Experiments, Health Care, and Federalism

As the New York Times reported:

Esther Duflo, a development economist at M.I.T., has been awarded the John Bates Clark Medal. The award is given to “that American economist under the age of 40 who is judged to have made the most significant contribution to economic thought and knowledge.”  Professor Duflo, 37, helped found the Abdul Latif Jameel Poverty Action Lab, whose affiliates do randomized experiments in poor countries to help determine what types of aid and anti-poverty programs actually work.

Wouldn’t it be great if we could experiment by allowing different states to engage in different policies, unmolested by the Federal Government, and then see how things work out?  These wouldn’t be randomized, but they would be consistent with the Constitution’s federalist plan.  And, of course, we sometimes do.  Unfortunately, we are often stuck with “one size fits all” plans imposed by Washington that, if they fail, fail big and fail for all of us. 

A smart argument I heard during the Obamacare debate (can’t remember where) applied this experimentation point to health care.  Wouldn’t it have been nice to see how similar health care plans fared in some places before adopting it on such a grand scale?  But maybe then we’d have seen how bad things are likely to turn out with Romneycare in Massachusetts and balked at repeating something like it at the federal level.

In the future, let’s remember that federalism has a number of advantages*, and we lose something when the Federal Government sucks more and more power and authority into Washington.

* Note: It should be noted that a due respect for federalism is different than thinking that states and localities are the saviors of our liberties.  States and localities have all too often been violators of our basic individual rights (see Jim Crow and other examples of “grassroots tyranny“).

3 thoughts on “Experiments, Health Care, and Federalism

  1. What a short memory you have for the acrimonious and obstructionist legislative climate that produced health care reform!

    OF COURSE progressive legislators would have loved to fully implement a known model of health care that had a track record of working! We don’t even need to wait to study (funny how often ‘study’ really means ‘wait’), we already have many such models. Hawaii, Oregon, Canada, several European countries.

    Unfortunately, American politics prevented any rational approach, and leaves us with a “dog’s breakfast” of HCR that will have to be improved incrementally over generations.

    ==========

    That’s just the HCR part of it…. More generally, isn’t it funny how often conservatives (beyond pileusblog) want a delaying study?! Take a look at the climate debate to see how far liberals might be willing to trust conservative promises about studies. Conservatives just don’t do science well.

    Just for kicks, could you rattle off any studies that culminated in legislation faithful to the recommendations of the studies? Without a robust list of action on studies, pardon the rest of us for thinking studies are mostly a delaying tactic.

  2. Is there an actual historical instance of this process–a problem is recognized, states experiment with different approaches, some approaches demonstrate their superiority, and they go on to be adopted on a nationwide basis? It sounds like something only an academic political scientist could believe.

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