Will Ebola Be Good for the CDC?
Ever wonder why on earth anyone thought socialism would work?
No, seriously: Ever wonder why? "From each according to his ability, to each according to his need" sounds very fine, but by the time socialism rolled around, this idea had been tried, and fallen apart, in multiple communes. Moreover, sponging, shirking relatives had been observed in families from the dawn of history. The universal desire to work less than needed had long been countered by some variant on the biblical rule that "he who does not work, does not eat." Why, then, did people want to throw out the profit motive and have the government run everything?
Conservatives and libertarians who ask themselves this question generally assume that socialists must have been naïve pointy-heads who didn't understand that socialism would run into incentive problems. And of course, as in any sizeable movement, there were just such naïve pointy-heads. Even if I'm no expert on the history of socialist thought, the reading I have done suggests that the movement itself was not actually this naïve; there were people who understood that, as economists like to say, "incentives matter." They thought that socialist economies would perform better despite the incentive problem 1 because of various efficiencies: streamlining overhead, creating massive economies of scale, eliminating "wasteful competition," and the many-splendored production enhancements possible through "scientific planning."
In hindsight, this sounds ridiculous, because we know that socialized economies failed on a massive, almost unprecedented scale 2 . Scientific planning proved inferior to the invisible hand of the market, scale turned out to have diseconomies as well as economies, and administrative overhead was not, to put it lightly, reduced. But before socialism was tried, this all seemed plausible. And one reason why is because the people who suggested it had already seen government planning work miracles.
I speak, of course, of the great public health achievements between roughly 1850 and 1960. Doctors and public health experts were given extraordinarily broad powers by the government, and they used them to eliminate the scourges that had made cities into pestholes from time immemorial. They built gleaming sewers and water treatment plants to wipe out virulent water-borne pathogens that used to regularly claim thousands of lives. Contact-tracing and quarantine of airborne and sexually transmitted diseases turned former plagues like smallpox and syphilis into tragic but sporadic outbreaks. Changes in building codes helped beat back mass killers like tuberculosis. Poison control cut down on both accidental and deliberate deaths. The Pure Food and Drug Act, and similar ordinances in other countries, reduced foodborne illness, and also, the casual acquisition of opiate or cocaine addictions through patent medicines. Malarial swamps were drained. Environmental toxins were identified and banned. Then they went and invented antibiotics and vaccines and vaccination laws, and suddenly surgery was as safe as a long-haul flight, TB was curable, and childhood illnesses that used to kill hundreds of people every year were a quaint footnote in your 10th-grade history textbook.
Having seen public experts work these miracles through the heavy hand of the state, people understandably concluded we could use miracles in other areas. They had a metaphor, so to speak. The metaphor wasn't very good, as is often the case, but it took a while to find out that you couldn't solve a problem in your steel supply chain with the same system that was so good at tracing cholera outbreaks to tainted pumps.
You know why I've been musing about this, of course: the mishandling of the first Ebola patients to be diagnosed on U.S. soil. The nation's public health apparatus has inherited the justly magnificent reputation of its conquering forebears. Sure, other areas of government might botch things up a bit, but the Centers for Disease Control sits on the hallowed ground otherwise reserved for kindergarten teachers and firefighters. Failure is shocking and horrifying. The institution that gave us so much faith in government now risks shaking that faith as nothing else could.
This is an overreaction to a terrible failure, for two reasons. First, big bureaucracies fail all the time, especially in the face of novel threats. A large institution is like a battleship: hard to sink, but also hard to turn. Public health experts of earlier eras made grave mistakes, like dumping London's untreated sewage into the Thames; public health experts of the future will too. The more important question is whether they correct themselves, as it seems to me the CDC is now doing.
The second is that this is not your grandfather's public health system. Public health experts were, in a way, too successful; they beat back our infectious disease load to the point where most of us have never had anything more serious than Human papillomavirus or a bad case of the flu. This left them without that much to do. So they reinvented themselves as the overseers of everything that might make us unhealthy, from French Fries to work stress.
As with the steel mills, these problems are not necessarily amenable to the organizational tools used to tackle tuberculosis. The more the public and private health system are focused on these problems, the less optimized they will be for fighting the war against infectious disease. It is less surprising to find that they didn't know how to respond to a novel infectious disease than it would have been to discover that they botched a new campaign against texting and driving.
Don't get me wrong: Fighting infection is still one of the things that the public health infrastructure does, and though I hope it doesn't come to that, I expect that our system will do a much better job next time. But the CDC did not botch the job because there's something wrong with Barack Obama, or government, or the state of Texas, or private hospitals. They dropped the ball because the public health system no longer needs to work so many miracles, and consequently hasn't had much practice. We shouldn't have let public health give us such an inflated belief in the power of government. But we also shouldn't forget that with the right task and the right tools, government is still capable of doing some wondrous things.
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And the socialist calculation problem, which most modern readers will probably know from the Hayekian critique of it.
I refer to economies in which much or all of the nation's productive capacity was nationalized, not to social democracies, which may have sacrificed some growth, but did not fail spectacularly, though I suppose there's still time.
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