The shape of progress

The French author and poet Paul Valéry (1871—1945) wrote, ‘‘Like a man rowing a boat that floats on the tide, we enter the future facing the past. Our eyes see only the landscape of the past; what tomorrow looks like, nobody knows.’’ Certainly, none of us has knowledge of what tomorrow may bring. To Valéry’s quotation we can add that, while looking at the past, we head into the future with our backs to it. To guide ourselves in this backward-facing journey, we make use of our experience and our five senses—–sometimes a sixth sense. Consider the case of a man walking backwards. He sees out of the corner of his eye pine trees here and there. Through the soles of his feet, he senses that the ground has turned sandy. His ears pick up the sound of waves, gradually getting louder. He smells salt in the air. Naturally he concludes, in his backward-walking journey, that behind him spreads the sea. But is it a small cove, or the great ocean itself? He does not know, and still the land in front of him is carpeted in green. With confidence based on his experience and knowledge of the path he has just trod, and through intuition he has cultivated on his journey, our traveler has acquired the skills he needs to continue, and applies them step by backward step. Let us look at some real-world examples of the principle of verification while looking back. In Japan’s healthcare field, public health insurance carries great weight. In the system’s biennial revision process, the Japanese Association for Dental Science (JADS) puts together a list of items it wants covered under public health insurance and submits its request to the national government in the form of a ‘‘health technology proposal.’’ The national government then examines this submission. Whereas in the past, dental coverage was granted to only about 15% of the items on the submitted list, in the 2016 revision, coverage was extended to an unprecedented 50% of them. I believe this was due to