように日本でも儒教を見直したらいいのに、なんて思います。結局歴史を辿っていけば私達のモラルはそこから来ているのですから。

Posted by: umm | January 08, 2008 at 01:08 PM

日本の医療問題の根幹は、単に国公立医学部の定員をなぜか異常に絞り続けた、という部分であって、他の要素はおまけみたいなものなんですけれどもね

Posted by: スープ | January 22, 2008 at 10:08 AM

ぷーさん、コメントが大幅に遅れて申し訳ありませんでした。
来週には余裕が出来るはず、を数週間続けて、とうとう数ヶ月が過ぎてしまいました。

現場にいらっしゃる方のコメントは私のように頭でっかちに議論を進める人間にとっては大変参考になります。オーバークオリティを要求するのは日本人の悪い癖ですが、通常はそれでもある程度のなぁなぁは許されているように思います。

医療が特に問題とされることが多いのは、ある意味医療業界全体が日本社会から村八分に遭っているからではないかと思うことがあります。実際、過去(数十年前)に「医者の態度が悪い」「医療過誤の隠蔽」といったことは実際にあり、そしてそのさい医療業界がそれに対して適切に対処してきたとは正直思えません。それが積もり重なって「医療業界は信用できない」という気風が生まれ、「医療業界の言うことは信用する必要は無い」「医療業界へのバッシングになるならば情報の正誤に関わらず何を言っても(書いても)良い」という流れが出来上がってしまったのではないかと(官僚も同様の流れがあるように思います)。この辺りは後でまた書くかもしれません。

横紙破りと所得には相関が無い、というのは大変面白いお話です。やはり、日本人の行動を縛るのは人のつながりであって、給与や恐らくはそれに付随する教育水準などではないのではないかと思います。多分、全員社内の診療所経由で専門病院に来診、という仕組みにした瞬間、借りてきた猫よりも静かになる日本人は多いのではないかと思っています。この辺りは次回に書く予定です。ちょっとまだ全体像の再構成が終わっていないので、その後の予定ですが・・・

Posted by: 馬車馬 | March 02, 2008 at 05:23 PM

ummさん、コメントありがとうございます。

そもそも、モラルというのは社会の明文化されていないルールを強制する「何か」につけられた名前であり、むしろ移民が多くなると必然的にモラルも低下する、というのが私の考え方になります。(人々の自信も実のところ理論上モラルに影響するのですが、その点はその内書いていくつもりです)

儒教というのも、どのレベルの儒教に戻るかで揉めそうではありますね。孔子の教え原理主義で行くのか、江戸時代に日本独自に発達した朱子学(や、そこからの派生)を根本とするのかで随分結果が違いそうです。

Posted by: 馬車馬 | March 02, 2008 at 09:50 PM

スープさん、コメントありがとうございます。

そんな理由があったとは知りませんでした。どうして定員を絞ったんでしょうかね?

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