… I think that economists have to approach their role as engineers with great humility. There’s a lot we don’t understand. Economics is still an early science. But let me read you the quote from Hayek that I included in my book. This is a quote from his free-market manifesto, The Road to Serfdom. And he wrote, “There is, in particular, all the difference between deliberately creating a system within which competition will work as beneficially as possible and passively accepting institutions as they are.”
So, that was Hayek. He understood that what makes a market free is that it has rules that allow it to work freely. And one of the metaphors I use in the book is of a wheel that can rotate freely. It’s not rotating in a vacuum. It has an axle and it has well-oiled bearings. And over time–people have been designing markets for millennia. And often the process of trial and error leads to better and better markets. But it can be a lengthy process of trial and error. And as we better understand what is required for marketplaces to help markets work freely we can sometimes intervene. And, you said ‘top down,’ but earlier you talked about Uber and Airbnb. Those are marketplaces that are not top down. People have been designing marketplaces forever. It’s what we do.
[UPDATE BELOW] I discussed the creepy side of President Obama’s “science czar” here. But there are more creepy things in the cabinet. The Wall Street Journal reports that the president’s health policy adviser, Dr. Ezekiel Emanuel, wants to implement an Orwellian-sounding “complete lives system,” which “produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.”
The WSJ piece continues:
Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely ‘lipstick’ cost control, more for show and public relations than for true change.”
True reform, he argues, must include redefining doctors’ ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the “overuse” of medical care.
Now a freer healthcare market could take care of rationing much more simply, while providing increased incentives for healthcare providers to provide better value to choosey consumers. The problem is, a freer healthcare market wouldn’t route power through Washington.
And yes, it is more about power than about wanting to spread scarce healthcare services around more equally. Otherwise, the government would pursue something like healthcare tax credits for lower and middle income Americans. And they would pursue meaningful tort reform to curtail wasteful defensive medicine and the regressive transfer of wealth from consumers (who pay higher medical costs) to wealthy trial lawyers.
And no, I’m not proposing that these power-hungry politicians are monsters. Most are probably sincerely convinced that their increased power will help them pursue the greater good down the road. It’s just that others have been down this road before, and it isn’t pretty.
UPDATE: Longtime medical ethicist Wesley J. Smith has a nuanced look at Dr. Emanuel here. The post concludes:
[H]e explicitly advocates rationing based on what appears to be a quality of life measurement. From the piece [in the Hastings Center Report]:
This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.
A lot of people are frightened that someone who thinks like Emanuel is at the center of an administration seeking to remake the entire health care system. Having read these two articles, I think there is very real cause for concern.