On the distortion of U.S. Medicare by the wrong incentives:
"We are not rewarding what we really want," he said. "We’re rewarding people for doing stuff that’s paid well. What we want to do is pay them well to do the right thing."
"They are rewarded for more services, not better services. They are rewarded for more care, not better care," said Dr. Elliott Fisher, a lead researcher for the Dartmouth University Atlas of Health. "Most of the U.S. health system is paid simply for each service, regardless of the results of that service."
Generally speaking, people do what pays best.
This is my review of Thomas Sowell’s new book: Intellectuals and Society
Sowell, T. (2009). Intellectuals and Society, New York, NY: Basic Books.
This is Sowell’s best book, not surprising because it’s his latest, and he encapsulates his observations on the myths, chimeras and sacred cows of current intellectuals. Most of these beliefs are so remarkably untrue that, much like those of education, their opposites are true. Dr. Sowell uses many of the themes he has developed before such as the stark contrast between the vision(s) of the anointed (those who believe that strong government programs will produce Utopia) and those with the tragic vision (those who believe in the limitations of Human Nature).
One of his best observations is the belief of intellectuals that theirs is such a difficult and specialized occupation that only the anointed can do it. “A sense of superiority is not an incidental happenstance, for superiority has been essential to getting intellectuals where they are. They are in fact often very superior within the narrow band of human concerns with which they deal. But so too are not only chess grandmasters and musical prodigies but also computer software engineers, professional athletes and people in many mundane occupations whose complexities can only be appreciated by who have had to master them. (p. 148).
And, on giants of industry which “control” a large part of a market. “Smith Corona, for example, sold over half the typewriters and word processors in the United States in 1989 but, just six years later, it filed for bankruptcy… Even at its peak, Smith Corona controlled nothing.” pp. 65-66). How well I remember the narrow window of the dedicated word processor where one could see a few lines of what one had written. The market took care of a good product by producing a better one. In government enterprises, such as education, things change, but don’t improve.
Sowell gives dozens of examples of where intellectuals get things wrong. “The amazing thing is that this history of failure and disaster has neither discouraged the social engineers nor discredited them.” Like the mighty Brooklyn Dodgers, “Wait’l next year.”
He also points out that all of the repressive regimes in Germany, Russia and Cambodia have had the backing of the majority of a country’s intellectuals.
Highly recommended.
Cheerio and ttfn,
Grant Coulson
Cui Bono–Cherchez les Contingencies
