As we consider the issue of unintended consequences in health care from certain policy formulations, we can bring in an example from another field. Let's review it and guess if the kind of policy questions I referenced below were applied to this case.
Residents in our city recently received this mailer:
It used to be that you would put your used computers and monitors out on the curb on trash collection day, and they would be carted off to be properly disposed of. There was no extra charge, and you didn't need to call anyone in advance. Now, you have to call a number or go to a website three days in advance and pay $12 for the pick-up.
It is easy to imagine why the new policy was adopted. Perhaps the old approach was costing the city a lot of money, and officials thought this would work better.
But let's think through the likely result. (Please note that I am not advocating this approach, but it seems to me to be a rational response.) Our city employs these rather large trash bins that are mechanically lifted and emptied into a garbage truck each week. The truck driver does not leave his perch as he rides along the street, and so no one sees what is in these barrels as they are lifted over the truck and emptied of their contents.
So, let's say I have an old personal computer and screen. I quietly -- after dark, so my liberal neighbors don't see me -- put them in my regular trash bin, which I then wheel out to the curb in its regular location. Next morning, the garbage truck comes by, scoops it up, and empties it into the back of the truck. No need for a scheduled pickup. No extra charge. No muss, no fuss.
But maybe I am wrong. Maybe the residents in this city are so motivated by environmental concerns that they would do no such thing. Wait, aren't those the residents who regularly litter our streets with recyclable bottles and cans or who don't pick up the ones they see there?
I am not being critical. I am just saying that people do what is easy for them. When you invent a policy regime that attempts to impose higher cost or inconvenience on the citizenry, there are often unintended consequences. I'd love to be proven wrong, but how will we know?
Here's how. Let's see if our city's commitment to transparency extends to the effectiveness of this new approach to disposal. It should be easy to have a section of the municipal website on which is posted the weekly summary of computer and monitor collections and payments under the new scheme, compared with the numbers collected previously.