Iatrogenics: Why Intervention Often Leads to Worse Outcomes

What context was missing? You can argue that the ACA has benefits or the US system is complicated but I did not simplify anything. From the article "Intervention—by people or governments—should only be used when the benefits visibly outweigh the negatives." My argument was 'damned if you do, damned if you don't' and politicians do not worry about the consequences of their actions.

I agree that I didn't use lame duck in the textbook definition but it does show the derogatory nature of not doing anything. Likewise congress would be called ineffective if they didn't pass laws. We often hear about gridlock when there's a balance of power with the 2 party system. I think saying 'deliberately designed to make doing something impossible' is an overstatement. Compromise is required. I see more and more that neither party wants to compromise, though. From my perspective, it's hard to talk about any Federal action that would be of benefit. Granted I'm jaded from seeing and being part of second order consequences. What kind of Federal action did you have in mind?

Edit I didn't address one of your points. You said the laws largely accomplished their purpose. What did you see as their purpose?

You are asking a question yet seem committed to ideas and political views already. here is an attempt to answer:

Through the Industrial Revolution medicine increased in scope and complexity and cost. By the 1970s people expected access to hospital care which was increasingly expensive to provide. Around the world most developed nations came up with some kind of universal insurance or single payer system to handle this. The US went with employer based care which limits who is covered and puts a burden on business.

Ongoing calls for universal basic care threatened market based care in the US, so Mitt Romney came up with a plan to provide universal care through government regulated insurance markets. Obama tried to bring this plan to a Federal level but was stopped by a complex array of social and political forces. As a notable example of what happened, Frank Luntz who often has interesting ideas to contribute to this day insists that the ACA was not an insurance program even though providing health care through private insurance was the central concept.

So now there are people who see the ACA as a compromised attempt to save market based insurance provided medical care and others who see it as some kind of strange intervention amounting to socialized medicine which oddly enough is exactly what it was designed to avoid. Where ACA was adopted it seems to be working reasonably well, and in Massachusetts where the original Romney plan was adopted everyone is insured and gets care through private insurance markets coordinated by the government.

The really big irony here is that by compromising ACA and then not even adopting it in some states it is increasingly likely that some kind of Single Payer system will end up being adopted at a Federal level. In this sense those who attempted political intervention have generated the most harmful possible result. That is the increasingly likely possibility that the existing system of providing health care in the US through insurance markets will be completely swept away instead of being reformed as Mitt Romney and Barack Obama advocated.

Although it is certainly written by a human being, this article gives me a similar feeling to ChatGPT essays. The tone is compelling and plausible. But when I thought about it, I realized it didn't make much sense.

> Rarely do we even consider that the cost of doing something might outweigh the benefits.

Cost vs benefit is the main thing that people consider when making decisions. It's a core decision making framework taught as early as elementary school social studies. Institutional decision making is rife with processes for assessing risks and performing cost-benefit analysis.

> Intervention—by people or governments—should only be used when the benefits visibly outweigh the negatives.

This advice is the decision making equivalent of "just don't write code with bugs." Easily achievable but pretty useless and completely impractical. Real world decision making involves operating under uncertainty at almost all times. If it didn't, the topic wouldn't be worth writing articles about.

I read something recently here, comparing this phenomenon to the phenomenon of overfitting.

The gist is that we want to leverage our ability to measure things that are easy to measure, which are correlated with things that are hard to measure, and then optimize for those things. The downside being that you will always implicitly be sacrificing the things you don't/can't measure, and these sacrifices tend to occur in greater marginal amounts as the low hanging fruit gets eaten.

There are obviously interventions which are so ill convceived that they have no place being implemented in the first place, but this mechanism applies to every intervention eventually.