Tag: public policy

Public Health is Harder than Long Division

Published on by D. G. Hart1 Comment

James Scott’s book, Seeing Like a State (1998) came up in this fascinating discussion of public policy, health systems, government, expertise, and legitimate political authority. The following is from a review of Scott’s book in The New Republic, May 18, 1998 (“More is Less”, by Cass R. Sunstein). This is precisely what state governors and their advisors are doing during the COVID-19 pandemic:

German psychologist named Dietrich Dorner has done some fascinating experiments designed to see whether people can engage in successful social engineering. The experiments are run by a computer. Participants are asked to solve problems faced by the inhabitants of some region of the world: poverty, poor medical care, inadequate fertilization of crops, sick cattle, insufficient water, excessive hunting and fishing. Through the magic of the computer, many policy initiatives are available (improved care of cattle, childhood immunization, drilling more wells), and participants can choose among them. Once initiatives are chosen, the computer projects, over short periods of time and then over decades, what is likely to happen in the region.

In these experiments, success is entirely possible. Some initiatives will actually make for effective and enduring improvements. But most of the participants—even the most educated and the most professional ones—produce calamities. They do so because they do not see the complex, system-wide effects of particular interventions. Thus they may recognize the importance of increasing the number of cattle, but once they do that, they create a serious risk of overgrazing, and they fail to anticipate that problem. They may understand the value of drilling mote wells to provide water, but they do not foresee the energy effects and the environmental effects of the drilling, which endanger the food supply. It is the rare participant who can see a number of steps down the road, who can understand the multiple effects of one-shot interventions into the system.

These computer experiments have countless real-world analogues. As everyone now knows, an unanticipated problem with mandatory airbags is that they result in the deaths of some children who would otherwise live. Less familiarly, new antiterrorist measures in airports increase the cost of air travel, thus leading people to drive instead, and driving is more dangerous than traveling by air, so more stringent antiterrorist measures
may end up killing people. If government wants to make sure that nuclear power is entirely safe, it should impose tough controls on nuclear power, but those controls will increase the price of nuclear energy, which may well increase the use of fossil fuels, which may well create the more serious environmental problems. . . .

On Scott’s view, the failed plans and the thin simplifications ignore information that turns out to be crucial. To be sure, an all-seeing computer, capable of handling all relevant information and envisioning the diverse consequences of different courses of action, may facilitate tyranny. But it need not blunder. This is the real lesson of Dorner’s experiments, for which Scott has provided a wealth of real-world counterparts. And this is not
the end of the story. Dorner also demonstrated the possibility of successful planning by those who are attuned to long-range effects. Scott’s analysis would have been improved if he had compared success with failure, and given a clearer sense of the preconditions for success.

Still, Scott’s advice is far from useless. It can be applied to contexts far afield from those that concern him here. His case studies help explain, say, why national regulation tends to work better when it consists of altered incentives rather than flat commands. Some of the most successful initiatives in American regulatory law have consisted of efforts to increase the price of high-polluting activities; and some of the least successful have been rigid mandates that ignore the collateral effects of regulatory controls. Scott’s enthusiasm for metis also suggests that certain governmental institutions will do best if they act incrementally, creating large-scale change not at once, but in a series of lesser steps. We might think here not only of common law, but also of constitutional law. Many judicial problems derive from a belief that judges can intervene successfully in large-scale systems (consider the struggles with school desegregation in the 1960s and 1970s), and many judicial successes have come from proceeding incrementally (consider the far more incremental and cautious attack on sex discrimination in the same period).

And Scott also offers larger implications. A society that is legible to the state is susceptible to tyranny, if it lacks the means to resist that state; and an essential part of the task of a free social order is to ensure space for institutions of resistance. Moreover, a state that attempts to improve the human condition should engage not in plans but in experiments, secure in the knowledge that people will adapt to those experiments in unanticipated ways. Scott offers no plans or rules here, and a closer analysis of the circumstances that distinguish success from failure would have produced greater illumination. But he has written a remarkably interesting book on social engineering, and be cannot be much faulted for failing to offer a sure-fire plan for the well-motivated, metis-friendly social engineer.

Congregationalism as Constantinianism

Published on by D. G. Hart475 Comments

Peter Leithart wants to add to my work as clerk of session. First, he’s reading a lot of sociologists of religion (would John Milbank approve?) on the capacity of congregations to function like families and provide for members in similar ways:

This social capital is not merely intangible. Congregations offer material support to needy members: “When people in congregations talk about building relationships and creating community, they are talking about more than warm, fuzzy feelings. These relationships often take on a depth of mutual obligation that involves pain and sacrifice, as well as joy and celebration. Once having entered these communities, participants are challenged to care for each other, in good times and in bad, and most of this caring takes place informally, rather than through organized programs” (65). Tangible support is particularly beneficial to immigrants: “In Chicago we encountered a congregation whose religious roots are in Nigeria—the Holy Order of Cherubim and Seraphim. There we heard, ‘Our church has a lot of immigrants that are coming to this country. Some of them are very young families. . . . So, you have the church trying to be like a family structure. To be able to mend all of this together so they can have a life.’ Mending together a life often requires informal assistance, rituals of healing and mourning, and the timely visit of a pastor”

Next, he thinks congregations can contribute to a number of the policy questions before the nation:

The US faces policy challenges of gargantuan proportions. Immigration, social security, drugs, race, crime and prison reform, health care, Islamicism and other international challenges. I’d put same-sex marriage, the ethical issues surrounding biotechnology, and abortion high on that list, and some would add environmental issues to the short list.

For ordinary Americans, that list poses two challenges. First, each is a hugely complex, apparently insoluble problem. A health care reform bill has been passed, but many doubt whether it will improve health care or lower costs. The difficulty of formulating a policy on immigration that answers to all American interests and values is evident in the fact that no such policy has been formulated and legislated. There are limits on what a war-weary America can do about ISIS.

Second, ordinary citizens don’t have the capacity to do much about any of them. We can vote, but few have the ability or opportunity to do much else. At best, we respond by bitching about the state of the world or engaging in Facebook polemics; at worst, we throw up our hands and find some way to avoid thinking about it.

For Christians, there is an alternative approach that disaggregates the problems and opens the possibility of constructive action. Instead of treating these issues as questions of national or state policy, we can examine them as ecclesial questions, questions about the ministry and mission of the church.

I don’t mean that we stop debating the merits of policy proposals. Institutional and legal patterns are critical, and there are definitely healthy and unhealthy, good and bad ways to organize our life together. But public policy isn’t the only way to address social needs, and for the church, legislated policy isn’t the primary way to address social needs.

No group of citizens can build a wall along the Mexican border, and few contribute in any meaningful way to formulating immigration policy. But nearly everyone lives in a town with a Hispanic minority. In addition to (or before) asking, “How can America control immigration?” Christians should ask, “What obligations do churches have toward immigrants? What can we do to proclaim the gospel to them in word and deed?” We shouldn’t merely ask how Federal or State governments can make health insurance available, but how churches can provide affordable basic medical care to the poor in a local area. We may not have the policy answers to the drug trade, but many churches support or provide help for addicts and some have effectively intervened to reduce gang violence. We can’t stop ISIS, but churches can send and support missionaries in Islamic countries, and churches can mount targeted evangelistic campaigns to Muslims in our neighborhoods. We can think of Muslim immigration to the US as a threat to our Christian heritage; we can also recognize it as one of the greatest opportunities for Muslim evangelism since the sixth century.

Well, one relief is that the economy is so bad in this part of Michigan that we don’t have that many Hispanics, so that round of meetings is not needed (even if it means finding a good Mexican-restaurant is a challenge). But how in the world if congregations barely agree on the order of service are we now supposed to find consensus on drug treatment procedures?

Plus, I’m not going near Islam (except when having drinks with our Muslim neighbor). Hasn’t Peter seen any of those ISIL videos?

Just this morning I was reading an almost twenty-year old verdict on the effects of modernity on Dutch Reformed churches:

Whereas once (and still in some isolationist communities) there was considerable homogeneity of perspective on virtually all matters of faith — that is, the Reformed message was uniformly accepted throughout the Reformed community — that is no longer the case. Among respondents in each of the countries under consideration, there is immense variation in matters of belief. Whether considering new understandings of Scripture or new formulations of divinity or new attitudes about the fate of nonbelievers, consensus is rare. On matters of political and moral concern, Christians of the Reformed churches have significant differences of opinion. (Rethinking Secularization: Reformed Reactions to Modernity, 281)

So do members of most communions (Roman Catholics included where they put the “it” in unity). But now Peter wants us to take on social policy? How much free time does he have in his new position?