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In my column for the December 23rd, 2009, edition of the Pittsburgh Tribune-Review I did my best to expose the hubris of politicians (and their advisors) who were then re-engineering the U.S. health-care system [2]. You can read my column beneath the fold.
A bridge too far
Modern standards for decent and sensible behavior by politicians are pathetically low. The same actions that would get any executive in the private sector fired (and perhaps sued) are routinely overlooked, even excused, when committed by politicians.
Case in point: When interviewed about health care legislation a few weeks ago on a local Washington, D.C., radio station, revered CBS newsman Bob Schieffer observed that “none of the senators really knows what’s in the health-care bill they’re debating.” Mr. Schieffer then immediately excused the senators’ ignorance by pointing out that “the problem they’re tackling is very complicated.”
Well, yes. Trying to restructure an industry that constitutes one-sixth of the United States economy is indeed complicated. It is so complicated that it’s impossible to accomplish without risking catastrophic failure.
Our world is full of complexities that defy human engineering. Can Congress engineer winter snow so that it never again falls on Minnesota? Can it engineer human romance so that none of us ever again suffers a broken heart?
Of course not. Any attempts that Congress might make to do so would be correctly read as arrogance of the highest and most hazardous sort.
Attempts to consciously redesign 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 and the mysteries of love, these long chains of human relationships weren’t designed by anyone. Like weather and love, they change, often unexpectedly; they also possess as many unique properties as there are persons involved.
And like weather and love, their all-important details are beyond the comprehension of would-be redesigners. These long chains of human relationships cannot be undone and reassembled at will by politicians and “experts” without risking enormous and unintended catastrophe.
For proof, look no further than Mr. Schieffer’s lament that the very “engineers” — the members of Congress — who are now attempting to redesign the details of the health care industry cannot themselves grasp the full meaning of, or even simply read all the words in, the bill that they’re debating.
It’s as if a committee of engineers trying to design, say, a bridge to connect New York and London draft a blueprint that is so huge and complex that none of the engineers can possibly comprehend its details. No engineer knows, or can know, exactly what it is he or she is helping to engineer.
Each engineer might fervently endorse the prospect of a bridge to connect North America to Europe. Each engineer might be able to offer a long list of all the wondrous benefits that a trans-Atlantic bridge would bestow upon motorists on both continents.
Some of these engineers might also even insist that crossing the Atlantic by car is a basic human right, one that must be guaranteed by government.
But despite the realness of the benefits of a trans-Atlantic bridge, if that bridge’s own designers cannot comprehend what they’re designing, no sane person would volunteer to drive across that structure if and when it is built.
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 what is built based upon the incomprehensible blueprint will work as advertised?
A trans-Atlantic bridge, of course, is not the same thing as a health care system: The bridge is much less complicated.
No matter how complicated the bridge, ultimately it is a physical structure, composed of lifeless materials that metallurgists, chemists and engineers understand quite well.
A human economy is very different. Each person — as producer and as consumer — has his own unique abilities and wants. Each person can respond imaginatively to unexpected problems that she encounters. Each person is a potential source of creative new ideas that might improve the operation of his medical office, her research lab or his insurance company.
With hundreds of millions of customers — everyone from those whose health care needs go no further than an occasional aspirin to those who need round-the-clock care in cancer wards — and with millions of providers doing countless different tasks, the idea that 535 geniuses on Capitol Hill can design this industry so that it will improve human well-being is laughable.
There are steps that Congress can sensibly take, but all of these involve removing government-imposed restrictions on the abilities of individuals to seek out, and to supply, health care provision within markets.
Health care will be improved only by unleashing the creativity of millions of people and by market competition. Health care will be severely damaged if it is designed and restricted by a few hundred arrogant political operatives.