Writing about health care reform, James argues:

Most of us have the sense that ourselves and our families would be worse off in a system where the government was even more influential and even more people were free riding.

First of all… I am not sure about that “most” qualifier, though I would be happy to accept “many.”

Second, there are times when the aggregation of impressions of millions of individuals does not add up to an accurate picture of a problem. Basically, people have very little ability to put things into context. You see it all the time when people are ask the quantify the impact of some decision or other. You could easily have written that same sentence to argue the following:

• Most of us have a sense that the price of gas would drop dramatically if we just drilled in ANWR.
• Most of us have a sense that we would be significantly richer if we stopped sending billions abroad in foreign aid.
• Most of us have a sense that crime would drop dramatically if we just ended immigration from Latin America.

None of those is actually true. So the problem is not a policy issue, but an education one in many cases. This is not a paternalistic argument. I don’t actually know what system would work better. Maybe we need even less government. Maybe we need a full-blown single-payer plan. I don’t know. But what I do know is that my impressionistic assessment of my own family’s situation is not a substitute for a broader policy debate.

Third, it is nonetheless true that James is highlighting a potent POLITICAL problem. As long as people believe what he believes, it is hard to have a productive debate. But in fairness, his belief is ideological at its core — a deep seated suspicion of government bureaucrats combined with an implicit deep seated trust in private sector bureaucrats.

Finally, all this reminds me of Machiavelli’s argument about the challenge of implementing new policies:

And it ought to be remembered that there is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. Because the innovator has for enemies all those who have done well under the old conditions, and lukewarm defenders in those who may do well under the new. This coolness arises partly from fear of the opponents, who have the laws on their side, and partly from the incredulity of men, who do not readily believe in new things until they have had a long experience of them.

The thing is… for all the incredulity of many conservatives, the empirics just don’t support the notion that we are getting anything like our money’s worth. And the fact is also that the many countries that have equally good health care systems at 1/2 to 2/3 the cost do so with a lot of government involvement.