Public Policy and Governance – Page 247

The Tragedy—and Promise—of the Commons

The “tragedy of the commons” is a term often used by economists and ecologists; it’s shorthand for situations where individuals who are acting independently and rationally in their own self-interest undermine the common good.

Indiana Law professor and activist Fran Quigley thinks the tragedy of the commons explains a lot about the state of American health care. As he explains in an intriguing new article he shared with me (not in print yet, so no link available)

Between the 15th to 19th centuries, the rich and the powerful fenced off commonly-held land and transformed it into private property. Land switched from a source of subsistence to a source of profit, and small farmers were relegated to wage laborers….

More recently, a similar enclosure movement has taken place. This time, the fenced-off commodity is life-saving medicines. Playing the role of modern-day lords of the manor are pharmaceutical corporations, which have taken a good that was once considered off-limits for private profiteering and turned it into an expensive commodity. Instead of displacing small landholders, this enclosure movement causes suffering and death: billions of people across the globe go without essential medicines and 10 million die each year as a result.

Quigley points out that producing medicine for profit is a relatively modern phenomenon–and says it is time to reclaim this commons, and he spends several pages showing how medicines fit the definition of a public good.

The public health implications of access to medicines generate another core quality of public goods: positive externalities. One person’s consumption of an essential medicine provides clear benefits beyond the direct consumer. Vaccines, for example, prevent both the recipient from getting ill and also from spreading the disease to others. If a society vaccinates widely enough, the chain of disease transmission is broken, leading to the quintessential public good of herd immunity. Global distribution of the smallpox vaccine has led to the eradication of a disease that once infected 50 million people a year.

I hadn’t known that “Until well past the middle of the 20th century, few countries allowed individuals or companies to hold exclusive rights to produce medicines.” ( I was aware that pharmaceuticals are and always have been, as Quigley points out “the very opposite of a laissez faire market.”) And I did know that the U.S. government is a major funder of medicine research.

Quigley is particularly critical of the notion that drugs can be patented, and points out that many countries limit the duration or scope of such patents:

Among governments and the public alike, medicines continue to be treated as a good quite distinct from consumer items like cell phones or flat-screen TV’s….Jonas Salk declined to pursue a patent for the polio vaccine, saying the patent belonged to the people. The creator of the first synthetic malaria vaccine donated the patent to the World Health Organization. As Salk said in 1952, “Would you patent the sun?”

Today, of course, major drug companies depend upon those patents for their profitability.

Economists call this process the transformation of a public good into a “club good,” like taking a public park and turning it into a gated dues-required golf course.

Quigley’s article is a fascinating history of how intellectual property protection overcame the previous widespread belief that medicines should be considered public goods, not consumer products. And he argues that

The history of pharmaceutical innovations, especially vaccine developments and life-saving treatments for infectious and chronic diseases, shows that the critical research behind these developments was created outside the patent system…The U.S. National Institutes of Health alone provides $30 billion annually for medical research, governments provide tax credits to support corporate research, and government health programs are bulk purchasers of patented medicines priced far above the costs of production. When it comes to medicines, taxpayers of the U.S. and other research-supporting countries are the very opposite of free-riders: they pay to build the bus, fill it with fuel, and hire the driver, but still are asked to pay a prohibitive fare if they wish to take a seat.

In fact, a decade ago, U.S. economist Dean Baker crunched the numbers and estimated the savings to the U.S. government if its health systems could provide medicines without the artificial mark-up imposed by monopoly patents. The resulting savings could fund the replacement of all private industry research and development several times over, while still leaving billions of dollars in remaining public benefit. A significant source of those savings derives from eliminating the for-profit pharmaceutical companies’ expenses on marketing, a cost that exceeds their investment in research and development. As it happens, there are more efficient use of resources than funding television ads for erectile dysfunction drugs.

When the article is in print, I will share a link, because this abbreviated review doesn’t do it justice. But the question is, given the extent to which current practices are embedded in our economic system, can it be changed? Quigley admits the magnitude of the barriers, but he provides a surprisingly long list of reform efforts currently underway.

What struck me most while reading the article was how easy it is to assume that “the way things are” is the way they’ve always been, and the only way they can be—and how difficult it is to identify and protect a steadily shrinking commons in an America that has lost sight of citizens’ essential interdependence.

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Secret Government

A few weeks ago, the Boston Globe ran an article that should be required reading for all of the activists–left and right–proposing deceptively simple”fixes” for what ails government.

The article began by noting candidate Obama’s promises to reign in the NSA, close Guantanamo, and roll back portions of the Patriot Act.

But six years into his administration, the Obama version of national security looks almost indistinguishable from the one he inherited. Guantanamo Bay remains open. The NSA has, if anything, become more aggressive in monitoring Americans. Drone strikes have escalated. Most recently it was reported that the same president who won a Nobel Prize in part for promoting nuclear disarmament is spending up to $1 trillion modernizing and revitalizing America’s nuclear weapons.

Why did the face in the Oval Office change but the policies remain the same? Critics tend to focus on Obama himself, a leader who perhaps has shifted with politics to take a harder line. But Tufts University political scientist Michael J. Glennon has a more pessimistic answer: Obama couldn’t have changed policies much even if he tried….

In a new book, “National Security and Double Government,” he catalogs the ways that the defense and national security apparatus is effectively self-governing, with virtually no accountability, transparency, or checks and balances of any kind. He uses the term “double government”: There’s the one we elect, and then there’s the one behind it, steering huge swaths of policy almost unchecked. Elected officials end up serving as mere cover for the real decisions made by the bureaucracy.

The article describes what Glennon came to recognize from a career that included stints as legal counsel to the Senate Foreign Relations Committee, and consultant to various congressional committees and the State Department: in a number of policy areas, but especially national security, the people we elect have limited ability to effect policy change. Bureaucrats–and the systems within which they operate–call the shots far more than most of us realize. As he notes,

It hasn’t been a conscious decision….Members of Congress are generalists and need to defer to experts within the national security realm, as elsewhere. They are particularly concerned about being caught out on a limb having made a wrong judgment about national security and tend, therefore, to defer to experts, who tend to exaggerate threats. The courts similarly tend to defer to the expertise of the network that defines national security policy.

The national security apparatus is probably the most extreme example, but the phenomenon that Glennon describes operates, albeit to a lesser extent, in virtually all large bureaucracies, public or private. (There’s a reason business schools and schools of public affairs offer classes in organizational culture—systemic dynamics make change far more daunting than those on the outside realize.)

When you add policy complexity and specialized expertise to systemic inertia, the barriers faced by would-be “change agents” become even more daunting.

This phenomenon is why well-meaning calls for term limits aren’t just naive, but dangerous. When a newly elected Congressman or Senator takes office, he is utterly dependent upon (nameless, unelected) staff to show him the ropes. With term limits, by the time he learns enough about how it all works to actually be effective, he’s gone. The result is to place even more power in the hands of staff members who have staying power and know how the system works—anonymous functionaries that voters cannot hold accountable.

It would be far better to use the original mechanism for limiting terms: the ballot box. Unfortunately, rampant gerrymandering has removed that option by ensuring that far too many districts are uncompetitive.

It’s a problem.

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An Interesting Double Standard

As the standoff between the loony-tunes cowboys who seized the Oregon bird sanctuary and the feds has dragged on, a number of folks have wondered whether federal authorities would be as forbearing if the miscreants were African-American or (gasp!) Muslim.

If history is predictive, evidently not. At Dispatches from the Culture Wars, we learn about a similar incident that did, in fact occur, in 1979, in Harris Neck, Georgia,

where members of the African-American Gullah culture of former slaves had been screwed over by the government. Unlike those in Oregon, these men were unarmed. And they were black. And that seems to have made all the difference.

As the Oregonian reports,

The drama unfolding with armed occupiers holed up at the Malheur National Wildlife Refuge in Burns is similar to a standoff that made national headlines 37 years ago in Harris Neck, Ga.

But there are also stark differences, including the race of the Harris Neck occupiers – mostly displaced descendants of West African slaves — and the tactics used by the FBI to quickly remove what the media casually called “squatters.”

Also, the 40 members of People Organized for Equal Rights who set up a camp on the patch of land south of Savannah on April 30, 1979, were unarmed.

The grievances of the “squatters” were considerably more substantial than those of the Bundys:

Following the Civil War, a white plantation owner deeded the land on the Georgia coast to a former slave. In the decades that followed, the descendants of slaves moved to Harris Neck to build houses, factories and boats. They fished, hunted for oysters and grazed cattle.

Harris Neck evolved into a thriving community. Its members were recognized as a culturally unique group of African Americans called Gullah.

But in 1942, U.S. military officials gave Harris Neck residents just three weeks via eminent domain to leave their property so they could construct an airbase for training pilots and conducting anti-submarine flights.

As the community’s young men fought in Europe during World War II, the U.S. government, encouraged by white county commissioners, came to Harris Neck and gave residents a notice to move, according to historical research by Emory University. Federal authorities bulldozed or burned Harris Neck’s houses, barns, businesses or crops.

The land was never returned to its Gullah owners, and eventually became the Harris Neck Wildlife Refuge; it was that land that the unarmed protestors occupied. Unlike the situation in Oregon, the federal authorities moved quickly; they obtained a court order to remove the demonstrators exactly one day after the “camp-in” began. Four men who refused to leave were forcibly dragged out, and sentenced to a month in jail for trespassing.

In all fairness, after Ruby Ridge and Waco, federal law enforcement personnel have altered the way they handle these situations, and for good reason.

Still, I wonder whether they’d be this patient if the occupiers were members of a disfavored or disempowered community….

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Why the Legislature Should Rip Off the Bandaid

When I was a child and scraped a knee or otherwise required a band-aid, I would dread removing it. Eventually, I learned that it hurt more to try peeling it off bit by bit than it did if I just gave it a good yank.

Fast forward to the Indiana General Assembly, and the back-and-forth about “four words and a comma.”

Leave aside all the rhetoric. Ignore who’s “right” and who’s “wrong,” and just look at the political realities.

If the legislature fails to extend full civil rights protections to LGBT Hoosiers, three things are guaranteed to happen: there will be a replay of the economic boycotts that threatened to knee-cap the state during the RFRA disaster; the business community will take out its anger on Republican officeholders (beginning with the Governor, but definitely not limited to His Holiness); and–worst of all, from the perspective of lawmakers trying desperately not to take a position on the issue— the battle will return in the next session. And the one after that, if necessary.

This is an issue that is crowding out other important matters that lawmakers need to address: infrastructure financing, education, economic development. It will continue to “suck the air” out of the legislative process until it is resolved. (And weenie bills with lots of caveats won’t cut it.)

Proponents of “four words and a comma” will come back again and again until those words and that comma are inserted into Indiana’s civil rights law. Furthermore, the ultimate success of their efforts really isn’t in doubt—as Bob Dylan said, you don’t need a weatherman to know which way the wind is blowing. Prolonging the agony is like peeling back that band-aid a painful bit at a time.

Senator Long seems to understand that. Others, not so much.

Hint to Indiana lawmakers: It will hurt a lot less if you just rip that band-aid off and do the inevitable sooner rather than later.

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Food, Water, Air and Government

Okay. Sunday sermon time.

For the past 30+ years, self-described “small government” conservatives have waged a propaganda war on the legitimacy of the state. While that war has rarely been as explicit as Grover Norquist’s famous threat to make government “small enough to drown in a bathtub,” or as intentional as the campaign I blogged about yesterday, the constant focus has been on what government does badly and the constant refrain has been that “we don’t need no stinkin’ government telling us to [fill in the blank].

Let’s stipulate that, yes, there are many things government at all levels does badly, and yes, we need to monitor its operations and correct its mistakes. Yes, there are good forms of government and oppressive forms, and thoughtful citizens should opt for—and attempt to institute— the former. But that is very different from the irresponsible attacks on the very existence of established political authority.

The shock that has accompanied the water crisis in Flint, Michigan demonstrates the extent to which even the most anti-government among us depend upon a well-functioning bureaucracy—not to mention the extent to which ill-considered ideological decision-making poses a very real threat to the well-being of citizens. (Especially citizens who lack the means to remove themselves from the polity and retreat into privileged enclaves where they can pay for clean water and other “amenities.”)

There’s a lot that might be said about Flint’s situation, and a lot of blame to go around, but the lesson to be learned goes well beyond the idiocy of “penny wise, pound foolish,” stubbornly ideological policies, or even official misconduct.

America is no longer a country of family farmers and small merchants scattered along the eastern seacoast. The overwhelming majority of Americans no longer grow and preserve our own food or draw our water from a pristine nearby creek. Cars and factories discharge pollutants into our air, airplanes criss-cross the skies, and we live in densely populated cities where—among other things— we can’t just toss our garbage out the back door. The list is endless.

American citizens are utterly dependent on the institutions of government to provide services we cannot effectively or efficiently provide for ourselves. We expect government to assign air lanes so our planes don’t crash into each other, to inspect the foods we buy at the local grocery so we don’t get ill, to prevent the local factory from discharging its toxic waste into our waterways so we don’t drink contaminants, and much more.

The private sector cannot protect even the richest gated communities from polluted air.

There are certainly areas of our communal life where government need not and should not intervene. Debates about the necessity and/or propriety of programs and initiatives is entirely appropriate, as is criticism of poor performance of government agencies or officials.

But.

When self-serving political rhetoric encourages our dimmer citizens to fear a “government invasion” of Texas, when the slightest effort to curtail gun violence sets off hysterical accusations of “confiscation,” when loony-tunes cowboys try to “take back” land held in trust for the benefit of all citizens, when efforts to ensure equal treatment of the nation’s more marginalized groups is rejected by zealots who claim exemption from the laws of the land “because God,” we have not only weakened the bonds of citizenship, we have endangered our own safety and well-being.

If we don’t retreat from our bipolar “government bad/private good” approach to complicated issues, there will be a lot more people drinking brown, lead-filled water and breathing toxic air.

Among other things.

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