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Uncertainty and Public Policy

Richard Taylor tells us why public policies always go wrong…

Werner Heisenberg’s uncertainty principle, to my layman’s understanding, says that the position and momentum of a particle, such as an electron, can never both be known with complete accuracy at the same instant, because any attempt to ascertain either one necessarily alters the other. In short, the observation itself changes what is observed.

Something like this occurs also in the area of social policy. That is, the attempt to solve some social problem renders the problem itself unsolvable as it stands, simply because the solution becomes itself among the conditions that gave rise to the problem in the first place. Public policies are thus inherently flawed.

This is doubtless not a fixed truth. Some public policies no doubt do work more or less as intended. Nevertheless, the principle in question operates with sufficient regularity that it is always a threat to any attempt at social engineering.

Of course it is generally known from experience that the implementation of a social policy, which may seem to be such an obvious approach at its inception, is likely to become bogged down even to the extent, sometimes, of total failure – but the explanation of this is less understood. The explanation will usually be found in this principle of uncertainty.

This can be illustrated with examples, starting with the simplest.

1. A two-lane highway becomes, over time, so congested that it is no longer safe. The solution seems to be to widen it to four lanes. But motorists, as they discover this improved highway, are thereby drawn to it, and eventually it becomes as congested as before.

2. A university decides that some means must be found for evaluating the instructional skills of the faculty. Peer evaluations are instituted, which involve having the faculty visit each other’s classes and render reports. Now the uncertainty principle comes into play: The professors resent such intrusions and are made self-conscious, so that their teaching falters, on top of which the evaluators, knowing that they will themselves be thus tested, tend to render only glowing reports on each other.

So it is decided to have the students themselves make the evaluations. These all follow the same format and are kept anonymous, and at the end of the term they are forwarded to the dean, where they will influence salaries, promotions, requests for sabbaticals, and so on. The result: Grades soar, to the point that most students get an A, the poorest of them a B, and a student who does nothing at all gets through with a passing C. No one is failed, or even confronted with an ignominious D.

3. Government pension policies provide our next example. Suppose a worker who has been contributing to the pension fund dies before the pension benefits can begin, leaving a widow. Fairness dictates that, since she presumably depended on him to some extent for support and would continue to had he lived, then she should receive the benefits that have been set aside for them. But what if she remarries, thereby, presumably, gaining a new basis for support? Should she still be eligible for that pension? Such benefits would appear to amount to an unearned windfall for her new husband, relieving him of his responsibilities for support. So the benefit is made conditional upon her not remarrying, or at least, not before a certain age, typically 55 or 60. What then happens is that widows (and similarly placed widowers) circumvent the restriction by entering into marriage relationships without the legal documentation of marriage. The solution thus transforms the problem and becomes self-defeating.

4. It is wisely decided that single mothers in poor and crowded urban neighborhoods need special assistance, lest their children grow up in poverty and drift to the streets and to crime. The best solution, of course, would be for women to marry, and stay married, if they are going to have children, thereby to some extent providing financial stability. Government cannot, however, create marriages. It is therefore decided to provide special economic assistance to single mothers, so that they do not have to choose between work and caring for their children.

The inducement is thus created for mothers to remain single in order to claim these benefits even if they are in a marriage relationship with a working man who can provide the economic support that this program is meant to provide.

This problem is now met by having agents make unannounced visits to mothers receiving these benefits to see whether any man is living there and, presumably, filling the role of husband. The simple discovery of a man is sufficient for the termination of benefits.

What is the result? The ultimate goal, of promoting marriage and family stability, is defeated, and the problem, rather than being solved, is exacerbated.

5. The area of public health gives rise to a whole host of problems, the solution to each engendering new ones, until the entire field becomes an unmanageable morass.

Thus, in a democratic society, it is considered that all persons should have access to health care. Not all can afford it; some lie ill, some die, for simple lack of means.

The problem is met by establishing publicly funded hospital care, thereby relieving everyone of the threat of this sometimes necessary but always expensive resort. This, of course, removes a considerable restraint on what hospitals may charge, and the costs steadily rise.

Such insurance is next extended to all medical care, after a fairly modest charge has been met by the patient in the form of a deductible. Now patients need no longer deliberate whether or not to have various tests and procedures. The deductible is soon consumed, and everything after that is free. And then dental costs, hitherto thought of as a more or less normal cost of living, are added, with the same resulting proliferation of procedures and rise in costs. There is little restraint on the part of patients or physicians, and bureaucrats hired to administer these programs do not care what figures they enter into their computers.

The next step is to include the cost of medications deemed necessary. The cost of these soon rises uncontrollably, as both patients and pharmaceutical companies put pressure on physicians to prescribe them, and the enormous charges for them are justified, with some plausibility, by the costs of the research that goes into their development.

It is now but a short step to the inclusion of mental illness under such coverage. As a result, the number of compensable treatments of these soon multiplies, to include therapy for such ‘disorders’ as shyness, discomfort when addressing audiences, frequent blushing, the ups and downs of daily life, and so on. Medications are developed for all of these, available only by prescription, and expensively advertised by their manufacturers.

Have public health problems been solved by these expanding policies? To some extent, of course, but each solution has generated new problems with the result that, over time, health care becomes vastly more expensive, the main difference being that the costs of it fall largely upon the public at large and go more or less unnoticed by the beneficiaries of them. What the patient sees is that medical treatment is relatively cheap or even free. Less noticed is the huge rise in premiums and taxes.

6. Our final example concerns the liability insurance provided to physicians and surgeons. Here the operation of the principle at issue is quite obvious and far reaching. Doctors feel compelled to have insurance coverage because medicine is an inexact science, and errors can threaten the well-being and even the very lives of their patients. But the mere fact that such protection exists enters into the problem it is meant to solve, because of the following factors: First, juries are aware that such insurance protection exists, and are thus induced by sympathy to arrive at extraordinarily high awards, knowing that the cost will be borne, not by the doctors, but by some insurance company. Second, attorneys, contemplating huge jury awards and consequently enormous fees for themselves, are induced to paint for juries the worst scenarios, wherein perfectly reasonable medical procedures are made to look like errors or oversights. Third, doctors themselves, knowing this, tend to adopt procedures that are meant, not to alleviate or cure illness, but to minimize the opportunities for attorneys to seize upon what can be made to look like errors. Thus, unnecessary tests and procedures, sometimes very costly ones, are undertaken simply to limit the possibilities of litigation. And finally, the astronomical costs of all this are borne, not by the doctors, but by their patients, either through their insurance premiums or their taxes. Whether the problems are, in the end, solved is therefore unclear. What is very clear is that they have been vastly exacerbated.

One would think that complications introduced by the uncertainty principle could be anticipated and dealt with in advance, but as this last example shows, these intended solutions will simply introduce new uncertainties, and the problems start all over again.

Richard Taylor is Emeritus Professor of Philosophy at the University of Rochester, New York. His latest book Virtue Ethics is just out from Prometheus.