New Gawande

Atul Gawande has an article in the current issue of the New Yorker praising the Senate health care bill for its address of the cost issue in health care reform! His view is partly based on the fact that we do not know all the answers in how to do this, emphasizing both our epistemic position and the fact that there is not one global solution. It is also based on the idea that trial and error is the way to approach this. I very much like this way of thinking, although I would also like to see government create more incentives to cut costs, although maybe I am missing something. His account of the growth of agricultural science is interesting in its own right. I do wonder, though, whether the analogy really holds up, one of the difficulties in arguing by analogy.

On agriculture in developing countries, Daniel Little has a tale of caution. You may increase productivity but at the expense of greatly increasing inequality such that many of the poor are worse off than before. I very much support his reference to Sen in helping people have the basic necessities to flourish. You can argue for this in a number of ways. I prefer a Rawlesian justice argument, but one can see how a utilitarian could also argue for this because once a person has the basic necessities, other goods have decreasing marginal utility. You can also see how this sort of action would violate Rawls' principle of Pareto efficiency; increases in wealth should not make anyone any worse off.