In the comments to my post on MRSA, a commenter says:

Providing access to primary care to those who are currently only getting emergency care is almost, but not quite, entirely unlike the problem of reducing medical error. (hat tip to the first person to get the reference.) While there may be a reduction in the rate of increase in costs after several years, there will need to be an immense effort made to train an army of primary doctors and get them into the communities where they're needed.

Please, stop reading Lomborg. Malaria and global warming are both serious problems. There is simply no reason whatsoever to pit them off against each other. This is even more the case where the solutions to the two problems require different commitments.



This is a very common complaint among liberals about Bjorn Lomborg, who basically argues that global warming is not a high priority relative to other things we could do to alleviate human misery; better to spend a little money on adjusting to global warming and a lot on malaria eradication, than a lot of money preventing global warming and a little money on malaria.

As it happens, I think Lomborg is probably wrong. But I think this criticism of Lomborg is wrong too.

Lomborg's critics essentially say "But we should do both!" But the universe is filled with awesome things we could do; unfortunately, it provides only limited resources with which to achieve them. We have to prioritize. Lomborg is absolutely right that we should order the list of things to do by the cost-effectiveness of reducing human misery, and do the things that reduce the most misery for the least money first. Yes, it might be nice if we did global warming and malaria eradication . . . but perhaps it would be even nicer if we did malaria eradication and sewage treatment. We should always, when considering a policy, consider whether the dollars might be better deployed elsewhere.

THis is particularly important because the governments of the western world are not run by benevolent dictators. They are themselves self-interested, and they are beholden to voters who are not overburdened with unlimited generosity. And for many of their efforts, like polio eradication or, arguably, fighting global warming, improvements will not scale smoothly. That is, it is several orders of magnitude better to have spent enough money to get rid of all the polio in the world, than to have spent half that money and achieved half that eradication. This means that it is probably better to put a lot of money into a few things, than a little money into many things. However nice it would be if those governments could do all good things, in practice, they will do only a few, so it behooves them to choose carefully.

Where Lomborg goes wrong, I think, is not that he urges us to prioritize carefully, but that he is too optimistic in his assessment of global warming. Specifically, he doesn't really address the problem of low-probability, but catastrophic systemic failures. If you change the weighting of those low-probability events--and in fairness to Lomborg, how to weight such things is a matter of hot economic and philosophical debate--then global warming starts to look more important than malaria eradication again.

The same logic may apply to MRSA eradication--or it may not. Perhaps we have the money to do both national health care and MRSA eradication, (assuming for the sake of argument that they are both good ideas.) Or perhaps MRSA eradication is not possible, or is too costly, or is for some other reason a bad idea.

But as a thought experiment, I think it's useful, because it illuminates different priors among different parties to the argument. Some people arguing over national health care on both sides are sort of present-centered utilitarians; they are interested only in the most cost-effective way to make people healthier, given the various political and economic constraints. They might rank MRSA higher on their list than national health care. But other people in the argument have additional priors about distribution; if they could only do one of these two things, they would choose national health care even if MRSA was cheaper or saved more lives, because they're also seeking a form of distributional justice. As I've said elsewhere, I don't think that government provision of health care is a particularly good vehicle for distributional justice. But mostly in this case I'm interested in separating the sheep from the wolves, because my sense is that almost everyone talking about health care tends to argue as if we're all trying to maximize the same thing.

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