Arnold Kling  

Politics is Not About Policy

PRINT
Scott Sumner, on One Foot... Afternoon Commentary...

David Harsanyi improves on David Broooks.


Mr. Hoover knows everything. He attended a high-brow graduate school and worked as a Senate aide before becoming a policy expert. (He even pretends to understand Jeremy Bentham.) He is a man who craves acceptance from the other smart people who surround him.

Jim is pretty smart, too, but hasn't squandered his talent working in Washington. Rather than theorizing about economics, Jim takes an authentic risk by starting a business. He ends up employing 20 people and creating the capital that helps pay for their health insurance -- as well as fund many of the social safety net programs that Mr. Hoover dreams up.

These are fictional characters. "Mr. Hoover" represents the self-assured technocrat. "Jim" represents the improvisational enterpreneur. In Bill Easterly's terms, "Mr.Hoover" is a planner and "Jim" is a seeker.

The Obama Administration represents an attempt to elevate the status of planners over that of seekers.

The idea that politics is not about policy, but instead is about the relative status of different groups, was stated by Robin Hanson and Tyler Cowen before I got hold of it. I say this because somehow Recalculation has become "Arnold Kling's idea," even though there are many antecedents and I think of myself as a promoter, not an originator.

Yesterday, I gave two talks at the University of Indiana in Bloomington. In the first talk, I started by referring to the movie Breaking Away, which is set there. Nominally, the movie is about a bicycle race. In fact, it is a movie about a contest for status, between a group of local boys ("cutters") and a group of students. At a national level, the Tea Parties are like the "cutters" and the Democratic elite are like the Indiana students. And the fight over status is as bitter and determined as the bicycle race in the movie.

In health care, I think that a central issue lurking in the background is the status of doctors. In my view, the status of doctors in this country is about as high as it could possibly get. (They think they still have room to gain status, at the expense of insurance companies, but I do not think that will happen.) My guess is that, over the next decade or so, a number of structural factors will cause the status of doctors do decline. Spending growth has to be curtailed. Inefficiencies in health care delivery have to be addressed. I predict that part of the process will be to reduce the authority and autonomy of individual doctors.

For doctors, health care "reform" could be either an opportunity or a threat. It would be a threat if it were used to spur the trend toward diminished physician authority. However, it may represent an opportunity for doctors to use their political clout to slow that trend and to preserve their status. My guess is that in the short run it will be the latter.


Comments and Sharing






COMMENTS (7 to date)
ThomasL writes:

In the realm of theory, I think there is still room to go up, as obviously the Utopian theoretician ranks higher than the doctor.

I agree, however, that doctors are far more likely to go down than up. By virtue of science they are still a little too accommodating to thoughts of costs, trade-offs, and imperfect knowledge. None of these exist in Utopia.

They'll end up licking Mr. Hoover's boots in the end just to stay a step higher than the proles.

Greg Ransom writes:

"Doctors" come in different status groups.

The Harvard U. doctors, for example, are in a different status game than the doctor working in a small practice unconnected to the research universities.

Etc.

z writes:

"I predict that part of the process will be to reduce the authority and autonomy of individual doctors."

Which is why whatever changes come will ultimately fail. Sure, doctors make bad decisions regarding patients. But I can assure you that disconnected parties, bureaucrats with protocols and regulations, and politically motivated public officials will make worse decsions regarding patients.

"However, it may represent an opportunity for doctors to use their political clout to slow that trend and to preserve their status." Politial clout? How many laywers are in Congress and in State Houses and Governors Mansions Across the country? How many physicians are in such roles. Any changes that come about will doubtlessly benefit the legal establishment and government bureaucracy at the expense of physicians and patients.

james gaulte writes:

The status of doctors has been on a downward curve for the past twenty years which has seen price controls by CMS and managed care.The prestige,income,autonomy and sense of satisfaction has decreased more in the primary care areas, chiefly internists and family physicians.Other than the retainer physician model(concierge)I see little to suggest that physician's status will return to anything close to where it once was.The support of the concept of "healthcare reform" without knowing what the provisions of the bills actually are by the AMA and several other physician organizations if anything supports the notion that organized medicine will take whatever bones are offered.

When the medical powers that be embraced the "new medical professionalism" in which the quest for social justice trumps the fiduciary duty of the individual physician to the individual patient they surrendered the moral high ground.

GU writes:

Just wondering, was Harsanyi invoking Herbert Hoover with his "Mr. Hoover" as the self-assured technocrat? I realize that Hoover enacted a lot of technocratic policies that worsened the Great Depression (contra conventional wisdom that he did nothing). But Hoover had a very distinguished career in the private sector (specifically mining) before entering politics. So Herbert Hoover isn't exactly the best example of the polar opposite of the "improvisational entrepreneur."

Jake Russ writes:

Arnold,

We get stuck to the things we name. "Recalculation" might not be originally your idea, but since you've named it, you now own it.

I'm wondering how you arrived at calling the idea Recalculation theory. It's a natural fit, but I'm wondering where you got the spark. Since I've started reading your posts about it and the many contra-recalculation posts, I can't help but laugh every time I get in a car with a GPS, one wrong turn and the computer starts blurting out "recalculating...recalculating..." as it tries to figure out the new route. I hear it and think, that's exactly what Arnold is talking about.

douglas fender writes:

Government will never know what efficiency is. It is unwise to give the government control of health care. What is needed is practical ways to lower health care costs and create jobs so people can work and make money to buy the cheaper health care insurance.

Comments for this entry have been closed
Return to top