THE EVOLUTION OF HEALTH SYSTEMS: Learning From Matt Ridley in the Evolution of Everything.

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Matt Ridley makes the argument in The Evolution Of Everything that change in human institutions is incremental, inexorable, unplanned and inevitable.

Change follows a narrative going from one stage to the next. It creeps rather than jumps. It has it own spontaneous momentum. It happens by trial and error- a version of natural selection.

The huge mistake, that we all make, according to Ridley is to assume that the world is much more of a planned place than it is.  Change, he describes, is the result of human action and not human planning.

The complexity of society and of systems such as a healthcare system does not imply a planner.  Darwin’s mechanism of selective survival resulting in cumulative complexity applies to all aspects of human culture.

Ridley states that the history of Western thought is dominated by skyhooks, by devices used to explain the world as the outcome of design and planning. This is an ego-centric view of the world required to prop up the fiction of free will and the myth of the Great Man.

The defining feature of cumulative culture- the capacity to add innovations is a very slow cumulative change accelerating towards today’s near singularity of incessant and multifarious innovation.  The more we exchange, the more value there is in specialization, the more innovation is created.

Specialization when coupled with exchange is the source of economic prosperity.  Gains in trade will encourage more specialization and so on to form a virtuous cycle. And most innovation comes from the recombination of existing ideas for hoe to make or organize things.

The free market is a device for creating networks of collaboration among people to raise each other’s living standards. It is a device for co-ordinating production and a device for communicating information about needs through a price mechanism. The free market is a system of mass cooperation.

The free market leads to more prosperity than government planning. There is a role for government in keeping the peace and enforcing rules and helping those who need help.

Free markets are like ecosystems. They work because they are efficient but also effective in providing solutions to problems that face customers.  Free market commerce is the only system devised where ordinary people are in charge.

The history of government over the past few centuries is that when the state steps in to provide something that was underprovided by people for themselves, things do NOT necessarily improve. They often get worse. Market failure is often used to describe this situation.

Previously in Russia and North Korea, the government was responsible for food, from field to fork. The result was dismal productivity, frequent shortages, scandalous lapses in quality in rationing. This is happening in healthcare systems as well.

The lesson from Matt Ridley is that if a system is frozen by constraints such as regulations and is not allowed to evolve, then that the system will fail.

We should rationally want our healthcare system to continue to evolve and innovate in order to help all of our citizens. However, our system is not meeting those needs in a timely manner. There is rationing every day in every province.

The issue is whether we should allow the healthcare system to evolve and innovate in the exchange of value that constitutes a free market for healthcare services with a certain level of care guaranteed for all.

Or should we allow the healthcare system to remain frozen by a maze of regulations,  strict enforcement and limited by the Canadian need for moral perfection, which, of course, is never attainable.