I have always thought that the great weakness of Obamacare is that its basic philosophy is to mandate that things be done the same way throughout the United States. John Stuart Mill is eloquent in laying out what is lost when top-down control pushes things toward a single approach instead of a diversity of approaches. On this theme for health care, see my posts
- Health Economics
- Evan Soltas on Medical Reform Federalism–in Canada
- Don’t Believe Anyone Who Claims to Understand the Economics of Obamacare
- Clay Christensen, Jerome Grossman and Jason Hwang on the Agenda for the Transformation of Health Care
Of course, the message of On Liberty, Chapter III: “Of Individuality, as One of the Elements of Well-Being,” paragraph 17 and 18 has a much broader application than to health care policy. It points to the benefits of the diversity fostered by liberty in a wide variety of contexts:
We have a warning example in China—a nation of much talent, and, in some respects, even wisdom, owing to the rare good fortune of having been provided at an early period with a particularly good set of customs, the work, in some measure, of men to whom even the most enlightened European must accord, under certain limitations, the title of sages and philosophers. They are remarkable, too, in the excellence of their apparatus for impressing, as far as possible, the best wisdom they possess upon every mind in the community, and securing that those who have appropriated most of it shall occupy the posts of honour and power. Surely the people who did this have discovered the secret of human progressiveness, and must have kept themselves steadily at the head of the movement of the world. On the contrary, they have become stationary—have remained so for thousands of years; and if they are ever to be farther improved, it must be by foreigners. They have succeeded beyond all hope in what English philanthropists are so industriously working at—in making a people all alike, all governing their thoughts and conduct by the same maxims and rules; and these are the fruits. The modern régime of public opinion is, in an unorganized form, what the Chinese educational and political systems are in an organized; and unless individuality shall be able successfully to assert itself against this yoke, Europe, notwithstanding its noble antecedents and its professed Christianity, will tend to become another China.
What is it that has hitherto preserved Europe from this lot? What has made the European family of nations an improving, instead of a stationary portion of mankind? Not any superior excellence in them, which, when it exists, exists as the effect, not as the cause; but their remarkable diversity of character and culture. Individuals, classes, nations, have been extremely unlike one another: they have struck out a great variety of paths, each leading to something valuable; and although at every period those who travelled in different paths have been intolerant of one another, and each would have thought it an excellent thing if all the rest could have been compelled to travel his road, their attempts to thwart each other’s development have rarely had any permanent success, and each has in time endured to receive the good which the others have offered. Europe is, in my judgment, wholly indebted to this plurality of paths for its progressive and many-sided development.
In this passage, I am impressed to see John articulate so early on a theory for why China fell behind that is still taken very seriously by economists: the idea that the top-down nature of the Chinese system under the 1644-1912 Qing dynasty hindered progress. It is worth considering how the end of the 21st century could see a reversal of roles, if the people of China embrace political, intellectual and economic freedom, but top-down control wins out in Europe and its offshoots.