In the realm of consequences, there are those we intend and those we do not intend. No matter the greatness of the cause or extensive forethought involved, there will always be unintended consequences. Some will be desirable and others not.
Explore This IssueACEP News: Vol 29 – No 02 – February 2010
If a toddler hits his head and concerned parents present him for evaluation, the intended consequence of a CT scan of the brain would be identification or elimination of a brain injury as the cause of symptoms. Satisfied parents would be a positive unintended consequence of the study (let’s hope that’s not the reason for the CT scan). A negative unintended consequence might be brain cancer 30 years later when the kid’s wife is pregnant with their first child.
History and economic theory are full of examples of unintended consequences. Sunken ships create a hospitable undersea habitat. Aspirin, initially sold as a pain reliever, prevents strokes and heart attacks. The adhesive used in Post-it note pads was originally thought to be a failure because it didn’t stick tight.
How great life would be if all unintended consequences resulted in happier fish and cool office stuff. But no.
Price controls (as in the 1970s) might, in the short run, help a few that can’t afford something; but ultimately, they lead to scarcity. Asbestos is a great fire retardant, but it causes lung cancer. Raising taxes may, in the short run, raise extra funds; but in the long run, it leads to lower revenues and an unhappy populace.
Andrew Gelman makes the point that when a simple system tries to regulate a complex system, things often go poorly. The “Great Society” is an excellent example of good intentions gone haywire. There is ample evidence that the creation of Medicare was the start of our current economic problems in health care and health insurance. Despite the outlay of a zillion dollars, we still have proportionately as many poor people, and we have subsidized out-of-wedlock births and destabilized families in the process. And who’s for that?
And here we are on the verge (well, maybe not, thanks to Massachusetts) of Congress voting to “fix” health care. Given that large-scale government meddling in the private sector routinely makes things worse, I have full expectations (bet-the-house-and-the-car expectations) that history will repeat itself abundantly.
Sure, it would be great if every one of our patients “paid.” Not so great, however, when the pay is 25 cents on the dollar. In order for this system to work, the government will ultimately control its costs by controlling prices (and access). And controlling prices leads to what? Scarcity. You’re learning fast.