The Cost-Benefit Analysis At The Heart of Our Republic

There is a joke: What do you call the person who graduates at the bottom of their medical school class? Answer: Doctor.

And the corollary: Do you want that doctor operating on you?

George Will's Washington Post column from today (10 February 2022) is grist for discussing not just the perils of the"nanny state” and well intentioned government overreach but also how should governments, institutions, society, and citizens approach risk.

[I debated whether to refer to individuals versus citizens and decided on the latter because the word carries with it the concept that we are responsible to others, including those we don’t know and may never know.]

When I was a Navy Preventive Medicine Technician I was inspecting a snack bar at an outlying airfield attached to Point Mugu Naval Air Station (NAS), just north of Los Angeles and Malibu. Because of the airfield’s remote location the snack bar was one of only two facilities where sailors and civilian workers could eat. The facility was badly run; “ptomaine palace” would be a kind description. I gave the snack bar a failing grade and went straight to the Operations Officer, gave him a copy of my findings and advised him to close the place for cleaning and to repair some faulty equipment. He read my report, tossed it back across the desk at me and asked me which item he needed to fix in order to get it back up to a passing grade.

I shouldn’t have been surprise I suppose—but was—at his attitude. “All of them” I answered and turned to leave. He told me to stay where I was and proceeded to tell me if he ran an Air Squadron with that kind of standard he’d never get anything done. As I finally left his office I prayed I’d never fly on an aircraft in any squadron he commanded.

The next day I was called into NAS Point Mugu's Executive Officer's office to explain my inspection result and recommendation. I proposed that a cost benefit analysis might conclude if there were only two places Navy and civilian personnel could eat at the airfield, if one of those facilities was a pig sty, the chances of someone—including aviators and aircrew—getting sick and being unable to do their job, or worse, getting sick while doing their job (such as flying an aircraft) that the Operations Officer's “minimalist” approach might be too costly with no real benefit involved. The Executive Officer agreed with my assessment and ordered to snack bar closed until it was cleaned and reinspected.

In his article, linked above, George Will cites a recent statement by Secretary of Transportation Pete Buttigieg that “Zero is the only acceptable number of deaths and serious injuries on our roadways.”

Will goes on to write, “Buttigieg actually is going to have to “accept” many vehicular deaths and injuries because the road to zero is paved with pipedreams… In government, every serious mistake is, at bottom, a matter of disproportion. Furthermore, risk assessment is a basic test of rationality, as is weighing the trade-offs when responding to risks.”

Well. Will is correct of course, to the extent that zero highway deaths is a pipedream and an unachievable goal. And it is also true that we won’t eradicate COVID-19 and all its variants. Nor will we eradicate Staphylococcal food poisoning and salmonellosis from greasy spoon snack bars.

When medical schools establish criteria for students to get passing grade they are making a cost-benefit decision. They are weighing the trade-offs of throttling the supply of graduated, soon to be interns, students against the risk of inflicting incompetence on unwitting patients. They are, in short, determining what level of incompetence the system can withstand. The question arises when “cost-benefit analysis” rears its head; who benefits, and who pays the cost?

A libertarian argument, which Will nicely demolished in one of his books (Statecraft As Soulcraft, possibly?) holds that the market would weed out incompetent doctors because the word would get out about them. Similarly, ptomaine palaces would go out of business, as would unsafe airlines. Unfortunately some or many lives will suffer, or be lost, in this process of discovery.

So government sets standards and establishes regulations to protect the public from slipshod or malevolent actors. Indeed the foundations of the regulatory state, often decried by conservatives, are laid in our Constitution which gives Congress the power to regulate interstate and foreign commerce and “To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.” Further, the Constitution vested the power of enforcement in the Executive Branch led by the President.

The political history of the 20th (and 21st, so far) Century has been characterized by tension between Congress and an assertive Executive. Congress, often reluctant to embrace regulation, even recalcitrant, has surrendered a great deal of its regulatory power to the President. In many cases Congress has waved off its responsibilities because individual members and caucuses within the two Houses don't want to annoy interests composed of donors or single-issue voters. It’s easier and safer, career-wise, to let the President and cabinet officers make regulatory decisions and then complain about executive overreach.

Complaints about overreach often employ the slippery slope; or some variation of “once you go down that course, who knows where you'll end up.” Democracies, unfortunately, exist on slopes and their slipperiness or steepness is up to voters and their elected representatives to determine.

James Madison, the architect of our Constitution, saw this and erected a structure of competing interests not only to balance the three branches of the federal government as we all learned in school, but also the federal and states governments and the people as a whole, whose consent it all depends on, or should.

If the Executive is too assertive and Congress too passive or complacent we risk an authoritarian—or in today's favored parlance among some right wing talking heads—or illiberal democracy (if there can be such a thing). If Congress chooses to obstruct and kneecap the Executive to weaken it politically or to promote the interests of its donor, or a passionate voter bloc, or pad the accounts of some of its members, then we are headed towards oligarchy or an American version of nomenklatura.

The Judicial Branch has a “break glass in emergency role” but reflexively looks for the political branches in both federal and state governments to do their jobs. And the political branches look to whomever will keep them in power; be it voters or interests.

As much of a cliche as it is, it is up to voters to steer our ship of state on its proper heading and correct course as needed.

The Department of Transportation cannot achieve zero highway deaths, but should it not try, as an ideal goal, to eliminate highway deaths. It isn’t intrinsically wrong to try, and it may be dereliction of duty not to. If the measures they take are too intrusive and counterproductive, Congress and voters can and should correct course.

The same goes for all of our slippery slopes, be they speed limits, gun regulations, vaccine and mask mandates, seat belts, whatever. It is up to voters to determine the attitude and angle of our democracy and whether it is slippery or not. If voters leave the decisions to TV talkers, smug self interests, and political carney barkers, they decide, in absentia, the country they leave behind.

The question of cost-benefit analysis centers on who benefits and who bears the cost.

Leaving Independence Hall after the Constitution was drafted, Benjamin Franklin was asked what they had given the nation. “A Republic, if you can keep it,” he answered.

Our burning question today is, can we afford the cost of losing it?