Sunday, September 25, 2005

The status quo is something to be changed, not something that constrains us.

I read "Mountains Beyond Mountains" about Paul Farmer. A doctor, he's one of those thoroughly admirable people who has devoted his life to both trying to do good in his immediate actions (i.e. tending to patients in poor places like Haiti) and has tried to shift the status quo on what is an acceptable way to behave toward the poor and sick. He's done amazing things in Haiti, Peru, and Russia, and probably more. In particular, he has devoted a certain amount of energy to arguing that the whole notion of "appropriate technology" and sustainable development is bullshit. That the first, in the context of medicine, simply means nice medical supplies for the rich and bad medical supplies for the poor, and that the notion of sustainability, particularly when it comes to funding drugs for TB and AIDS isn't worth worrying about: get the drugs (and money to fund the purchase) however you can and you'll figure something out when the money runs out. Basically, screw any attempt to decide what's plausible, and just do what's best for your patients, regardless of the context.

The moral pull of that view is rather strong: yeah, why do we let people languish? Let's be active, and screw worries about money, the money will come. Regardless, we shouldn't embrace the idea that we have to ration supplies and what not. The status quo is something to be changed, not something that constrains us.

This last is where my economics background comes into sharp conflict with my more moral moments. Because economics, particularly when thinking about policy, is all about how, given a fixed amount, do we spend it best and most efficiently. You assume a hard budget constraint and try to maximize various objectives under that constraint. This is the perfect task for a technocrat. But at the moment that you say the status quo isn't what we have to work with, that we can, and will, shift it, you end up in a very different position: an activist one -- think Jeffrey Sachs. And there seems to be something untoward -- impolite and impractical? -- about an economist who questions the status quo: you've been given your budget constraint, now work with it.

Yet you look at the career of a Paul Farmer or Jeffrey Sachs and they've succeeded at moving the budget constraint by sheer dint of pushing and pulling and being dynamic and brilliant and bull-headed and rude. Sure they haven't moved it as much they would like, and some of the movements they think they've made have been taken back, but, nonetheless, on net there is more money going places it didn't go before. And being spent in ways that hadn't occurred to people before (this is especially true for Farmer). So the world is better off for them not having taken the budget constraint as given, a troubling thought for one devoted to the language of economics.

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