Wednesday, August 14, 2013

Bad Policy Advice or Bad Governance

William Watson argues today that evidence-based policy-making can produce bad policy.  Maybe, but ideology-based or evidence-less based policy might just be far worse, right?  This reminds me of certain political scientists pushing against hypothesis testing.  The advice at the end is correct--that we should be mindful of the reality that experts will disagree, that the evidence is not always clear, and that choices have consequences.

The funny thing is that Watson uses pretty selective evidence to illustrate (not test) his argument--his ability to get a doctor.  Now, to be clear, I had pretty much the same experience .... in Quebec.  One thing this article does (perhaps it was written for Quebec audiences first and foremost), and a common mistake it is, is to conflate a provincial policy with a Canadian experience.  It may be the case that provinces besides Quebec also messed up the sizing of the medical community, but one thing that all folks who compare Canada to the US or anywhere is must ALWAYS keep in mind is that the administration and thus the quality of medical service varies by province because the provinces run them.

When I moved to Ontario (using my experience to generalize) from Quebec, it took us a few weeks to find a clinic and a doctor.  Both the clinic and doctor are wonderful--the service is quite fast--appointments within a day or three, the facility is clean and modern, the doctor is responsive, and so on.  The emergency rooms can be a bit slow, like Quebec, but they are not beaten to crap so that they look like a 2nd or 3rd world facility (that would be Lakeshore General in Montreal).  It really is night and day.  It is not utopia, but anyone making arguments about health care in Canada must be wary of generalizing from their province's experience especially if their province happens to be Quebec. I have long argued that anything that Quebec's government touches turns to crap, that Quebec could not administer a lemonade stand (see here for how opposition politicians are of little help).

The argument Watson is addressing is the notion that doctors were creating more business for other doctors, so if one cuts the number of doctors, there might be less spun up health care expenses.  This seems like an incredibly stupid theory, and I have no clue as to what evidence was used to test it (I am not a health economist nor was I around at the time).   It seems real convenient to a government that might be interested in cutting costs and being not so accountable for good government (because elections based on nationalist issues tended to distract SQUIRREL! the public from issues of good governance).  So, was it really that experts advocated cuts in doctors or was it that the government of the day listened to the advice that matched their preferences?  Oh, and where did the doctors go?  Ontario and elsewhere, right?

So, I would argue that we need to be careful about the evidence that we use (perhaps my experience in Ottawa is an outlier), that we need to keep in mind the source of policy-making (province or federal), and that we need good theory and good evidence AND we need to keep in mind that there are always tradeoffs and second/third order consequences. 

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