American Elephants


The Social-Engineering Approach to Health Care by The Elephant's Child

John Goodman offers two fundamental ways of thinking about complex social systems: the economic approach and the engineering approach.

The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice.

Goodman, the father of the health savings account, calls this “cookbook medicine” which gives doctors rules and protocols for treating patients with various symptoms, and they must record each step along the way. Cookbook medicine does not bother with the differences among people, and is the opposite of personalized medicine which aims to tailor the therapy to the characteristics of the patient.

While it is useful to consider the standard protocols, people are not all the same. Medicine adapted to the genetic makeup of a person is in its infancy, but shows promise. When the cookbook becomes a rulebook to be followed slavishly, we’re in trouble. When complying with endless checklists takes valuable time away from patient care — that’s what’s happening in American medicine. A recent study of emergency room physicians found that they spend more time interacting with screens than patients, clicking the mouse 4,000 times in a 10-hour shift.

The Affordable Care Act was heavily influenced by the engineering model. After all, our bureaucrats are certified experts, and what are experts for if not to tell everybody else what to do and how to do it. Only social engineers would think of running “pilot programs” to control health care costs. What is the purpose of a pilot program if not to find something that appears to work, so you can order everyone else to copy it. Therefore you have the mess of digitizing all medical records and the result that hospitals have different systems that cannot talk to each other?

Dr. Virginia McIvor, a pediatric physician at Harvard Medical School explains the problem:

When a healthy child visits, I must complete these tasks while reviewing more than 300 other preventative care measures such as safe storage of a gun, domestic violence, child-proofing the home, nutrition, exercise, school performance, safe sex, bullying, smoking, drinking, drugs, behavior problems, family health issues, sleep, development and whatever else is on a patient’s or parent’s mind. While primary-care providers are good at prioritizing and staying on time — patient satisfaction scores are another quality metric — the endless box checking and scoring takes precious time away from doctor-patient communication.

If you have been to a doctor recently, you have probably noticed the multiplication of forms you must fill out, questions you must answer. I have noticed that the form now contains a line for “refuses to answer,” which may indicate progress of a sort.

John Goodman is the father of the “health savings account” which works precisely as promised and has been a great favorite. He is president of the National Center for Policy Analysis (NCPA) and he blogs regularly on health care matters (you can sign up to receive his columns), and his book Priceless takes on the health care problem.

There are great things happening in medicine that are promising for the future. The engineering rulebook is not interested in other people’s expertise or innovation.

The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412
The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412
The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice. – See more at: http://healthblog.ncpa.org/cookbook-medicine-2/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-36412


Accept the World As It Is, Warts and All. by The Elephant's Child

I have refrained from mentioning the Duck Dynasty flap, now over, because I am unfamiliar with the show, but the controversy goes back to a familiar theme — the more things change, the more they stay the same, which is an English translation of the French plus ça change, plus c’est la même chose. This Christmas has been remarkable for its political correctness.  Lo, it is the Winter Holiday, and you must refrain from offending anyone.

The Air Force rushed around banishing their nativity scenes, in case someone might find them offensive. School principals and Veterans Administration busybodies banned Christmas Carols, or changed the words to remove any reference to the reason we were having the holiday in the first place.  The VA wouldn’t allow Christmas cards made by children if they mentioned any religious words, references to Christmas, Christ, or Angels which might offend the veterans in VA hospitals. The Obamas sent Kwanzaa greetings to whoever celebrates that holiday, but mention of Christians is out of line unless it’s the media writing of all the Christians being slaughtered in the Middle East. Chaplains were told to knock off the Jesus talk, and not to mention God either.

I have never understood why anyone should be protected from being “offended.” Part of life is learning how to cope with being insulted, having your feelings hurt, being treated unfairly, or bullied. Life is unfair. You will have your feelings hurt, and protection doesn’t come from some social-engineering regulation passed by leftist loonies, but from your own internal armor and stoical resignation that recognizes the imperfect humanity of the world.  Not everybody is nice, even nice people are sometimes mean, and there is real evil in the world. Get used to it. You can always try to be nice yourself, that might help.

The United States has recognized that there are many religions in the world, though we remain a Judeo-Christian nation. Our very first settlers were seeking religious freedom to practice their own religion free from the dictates of the state. And they were escaping a long, long siege of religious wars. Catholicism, Church of England and Scottish Presbyterianism fought bloody, chopping off heads wars, and Puritans, Pilgrims, Shakers, Mennonites, Quakers, Episcopalians, Jews, Dutch Reformed, German Reformed, Irish Catholic, Scots-Irish Presbyterians, and all sorts of odd sects came to America and some new ones arose here, and for the most part they learned to get along, with a few notable exceptions here and there. But comparatively speaking, we Americans are pretty outstanding in the getting along department.

It seems to me that we have become more sensitive to offending by the mention of religion only in the wake of 9/11. Can we ask young Muslim women to uncover their faces for drivers’ license photographs? Must swimming pools set up separate hours for female swimming? TSA bans one inch long key chain knives, but finds no problem with 15″ metal knitting needles. Elderly people in wheelchairs will be subjected to invasive searches while young Middle Eastern men with one-way tickets will be passed through for fear of being accused of “ethnic profiling.”

It is a mindset that does not accept the fallible, imperfect nature of humanity. That does not truly recognize that there is evil in the world, and is prepared to deal with it. You cannot regulate niceness, kindness or peace.

Does tolerance mean constant tippytoeing to avoid giving offense? Good Grief. I was writing about this same thing two years ago. The more things change the more they stay the same. Troublesome words, troublesome ideas.



We’re Simply Sick and Tired of Social Engineering Schemes! by The Elephant's Child

John Goodman is a Health Policy scholar at The National Center for Policy Analysis.  He is also the “”Father of Health Savings Accounts,” which are one of the  money-saving health care innovations that actually work.   His Health Policy Blog is an excellent source for keeping up-to-date on the facts and follies of ObamaCare. You can subscribe, it’s free.

He says, in a recent post, that “There are two fundamentally different ways of thinking about complex social systems: the economic approach and the engineering approach.”

The social engineer sees society as disorganized, unplanned and inefficient. Wherever he looks, he sees underperforming people in flawed organizations producing imperfect goods and services. The solution? Let experts study the problem, discover what should be produced and how to produce it, and then follow their advice.

Social engineers invariably believe that a plan devised by people at the top can work, even though everyone at the bottom has a self interest in defeating it. Implicitly, they assume that incentives don’t matter. Or, if they do matter, they don’t matter very much.

To the economist, by contrast, incentives are everything. Complex social systems display unpredictable spontaneous order, with all kinds of unintended consequences of purposeful action. To have the best chance of good social outcomes, people at the bottom must find that when they pursue their own interests they are meeting the needs of others. Perverse incentives almost always lead to perverse outcomes.

In the 20th century, country after country and regime after regime tried to impose an engineering model on society as a whole. Most of those experiments have thankfully come to a close.  By the century’s end, the vast majority of the world understood that the economic model, not the engineering model, is where our hopes should lie. Yet there are two fields that are still completely dominated by people who steadfastly resist the economic way of thinking. They are health care and education.

You can tell, he says, when the social engineers have hit rock bottom.  They start a pilot program. And this is the “only idea for controlling costs in the Patient Protection and Affordable Care Act (PPACA, ObamaCare).” We do have lots of examples of pilot programs and social engineering, and we should have learned that social engineering does not work.

Both these experiments reveal two important things about pilot programs: (1) it is possible to spend an enormous amount of money to learn something ordinary people with an ounce of common sense (people without PhDs) probably could have told us anyway and (2) no matter what we discover, politicians are likely to do what is politically expedient for them to do in any event.

Pilot programs assume that the engineering model will work.  They believe that experimenters can discover the best way to practice medicine and then the regulators can force all the doctors in the country to copy that model.  Ah, yes.  The regulators!  The social engineers always assume that people can be ordered to do everything their way. The problem is that in their hubris, they always fail to understand humanity.

There are hundreds of natural experiments that have bubbled up all over the country without the federal government spending a dime.  But we don’t know how to copy what doctors do at those centers of excellence, nor do we even know how to describe what they do.

ObamaCare engineers many new benefits.  Health insurers are raising their premiums as a direct result of the health care overhaul in coming weeks.  The law mandates free preventive care that raises costs.  But I thought that they claimed that preventive care would lower costs!  Some consumers could face total premium increases of more than 20%.  Ours is going up by 16%.  The social engineers screwed up again.

ObamaCare passed without a single Republican vote.  We’re really proud of them for that vote.  There is a long history of the failure of social engineering.  If we fail to learn from history, we’re really in trouble.  But to repeat myself once again, Liberals aren’t much interested in history. They fall in love with their ideas — without considering the consequences.




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