TCS Daily


Gonna Cruise the Miracle Mile

By Megan McArdle - October 28, 2003 12:00 AM

In my previous life as a technology consultant, I was often handed plans in which the critical step seemed to entail the use of expensive equipment that the client didn't have, and had no intention of installing. It was not unheard of, in fact, for plans to require equipment that hadn't actually been invented. The first time it happened, I naively went to my project manager to inquire about it.

"What happens here?" I asked him, pointing to the space between the two steps that I couldn't quite figure out how to bridge.

 

His eyes crinkled with a sort of world-weary sympathy as he nodded towards that pregnant space. "That," he intoned solemnly, "is where the magic happens."

 

Needless to say, the plan had to be extensively -- and expensively -- reworked, but only after it had become excruciatingly clear that the plan could not be executed as written. The phenomenon is common enough that one of my colleagues coined a phrase for that yawning gap where the magic happens: "the Miracle Mile."

 

Health Care's Miracle Mile

 

When I left the technology field, I assumed I'd seen the last of those weary miles. Such optimism! Every time I open a newspaper or begin research on an article, I run into some politician or policy wonk brandishing a plan that seems eminently workable except for that one tiny space where reality must miraculously transform itself into something more amenable to the would-be policymaker's dreams.

 

Consider health care. With Congress currently trying to hammer out a prescription drug benefit for Medicare, we are seeing once again calls for a single payer system that can solve our national health care crisis once and for all.

 

But we don't have a health care crisis in this country. We have a problem of limited resources and unlimited desires, just as with food, automobiles, and sleek-palmtop gadgets that beep to remind you when you have a column due. A single payer system will not, despite the extravagant claims of its advocates, allow us to consume unlimited quantities of health care at low cost.

 

A single payer system will fix some people's problems, mostly low-income people who lack health insurance, and who have a disease with a well-developed treatment. But lowering the cost to consumers of health care increases demand for services, and pushes up costs to taxpayers; to curtail those costs, the government eventually resorts to rationing or price controls, which result in shortages and diminished innovation. Ultimately, a single payer system would improve the lot of the uninsured at the expense of the elderly, and those who have diseases for which no good treatment has yet been invented.

 

Perhaps there is a legitimate argument to be made that the tradeoff is worth it. But ask a single payer advocate about those tradeoffs, and it's likely that they will explain that that's not the kind of single payer system they're going to implement; they want the kind that provides lots of innovation, and all the health care people need, while costing less than our current system. Ask them to provide an example of a government bureaucracy that has managed to combine high levels of service with low costs, and you will get a vague explanation about the glories of preventive care, or (my favorite), the government's well known ability to reduce red tape and administrative overhead. But it doesn't really matter what the explanation is, for every one of them seems to rely on a monolithic government bureaucracy transforming itself, against all experience, into a low-cost, high-performance, customer-focused powerhouse. That's where the magic happens -- if we all wish hard enough.

 

My Own Miracle Mile?

 

This phenomenon is certainly not limited to liberal causes like universal health care. Conservatives also support policy choices based on some idealized vision of how they might work in the best of all possible worlds, rather than on how they will actually be implemented in this one. And I am beginning to fear that I may have fallen into that error myself.

 

I supported the war on Iraq darn near unequivocally. I thought -- and still think -- that Saddam Hussein posed a strategic long-term threat to US interests. I thought that the only viable alternative to war, sanctions, were unspeakably cruel to the populace, while doing little to either punish Hussein, or remove him from power. And I believed that we could build a stable democracy in the Middle East. In the long run, I thought we'd all be better off. And in the short run, if it cost me some money -- well, it was a price I was willing to pay.

 

But my inclination to support the war rested on the assumption that once it was over, we would be ready, willing, and able to rebuild Iraq after we invaded. If we aren't going to do this, why invade in the first place? In order to convince the world that we're the superpower equivalent of a malevolent toddler who smashes anything that catches his eye? Even if you didn't support the war, isn't the folly of refusing to pay for reconstruction evident? If we pull out now, with Iraq in a shambles, we're writing Al-Qaeda's recruitment brochure for them. And we're utterly destroying any credibility we might have with the rest of the world.

 

But while I still think we can help Iraq transform itself into a functioning free society, I'm terribly afraid that we won't.

 

Bad enough that anti-war protesters -- who were terribly, terribly concerned about the plight of Iraqis before we invaded -- are now staging demonstrations to urge us to pull out immediately now that we're the only thing standing between those Iraqis and anarchy. But there are actually rumors that the White House is contemplating accelerating our departure, which seems lunatic to even discuss when the country doesn't appear to have a functioning anything.

 

Even more incredibly, the Senate, which voted for the war, is now demanding that we make the Iraqis shoulder half the costs of reconstruction. The sum in question, $10 billion, is almost equal to Iraq's entire annual GDP; for us, it represents approximately one tenth of a percent of our national income. That we are even thinking about beggaring Iraqis over so trivial a sum boggles the mind. And I'm beginning to wonder if my support for the war didn't rely on a Miracle Mile in which our government, in defiance of my basically libertarian instincts, had the desire and the will to do whatever it takes to help the Iraqis become prosperous and free.

 

Make the Magic Happen

 

But I haven't given up hope yet. I don't think that the American citizenry begrudges the Iraqis a little financial help, if it will help bring peace and prosperity to a dangerously -- and expensively -- unstable region. After all, we're talking about $35 apiece, which is a bargain for what we'd be getting. I'd like to think that Americans would do it even if it didn't benefit our long-term strategic interests, just because we value our freedom enough to know how much it would be worth to someone else.

 

If there are any senators reading this, especially ones who voted to stick Iraqis with the bill for reconstruction, I'd like you to know that I, for one, am willing. Being a journalist is not the world's most lucrative career, but I think I can scrounge up $35 to help rebuild Iraq if you'll let me know where I can send the check.

 

And if any of my readers are also disturbed at the prospect of charging the Iraqis for the privilege of being invaded, I hope you'll write your senator and let him or her know that you, too, are willing to contribute your $35 to put things right in Iraq. If they hear from enough of us... well, maybe if enough people wish for something, we can make magic happen after all.
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