Monday, July 26, 2010

Irrational Non-exuberance

We do not sufficiently appreciate, I fear, the dilemmas that prevent rational decision-making to solve problems in ways that promote the common good.

The rational solution for health care would be to provide Medicare for all. This would be more efficient and provide good services at lower costs, especially if people were forced to pay for expensive treatments that have not shown to be sufficiently effective to merit public subsidy. But such a solution is not politically possible.

It seems clear that gifts to doctors from drug companies lead to more prescriptions for expensive  brand-name drugs rather than much cheaper but equally effective generics. But so far no legislation has been passed to accomplish that. My experience has been that some doctors don't take cost of drugs into account  but out of habit prescribe what they are most familiar with or what they have been bribed to do. I have educated a few doctors myself on this score.

The best way to reduce oil consumption would be a carbon tax on producers and a tax on gasoline on consumers. This would reflect the true (full) costs of consumption and make energy alternatives attractive to investors. But the rational solutions are not politically possible because of the power of oil companies and the love affair of Americans with cars and cheap gas.

If we want to reduce obesity, we could make unhealthful  foods more expensive by eliminating corn subsidies and taxing obesity-producing foods. But this is not politically possible.

We could have saved hundreds of thousands of lives if we had begun decades ago to make tobacco an illegal product and enable a transition for growers and give producers of cigarettes time to find alternatives. But political exuberance for that rational solution was lacking. Rates of smoking now vary by class and education -- the higher the less use of cigarettes, whereas puffing away was a  standard feature of movies decades ago, associating it with sophistication.

Ideally, we would treat Palestinian interests equal to those of Israel, but don't because of conservative Christian religion and the power of the Israeli lobbies. Sensible gun control is impossible because of a persisting frontier and rural mentality, aided and abetted by  the political power of the National Rifle Association.

More politically feasible  are measures that provide more information but are less effective in inducing behavioral changes.  Information on labels and restaurant menus about calorie and fat content is good but relatively ineffective in changing what people eat. Public information campaigns on the merits of conservation and healthy eating habits presuppose that facts about what is good and bad for health will persuade people to change their habits cannot be bad. But how effective are they?

In short, in many cases what is effective and good for most is politically impossible because of the powerful self-interests of short-sighted  citizens and the rich and powerful -- especially large corporations and well-organized special interests like the National Rifle Association, the Israeli lobbies, and  regional Cuban voting power. On the other hand, what is politically possible is relatively ineffective in promoting justice and the common good.

Wouldn't it be refreshing to see some rational exuberance for what is both effective and in the common interest? Tomorrow I will tell you about some other utopian dreams.



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