To promote the general welfare…

According to Thomas Jefferson “The purpose of government is to enable the people of a nation to live in safety and happiness. Government exists for the interests of the governed, not for the governors.” In a nutshell, government exists to serve and to protect the public. This view of government (not surprisingly) echoes the Preamble to our Constitution, which identifies some fundamental functions of government:

  • To form a more perfect union,
  • To establish justice,
  • To provide for the common defense,
  • To secure the blessings of liberty,
  • To promote the general welfare, and
  • To insure domestic tranquility.

While these are all worthy goals, for the purposes of this posting (and to avoid stepping too far outside my realm of expertise) I’d like to look primarily at the penultimate function – to promote the general welfare – in the context of issues that are strongly dependent on science and/or technology.

In 1963 Kenneth Arrow (who was awarded the 1972 Nobel Prize in Economics) wrote a fascinating paper (Uncertainty and the Welfare Economics of Medical Care) in which, among many other observations, notes that medical care is complex and requires a high level of knowledge and understanding in order to stay informed and to make informed decisions. For this reason, the patient “does not have the knowledge to make decisions on treatment, referral, or hospitalization” and must delegate many of these decisions to the physician. Of course, anyone can call themselves a physician, and it is not always easy for a patient to figure out who is (or is not) competent – for this reason, it is reasonable to insist that anyone calling themselves a physician be able to back up their claim. In this case, government helps to “promote the general welfare” by requiring people to demonstrate a minimum level of knowledge and training in order to be called a physician, and the government can remove these credentials if a person proves to be unworthy of the special trust awarded to those of us put our health and our lives in their hands.

There are many more reasons than this to read Arrow’s paper, but I’d like to extend this particular thought beyond medical care into other areas in which, to use Arrow’s term, “information inequality” can be a significant factor in being able to make a good and informed decision on matters of importance.

Consider, for example, how many of the questions facing society are grounded in science – and how many of these questions can only be addressed by using scientific knowledge and methods. How much lateral acceleration should a solvent-carrying pipe be required to withstand, for example? How much (if any) chlorine and fluorine should be added to our water supplies? To what cleanup standards should we remediate a contaminated site – and does it make a difference if the site is in the wilderness, in a slum, beneath a city park, or outside a factory? None of these decisions can be made without first looking at the underlying science – how dangerous is the solvent, what are the benefits and risks of adding chlorine and fluorine to the water supply, what is the risk from a contaminant and how much are people (and animals) exposed to it, and so forth. Without a solid grounding in the science underlying an issue we might make a good choice, but it’s likely to be by chance rather than by design. This is where government comes in, pursuing its mission to promote the general welfare.

During my student days I used to get into some great discussions with, of all people, my favorite hot dog man on campus. A staunch Libertarian, he would good-naturedly attack me for my job working in the state health department – his refrain was always to let the marketplace sort out all of these issues. I suppose that he thought this would happen by the public realizing that, for example, patients of a bad radiologist would parade their skin burns and warn others away, or that a cluster of cancers around a radioactively contaminated site would lead potential customers to eschew one brand of home appliances in favor of another. But there are a few problems with this approach.

One problem is that you have to create pain and suffering – victims – in order for market forces to begin to kick in; I’d like to think that the general welfare is better-served by preventing needless illness and death rather than using it as a warning. Another is that many of the risks we face are subtle – radiation-induced cancer might affect only a small fraction of those exposed and might not show up for decades after an exposure for example and teasing out the cause of a subtle health effect with so long a latency period requires the time and patience (and funding) to do a long-term study as well as the ability to interpret the results. For the marketplace to be able to identify health effects such as radiation-induced cancer the interested citizens would have to either school themselves in the intricacies of epidemiology, biology, and radiation science or they’d have to find one or more professionals to perform this study on their behalf. What government can do in such a case – where any rational decision requires specialized knowledge and skills – is to provide the citizens just this sort of professional study and scientifically based guidance.

Over time I came to view my role (and that of many of my colleagues in government) to be just that. Given that we cannot reasonably expect the majority of the public to have the specialized education, skills, and experience to make informed decisions on most (or even all) of these science-intensive issues, I saw my job as helping to fill in these gaps in order to help promote the general welfare. And not just my job – that of my colleagues in many other agencies as well. I know that I don’t know much about, say, asbestos – but luckily there’s a bunch of scientists and regulators at the EPA (and various state agencies) who DO understand it and who can help make sure that my family and I (and you and your family!) aren’t exposed to harmful amounts of the substance. Similarly, I don’t know much about restaurant sanitation, and I certainly can’t insist on inspecting kitchens or food processing plants before I sit down to dinner. But, again, that’s OK because I don’t have to be an expert – I can rely on government inspectors to have this level of expert knowledge. In fact, much of government provides these services on our behalf, and I would argue that the general welfare is improved as a result.

Now – lest I be accused of being a big government type – I also think that there are places where the government over-reaches. Some regulations are needlessly restrictive, some agencies are needlessly confrontational, and there is no doubt that all levels of government wastes a lot of time and money. But a lot of what government does is to help put us – the citizens – on a level playing field with businesses who, whether maliciously or not, would otherwise be able to take advantage of this information inequality.

Finally, I also feel obligated to point out that science should be the foundation and the starting point for decision-making in many of these complex areas, but it should not be the last word. As a scientist I can, for example, calculate the amount of radiation exposure that will result from a given amount of radioactive contamination left in a building after a terrorist attack. I can even calculate the risk that this radiation poses to those who are exposed to it, and I can give you my best scientific opinion as to whether or not this should be considered an acceptable risk after also considering the cost of further cleanup and other factors. But I can’t necessarily tell you that society should accept this level of risk because that gets into areas in which I am not qualified to address. I can’t, for example, do more than guess at the social and psychological stresses from living in areas that, while acceptable to me as a radiation scientist, are frightening to a non-professional. I also can’t assess whether or not the cost in lost tourism revenue will be more or less than the cost of additional cleanup, and my science won’t help me to determine the issues of fairness when government promotes cleanup standards and apportions aid to those afflicted. None of these decisions can be made without informed scientific input, but none of these questions can be solved with a calculator.

So – to bring this to a close, I’d like to go back to where we started and to briefly summarize. The purpose of government, among other things, is to provide for the safety and happiness of the governed and to provide for the general welfare of a nation’s population. One of the ways that we do this is by developing and promoting safety standards, including in areas that can be quite scientifically complex. For that reason, it seems to me entirely appropriate to ask that government help the governed by having knowledgeable professionals develop solid science-based guidance that can form the basis of regulations that are (hopefully) protective of the public welfare without being needlessly restrictive or expensive. Idealistic? Well…a bit, particularly because of the adjective – “needlessly” – which is open to interpretation. But if science can at least get us to through the quantitative parts (what can be crunched on a calculator) then hopefully the problem can be turned over to those who are more skilled with the non-quantitative aspects of the problem to come up with a solution that might not make everyone happy, but that will at least irritate as few as possible.

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