Monday, March 21, 2011

ObamaCare vs. Conflict of Visions

Thomas Sowell's 1987 book, Conflict of Visions has a simple argument. All the political differences between conservatives and liberals come down to a different vision of human possibilities.

Conservatives believe in a "constrained" vision that humans are all about the same in ability, and that social systems and cultures evolve by millions of interactions between millions of people.

Liberals believe in an "unconstrained" vision that certain humans are more evolved than others. These evolved folks have the ability to teach the others how to advance to a higher plane and they have the ability to organize the future in specific political projects.

Like ObamaCare.

In Why ObamaCare is Wrong for America, authors Grace-Marie Turner, James Capretta, Thomas Miller and Robert Moffitt take the "constrained" vision of conservatives, that you cannot design a system of health care in a 2500 page law and expect it to work. Grace-Marie Turner:

The law claims that experts in Washington are going to figure out what is the right treatment, and what's going to be the protocols. Doctors are going to be judged based on how they follow those protocols whether or not it's the right thing for their patient.

The ObamaCare assumption is that you can design a protocol in Washington and apply it in a one-size-fits-all centralized mechanism to the whole country. Reality, says Turner is different.

We're moving toward ever more personlized care, where we can find out before somebody starts a round of chemotherapy, for example, whether or not that chemotherapy is going to work with them through genetic testing. That's where science is moving, to make sure that treatments are targeted toward what we can learn about that individual patient.

In other words, effective health care is care individualized for the individual patient in a collaborative process between doctor and patient.

This is the basic conflict between conservatives and liberals. Conservatives say that society, culture, and the economy are all discovery processes where people interact and discover through organic processes like the price system what works and what doesn't. Liberals believe that an avant garde of advanced experts and ethicists can design and implement a positive plan that can be administered by a central administrative structure.

Conservatives have said again and again that the market system has demonstrated that the liberal vision is just wrong. Whenever liberals have designed and implemented a rational top-down system, whether in Social Security, Medicare, public education, clean energy, or welfare, it always fails because the world is just too complex a place to be fitted into a one-size-fits-all plan.

Thus ObamaCare is a vast real-world test of the liberal vision, more ambitious and more risky that any previous of their national plans. We will see in the coming months and years whether the American people will put up with this top-down plan, and also whether it can work at all without utterly breaking up the health care system.

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