In response to an op-ed by E.J. Dionne:
‘So the problem is not the welfare state, it is the central planning.
Obamacare provides the illustration of this, as I think many people have intuited. The “economic problem,” of course, is inescapable in health care. The supply of health care is scarce (only so many resources can be dedicated to it relative to other ends in society) and the demand is pretty close to unlimited. Somehow or other we have to decide how to allocate these scarce means among all the different ends–preventive medicine, end-of-life care, primary research, specialists v. generalists, etc.’
And under the ACA, we’ve opted to involve politicians and their short-term goals (getting re-elected) much more than before in making these decisions, which I understand to be a net loss. If folks at the AMA or independent panels think they’ll be operating free of such public-choice and political pressures, they might want to think again.
Here’s Pournelle’s Iron Law of Bureaucracy:
‘Pournelle’s Iron Law of Bureaucracy states that in any bureaucratic organization there will be two kinds of people”:
First, there will be those who are devoted to the goals of the organization. Examples are dedicated classroom teachers in an educational bureaucracy, many of the engineers and launch technicians and scientists at NASA, even some agricultural scientists and advisors in the former Soviet Union collective farming administration.
Secondly, there will be those dedicated to the organization itself. Examples are many of the administrators in the education system, many professors of education, many teachers union officials, much of the NASA headquarters staff, etc.
The Iron Law states that in every case the second group will gain and keep control of the organization. It will write the rules, and control promotions within the organization’
The fact is, with Obama’s political coalitions we already see union-interests, rent-seeking volunteers and activists influencing our politics. Such is politics, in fact. I don’t necessarily begrudge these folks their idealism and desire for change, but I do begrudge the means by which they are pursuing that change and the consequences of their idealism.
The less there is or there is perceived to be, the more people tend to fight over it, which suits some people accustomed to seeking their interests through political activism just fine (there will be winners and losers here), but we’ve arguably chosen a very poor way indeed to meet the moral aim of inclusion through health-care access, overall economic growth and thus more racial and pluralistic tolerance, as well as equality under the law (our politics seems even more contentious than ever).
As if the partisan divide, the rollout of Obamacare, the unmet political promises and the sheer complexity of the law wasn’t enough to make you doubt already…
Related On This Site: From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”…Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’…From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’