photo by EfrankE

Monday, March 22, 2010

Health Care Reform of the Cabrini-Green Variety?

Nearly 39 years ago, I began matriculation as a student at a large Midwestern university in the Urban Planning program. At the introductory lecture of one of my classes, our professor introduced us to the thesis: There is No Free Lunch.

Since most of us freshmen previously had only lived in our parents’ homes and survived largely through their financial support, this was a concept that had never occurred to us. Our professor gave example after example of attempts, under various governing authorities, whereby, usually well-intentioned, planning programs had wrought outcomes with various measures of unplanned, adverse consequences.

His warning to us, as potential future urban planners, was that we must recognize that imposed solutions to problems, whether social or infrastructure-related, would most likely result in unforeseen problems and costs to someone or something.

The most memorable example of failed social planning was the Cabrini-Green housing project in Chicago. In attempting to create post-war, urban renewal, large numbers of poor people were relocated from dilapidated lower-density neighborhood housing into a mega-complex of government subsidized, high-density, mostly high-rise buildings. At its peak, about 15,000 poorer people lived in the housing complex.

Obviously, increasing housing density is a logical, cost-efficient use of land and materials. The thinking was that newer, cleaner, cheaper-to-build, albeit, elevated, housing would produce better living conditions for the poor. I suppose you could say the plan was to bring about hope and change.

Contrarily, people lost their sense of neighborhood and social connectedness. High unemployment was characteristic of the complex. The city found it too costly to provide adequate city services, including the necessary police patrol. Conditions deteriorated and drug-fueled, gang-perpetrated crime skyrocketed. Many residents lived in isolation, fear and increased hopelessness. Some years ago, much of the complex was demolished.

Does the same kind of hubristic thinking that created Cabrini-Green underlie the belief that government control of health care will increases it’s efficiency and economy by administration through a distant and faceless bureaucracy?

Personally, I suspect so, and that a similar fate awaits the public under government-imposed health-care reform. Undoubtedly some parties will benefit. Who they will be will become more evident with time. So will the many of whom new costs and sacrifices must be borne. Regardless of the nobility of motive, or lack thereof, of what anyone chooses to do, build or buy, the cost must be paid for by someone.

There is no free lunch.

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