As election time draws closer even medical bloggers feel compelled to make political comments. Some are to the left, others the right and still others libertarian. Politician's vacuous slogans dart around suggesting empty choices and the frustrating sometimes scary world we live in is offered a glimpse of salvation made human in the form of politicians.
When things are going badly according to some observers the obvious solution is to thrown the rascals out. Many times the perceived rascals have been rejected and yet things change little and at the end of the term of their replacements the refrain repeats . If we replace those who are variously described as incompetent, dishonest or evil with folks who denounce all or much of what when on before why does the wheel keep turning?
Thomas Sowell has something to say about that. Throwing the rascals out does not work because we are replacing them with humans who will face the same incentives, constraints and feedback ( or lack of it) that their predecessors faced. It is the defining characteristic of the institutions in which they work that do not change. The same army of lobbyists will descend on the newly elected senator as they did on his predecessor. The same pork selling and trading will take place
with the pre election rhetoric of eliminating the special interests fading away. The incentives do not fade away.
Sowell, of course, said it much better:
Much discussion of the pros and cons of various issues overlook the crucial fact that the most basic decision is who makes the decision, under what constraints, and subject to what feedback mechanism. This is fundamentally different from the approach which seeks better decisions by replacing the bad guys with the good guys-that is by relying on differential rectitude and differential ingenuity rather than a structure of incentives geared to the normal range of human propensities.
When we hear how government programs will fix this or that and provide this or that it is worthwhile to listen to Sowell. He explains that government is not "society" or the embodiment and machinery of "the public interest" and it is not a single decision making unit but rather;
..an overlapping montage of autonomous branches, agencies and power cliques-each of these responsive to outside coalitions of interest groups or ideologists.
With that in mind it is not surprising that the lofty promises for a fix for this or that (including the health care situation) are never fulfilled.