Wednesday, October 16, 2013

Tacking against the wind, but making progress

In the old days, there was a reason politicians avoided health care issues.  The simple reason was that it was too complicated.  Also, change was viewed as a zero-zum game, something noted by Machiavelli:

It ought to be remembered that there is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. Because the innovator has for enemies all those who have done well under the old conditions, and lukewarm defenders in those who may do well under the new. This coolness arises partly from fear of the opponents, who have the laws on their side, and partly from the incredulity of men, who do not readily believe in new things until they have had a long experience of them.

To this I would add the inevitable screw-ups that occur when a government actually tries to implement the changes that it has pushed through the legislature.  Sometimes the mess-ups are logistical in nature.

Witness the huge degree of incompetence on the part of the federal government in setting up the insurance exchange website.  "We were surprised by the level of traffic," was their most common response as people had trouble connecting and using the site.  What on earth did they expect? 

The dysfunction that emerged was palpable.  The Washington Post reports today:

The number of visitors to the federal government’s Web site dropped 88 percent between Oct. 1 and Oct. 13, according to a new analysis of America’s online use, while less than half of 1 percent of the site’s visitors successfully enrolled for health insurance the first week.

(Why didn't they just contract with eBay or some other experienced retail provider?)

Sometimes the mess-up is because of an incompletely considered set of policy changes.  In the UK, the National Health Service is going through a difficult set of pushes and tugs resulting from several new government's policies.  The public is confused.  The clinical and admininstrative staffs are confused.  The NHS itself says, please, just leave us alone.  Here's an excerpt from Alastair McLellan at the Health Service Journal:

Whether it is Monitor’s application of competition rules or the CQC’s inspection teams crawling over blameless hospital trusts so politicians can assure the public “something is being done” - the NHS response often is, “Why can’t you just leave us alone and let us fix these problems ourselves?”

I bet Machiavelli would have advised both countries not to try.  Or he would have said, let's make sure we build a real coalition of the willing who want to make these changes and who will advocate for them--not only during consideration by the legislature, but also during implementation.  It is in the latter period--when the glitches inevitably occur--that short-term-minded politicians quickly back away.  The coalition that advocated for change moves on to other things, the bureaucrats take over, and the public is reminded of the old joke:  "I'm from the government, and I'm here to help you."

Notwithstanding these responses, the policy change does result in a new status quo, which itself becomes as hard to change as the status quo ante.  In that respect, we are not like Gatsby. (“So we beat on, boats against the current, borne back ceaselessly into the past.”)  No, we muddle through, tacking against the wind, ever so gradually making progress towards an uncertain destination.

It is worth the try!


Anonymous said...

I read this post twice, and still find it opaque; quite unlike your usual clear-cut style.
What is the point you are trying to make?


Paul Levy said...

Uh oh. If I have to explain again, it was really unclear. Let's see if I can figure it out! :)