An Open Letter to CBS Newsman Bob Schieffer

by Don Boudreaux on December 14, 2009

in Complexity and Emergence, Health, Hubris and humility, Man of System

Dear Mr. Schieffer:

Interviewed on Friday by WTOP radio, you observed that “none of the senators really knows what’s in the health-care bill they’re debating.”  You then excused this ignorance by noting that “the problem they’re tackling is very complicated.”

While you’re correct that trying to engineer an industry that’s one-sixth the size of the U.S. economy is indeed very complicated, such complexity – far from excusing Congress’s ignorance – should be Exhibit A in a criminal indictment of Congress and the White House.  Our world is full of complexities that defy human engineering.  Can Congress engineer winter snow away from Minnesota or summer hurricanes away from the Gulf Coast?  Of course not, and any attempts Congress might make to do so would be seen immediately to be hubris of the highest and most hazardous sort.

Attempts to consciously re-design the health-care industry are equally hubristic and hazardous.  That industry is one of billions of unique, often personal, relationships, each of which is part of countless long chains of efforts to transform raw materials and human effort into life-improving and life-saving drugs and treatments.  Like weather, these long chains of human relationships weren’t designed by anyone.  Like weather, they change and evolve.  And like weather, their all-important details are beyond the comprehension of would-be re-designers.  These long chains of human relationships cannot be undone and reassembled at will by politicians and ‘experts’ without risking enormous unintended catastrophe.

Want proof?  Look no further than your own lament that the very ‘engineers’ – the members of Congress – who are now attempting to redesign the details of the health-care industry cannot as much as read and grasp all of the words on the bill that they’re debating.

If an engineer can’t read and understand even his own blueprint, why should we trust him to understand the vastly more complex reality that his blueprint allegedly represents?  And, more importantly, why should we trust that engineer with the task of redesigning that reality?

Sincerely,
Donald J. Boudreaux

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  • Good argument from you guys. Though I do have to disagree with some of what has been said.
  • jacoboost
    You go girl!

    Sorry, that's all I have to add.
  • PerKurowski
    This is indeed a great post, not meaning of course that the health sector does not need massive amounts of changes, but making clear that those changes, since it is a complicated issue, are most probably better achieved by reducing instead of increasing outside meddling.

    Look for instance at the financial sector were the regulators “the schemers” in the worlds of the Joker, arrogantly believed they could tackle the extremely complicated issue of risk… and look at what a mess they made of it, with their silly capital requirements based on risks perceived by some very few (3) humanly fallible credit rating agencies. You would think they had learned a lesson…but no… since that is the stuff they´re made of.
  • johndewey
    PerKurowski,

    I applaud your suggestion that outside meddling in the health sector be reduced. But I'm not sure I understand your post altogether. Are you saying that the health sector "needs massive amounts of changes"? What needs to be changed? If you mean that medicare should be replaced with a private solution, then I agree. But I'm not sure that's what you are referring to when you write "massive changes". Can you elaborate?
  • PerKurowski
    "massive changes". Can you elaborate?

    First let me clear that thank God I have not had the need to be in close contact with the US health sector nor am I a health sector experts but let me list some of the issues that I would think of including in “massive changes”

    First I would request each hospital to centralize any attention in one single invoice so that every service provider involved is held responsible before his peers on what he is charging. This comes in fact from a personal experience when I had to take an uninsured visiting nephew to a hospital suspecting appendicitis and I received 7 different invoices, some of them from practitioners that I could not for my life remember having done anything… and this is though there was no appendicitis. And so a free for all grab as much as you can system is wrong and should be changed.

    Second, I have seen firsthand how many lay on the uninsured to extract as much as they can, and in a socially important issue like the provision of health, I do not believe that charges for services should discriminate in favor of those insured against those uninsured… the price should be the same for all. The incentives of having the insurance company strive to lower the costs for their clients though important and laudable, on an individual level, do not perhaps provide a reasonable accumulative social result. You can actually see some service provider´s eyes illuminate when they get hold of an uninsured.

    Third, I cannot but feel that the insurance companies have been empowered too much in their relation to the physician and their clients and are using tools that do not really belong in a free market. Some of them might be regulated as to how much they can charge, and so playing it rough might be their only way to extract a decent profit… but, nonetheless I get the impression there are some monopolistic or cartel forces being in play.

    Fourth, worried about the implication for an individual´s health insurance if for instance his genetic map became publicly knowledge, I have always argued for having only one big risk pool, and from where insurance companies can bid for their clients but only discriminate them on the basis of in which State they live.

    Fifth, of course I also believe that some type of tort reform is needed to control the excesses and that this should be perhaps the first bridge any health sector reform would have to pass in order to proceed to the next issue. The way it seems that the legislator will avoid the issue, reflects very bad on them.

    Sixth, to sum it up, no matter how much the interested parties proclaim it, I am not sure the US is getting the enough bang of those mindboggling amounts that are spent on health.

    But, then again, being no health service provider or big health service consumer, thank God and a foreigner on top of it, I could be perfectly mistaken and you might have a system that only requires some marginal polishing.
  • johndewey
    I am not sure the US is getting the enough bang of those mindboggling amounts that are spent on health.

    The latest statistics I've seen show that the U.S. spends 15% of GDP on health care, compared to 11% for Germany and France and about 9% for Italy and Sweden. Perhaps that is a mind-boggling difference to some, but not to me.

    I have seen an estimate that 10% of health care costs in the U.S. are driven by lack of tort reform. I think it is even higher than that, based on anecdotal evidence from members of my family who health care practitioners. So perhaps we in the U.S. spend an additional 1.5% to 2.0% on health care because our health care providers are all afraid of lawyers (They definitely are afraid!).

    Not sure what you know about Americans. Many of us are obese (not me!), in larger percentages than in Europe or Asia. That also drives up health care costs.

    Finally, Americans spend more on health care because we have more disposable income per capita than almost everywhere else. It should not be surprising that we spend a large protion of that extra income on health care.
  • Barbarossa
    Agreed. I've made similar points before. YOU don't mind me agreeing with you, do you? :-)
  • johndewey
    Of course not. And I don't mind when you disagree with me. Now, if you start insulting me the way that one person insults those who comment here, then I might object.
  • johndewey
    "and so playing it rough might be their only way to extract a decent profit"

    Not sure what you mean by "playing it rough". As a consumer of health insurance, I appreciate that my insurance company keeps premiums low by only paying the benefits for which it has contracted to pay. I am very well aware of the insurance fraud perpetuated by patients and physicians in the U.S. Such fraud is so commonplace that many otherwise moral persons have no qualms about getting their "fair share" through bogus claims.

    How would I solve the problem of health care fraud? Spend much more money on investigation and detection. impose long prison sentences on those who are caught.
  • PerKurowski
    Not sure either with what I mean with "playing it rough" and which most probably is exactly why I used it, since I sort of have the feeling they exploit their strength in as many ways they can but, being an outsider, I cannot put my finger on the how where and when.
  • johndewey
    Thanks for the detailed explanation.

    I definitely agree on the need for tort reform, though I feel that is a massive change to our legal system rather than to our health sector. Tort reform would provide huge benefit to more than just the health sector.

    The simplest way to achieve tort reform is to adopt the loser pays principle that the rest of the world follows. Right now, a plaintiff faces little risk in lawsuits. It's been described as playing the lottery. A lawyer for plaintiffs can lose 99 percent of his cases against big corporations and still be wildly successful when a jury awards a multi-million dollar verdict in his favor.
  • whiskeyJim
    Beautifully written sir. I believe it to be one of your best posts in a long line of many. The irrationality of our 'experts' both in and out of politics has become breath taking. I can no longer imagine the future without a stab of fear.
  • Are you any relation to Indiana Jim?
  • whiskeyJim
    I was born in Indiana. My name is Jim. Beyond that, the two words have never been conjoined to describe me:)
  • Cheers
    I'm surprised you didn't grab the low-hanging analogy:

    If an engineer can't read and understand all of the complexities of the blueprint for a bridge, why are we putting our life in his/her hands by letting them build it?
  • Cheers,

    Why should Don have talked about bridges? We couldn't understand his reasoning as it applied to health care without an analogy to bridges?

    What is this, kindergarten?







    Your bridges analogy is fine, but so too are a lot of others. When you write your treatise, you can use any analogy you want. But when someone else had done so, and magnificently, why not just celebrate it?



    not the implication that it was the only way to express the matter and that your dig at Don for having expressed things in his own way rather than yours.

    Your dig at Don was irritating. He did a great job. Why not celebrate it. If you want to suggest a different way of expressing things, that's fine, but why with a dig at anyone who didn't do it just your way?

    Your metaphor was very good, but why not just offer it without the dig at Don? He did a great job. Let's celebrate that, criticize Don for not having used it any more than you for not having used some other? put the matter in his own words rather than yours. He did a magnificent job. Let's just celebrate that. And, if you want to elaborate
  • johndewey
    DG Lesvic,

    What dig at Don? 'I'm surprised you didn't ..." is not a criticism.

    Lighten up, man. Your comments are going to be more easily accepted if you'd refrain from telling other people what they should or should not write. It's not your blog.
  • Barbarossa
    DG, I like you, man, and usually agree with you, but, alas--and I hate to admit this--I have to agree with johnny boy over there. I read Cheers four times and didn't see any sort of "dig." I think he was merely offering up an alternative analogy for the sake of additional clarity. In a certain sense his analogy, I think, was more apt, although Don's do drive the point home with more humor and more mockery of the obvious ridiculousness of our politicians and their schemes.
  • Barbarian,

    You like me and usually agree with me?

    That worries me.

    And you read Cheers four times?

    You must be a glutton for punishment.

    I'm not usually the reverential type. And you might have noticed the numerous occasions on which I have taken issue with Don. But some of his work does make me feel reverential, and I HATE to see it belittled. Just my feeling. You express yours. I'll express mine.
  • Barbarossa
    I'm certainly not trying to censor your opinion, and I certainly didn't imply that you shouldn't express one; all I was saying is that I disagree that Cheers was belittling Don, but if that's how you perceive it, well, you're certainly entitled to your opinion. And I'll continue to agree with you in spite of the concern that that generates for you whenever a statement you make logically necessitates that I as a rational person be in accord with it. But if it'll make you feel better, I won't tell you that I'm agreeing with you :-).
  • "Ya, and it isn't Manila Bay, either, so go steam into Hell," isn't a criticism either, just a friendly suggestion.
  • seanooski
    Doing nothing isn't the answer either, but completely dismantling all the government's interventions into health care is even less likely than passing what they currently "debate". Politics is not about solving problems, capitalism is. Politics is about gaining access to the largess of taxation, and rewarding your accomplices with it. As compelled as I am to follow the politics, I truly loathe politicians.
  • Politics is about conscription.
  • jorod
    If you want to end the love affair with governement control, let the government take over the care and maintenance of all the elevators in Washington, DC.
  • Prof Boudreaux,

    That was one of the most brilliant statements in the history of the human race, and should be carved into Mt Rushmore.
  • In fact, that may be your best yet, which I say after, what is it, now, a year or two, of delight and amazement at your commentary. It must all be assembled into a book, the Sayings of Chairman Don, and don't let false modesty deter you. This must be done!
  • Randomobserver
    It is a very good letter. However, I doubt that Congress is trying to "engineer" a bill that would best help the American people. They're trying to engineer their re-elections. A year ago, this bill would be golden. As popular opinion stands now, I am not sure why there are as many Senators supporting the bill as there are.
  • Don wrote: "Can Congress engineer ... summer hurricanes away from the Gulf Coast? Of course not..."

    That's either a remarkably bad or remarkably good example, I'm not sure which.

    Are you aware that Bill Gates is indeed trying to engineer summer hurricanes away from the gulf coast and who can doubt that he'll turn to Congress to finance it?
  • NathanS
    For anyone who has read the recent Super Freakonomics, this is a somewhat annoying post by Don. It is not Hubris to control the climate. We've been doing it for hundreds of years. These modules will cost on the order of 100 bucks each. A few thousand strategically placed would noticeably reduce the power of a passing hurricane. They would be so cheap you could just let them drift away as the winds came.

    Of course the government will inevitably screw something like this up, but I definitely see a future interest by insurance companies for deploying and maintaining these fields to blunt potential losses.
  • Affecting climate is not the same as controlling climate.

    What effect would such manipulation have on ecological systems?
  • NathanS
    Actually, I think it would be impossible to control climate without affecting it so I have to disagree with your response.

    The environmental impact is a subjective measure that varies from little to none, but since you've been provided a resource to research these avenues I'm sure you've already found the answer.
  • Actually, I think it would be impossible to control climate without affecting it so I have to disagree with your response.

    To control something implies that one can affect it purposefully with predictable results. To affect something does not necessarily imply that one is controlling it.
  • NathanS
    Ahh, and nothing is truly controllable, so the word control is a useless in the English language.

    I guess if nihilism is your thing.
  • It's not useless.
    I control my car pretty well when driving. I have no control over other drivers, though I certainly can affect them.
    I control hand tools pretty well.

    However, we have no knobs, dials, wheels, etc. for "controlling" climate, though it seems pretty certain that we can "affect" it to some degree. The important thing to realize is that other things affect climate far more than we do.
  • NathanS
    Sulfur dioxide pumped into the atmosphere is a fairly cheap and simple way to directly reduce the temperature. The level of control over a car or a climate is all a matter of perspective. At one point the climate will be a function of a dial, and we are quickly approaching that point. Once again, if you have read anything on the subject, the prospect of cooling the climate is fairly simple.
  • I agree that we can affect the climate.

    If you cool the atmosphere, what will the ocean do, how will cloud cover be affected?

    What if there is also a major volcanic eruption?

    What brings on ice ages?

    What ends them?

    Do you know the answers?
  • NathanS
    What does driving your car do? Warm the climate? Release soot? Based on your statements cars should be outlawed.

    You seem to claim that it's impossible for us to affect the environment with our cars, but harp against the intervention in the climate to counter that heating in the event that it happens. How is this any different that those seeking to control climate change by impoverishing and starving millions of people for marginal reductions in CO2?
  • I'm making no such claim.

    The discussion is about the difference between "affect" and control. I agree we can affect the climate, and perhaps in a desired manner, but we should never mistake our ability to affect the climate with our power to "control" it.

    It should be obvious that not all of the factors that determine climate are under our control.
  • NathanS
    And to some extent the control over your car is an illusion. You only control your car under a specific set of circumstances. Try controlling your car while it's floating in the air, sitting in water, or when it is too cold or hot for you car to operate. This is no different than the objections you produce for the control of the climate.
  • I don't know why you're getting into the metaphysics and semantics of it. Perhaps your psychic penis needs relief.

    I get in my car and just about 100% of the time, I reach my intended destination by traveling on prepared surfaces, which is within my expectation.

    I do not grant that we have the power, at this point in time, to "control" the climate anymore than I think human activity to date has had any significant impact on climate.

    If you think affect and control have the same meaning, then I suggest you fetch a dictionary.

    Do we have a sound explanation for the cooling from the '40s to the '70s?

    What is the most significant factor that determines atmospheric CO2 levels?
  • NathanS
    Ahh yes, the famous psychic penis argument.

    So I guess when I want to use the word control I must consult my hierarchy of controllability diagram, as furnished by Sam Grove, to find out if you individually agree with the subjective use of a word, because if not I've violated the sanctity of the psychic penis.
  • Methinks1776
    Tryin' ain't doin'.

    I believe the professor said they can't do it, not that they won't pour all of your money down the toilet trying.
  • Gary
    For the kind of money this health bill is going to cost, I'm not so sure they couldn't engineer summer hurricanes away from the gulf.

    It wouldn't be a prudent use of taxpayer dollars, but what Federal program is?
  • vidyohs
    Sheeeeet Mon! For de money dey be tro'n round they gonna done move da Gulf Coast, not de hurrycane.

    Dey on're pro'em is dey doan know where to put de Golf Coast.
  • Barbarossa
    lol
  • Excellent letter.

    Poor journalism abounds. I'm amazed at the stuff that wouldn't pass muster in my high school media and debate courses that are considered respectable journalism.

    I gave some credit to Kroft last night on 60 Minutes for pushing Obama on the monstrosity of heath care bill, but then Kroft let him change the subject and essentially say, 'something is better than nothing.' He should have followed up with, 'Maybe not. Are you sure? Has your desire to pass something overridden your desire to pass something that works?"
  • Truck_Party
    Good stuff, it'll go over his head though.

    i'd bet someone's showed you this, but in case they haven't, caplan vs. hayek. http://econlog.econlib.org/archives/2009/12/two...
  • Marcus
    Once you've reached the conclusion that people are either helpless, ignorant, irrational or otherwise morally inferior to yourself then you can rationalize the taking power over them.

    To be a progressive is to have a bleak opinion of human beings.
  • Mark
    I listened to an interview with Robert Reich on the radio on the way to work last week, and it was pretty clear from the answers that he does have a bleak opinion of human beings.

    In his view of the world, humanity needs people like himself to tell them how to think.
  • brotio
    Mark,

    You've seen it right here at the Cafe with Yasafi. We have in our midst a medical doctor who believes that only politicians can determine how much liberty a man needs in order to be free.

    Doesn't matter whether that politician ever held a private-sector job (that's probably a disqualifier to Yasafi, anyway). If a politician has a "D" at the end of their name, then they are imbued with wisdom beyond mere mortals.
  • vidyohs
    Yeah brotio,

    And another thing that should be scaring the hell out of folks is the upfront in-your-face announcement that if Congress doesn't pass a Cap and Trade bill that Obama likes, then the administration is going to shift into the Dictatorship mode and the EPA will rule by fiat.

    To Congress, "You do it as people's representatives, or we do it as King and court."

    Not too much of the principles of freedom and a republican form of government there.
  • Methinks1776
    Well, at least all other human beings.
  • JohnK
    That's how progressives define equality.
    They are equal, everyone else is inferior.
    They tolerate each other, everyone else is not to be tolerated.
    They include each other, everyone else is not to be included.
    They respect each other, everyone else is not to be respected.

    In their mind that makes them tolerant, inclusive, respectful believers in equality.

    In my mind they're a bunch of liars and hypocrites.
  • Gil
    That doesn't make any sense. The term 'Progressive' has become the new term over 'Socialist' for Libertarians and refers to someone who's not a Libertarian and therefore evil. And, of course, Libertarians use the term so wildly it doesn't make sense to any non-Libertarian.
  • Methinks1776
    Huh....I think a fellow called Orwell wrote a little book about that a while ago. Got the word "farm" in the title.

    BTW, in my mind they are simply the enemy of everything that makes life worth living.
  • Marcus
    True!
  • ArrowSmith
    Bush/Cheney got away with "war crimes", so this is ok.
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