We may feel daunted by the sheer complexity of life today. Even when we are removed from major urban centers, we find ourselves living within many complex systems. There is seemingly no end to examples: the food distribution system, the electrical grid, the transportation system, community crisis response plans, virtual networks that connect us with the entire globe, and so on. One might be tempted to opt out by living “off the grid,” but that has its limits, not to mention its inconveniences. It is tempting to try to tinker with a complex system by targeting the aspects that we don’t like while trying to keep the rest intact, but that doesn’t acknowledge how complex systems operate.
The human body is a reasonable analogy. It’s a complex system — actually, a system of systems — and things do go wrong. Medical professionals often target the malfunctioning parts. Sometimes, medicine has a pretty good idea of how those parts affect the whole. You can take out an appendix with little effect so far as is known. Best not to take out a brain tumor unless you REALLY know what you’re doing, and there may be far-reaching effects anyway. Please don’t take out the heart unless you replace it. Increasingly, all forms of medicine are embracing a more complete, holistic approach to understanding human body, mind and spirit.
Take the Affordable Care Act (also know as “Obamacare”) as a different kind of example. It is an extremely complex system built from input from its major constituents: insurance companies, providers, patients, states, Congress, plus interfaces with already existing health care plans. The ACA began in 2009 by building on an already intricate web of health-care measures and then aiming to extend coverage to millions who didn’t have it.
The trick with health care is, like all forms of insurance whether private or public, to distribute the risk among everyone because we never know when we’re going to need it. That is what we do with car insurance. Liability insurance is required by law because you never know when you’ll be in an accident for which you can be held liable. Nobody ever claimed that the compromise measure of Obamacare is perfect, but it is important that revisions do not damage its “vital organs,” such as coverage for people despite pre-existing conditions. Both major parties have discovered that modifying the complex U.S. health care system is no easy task, even when everyone agrees that some improvements are needed. There are disagreements about how best to accomplish those.
There are naturally competing interests in the web of health care coverage in the U.S.. Some insurance companies would prefer to take out the “high-risk pool” and people with pre-existing conditions, then collect premiums from the healthy and guarantee substantial profit. Many people who are young or basically healthy would prefer not to take out any insurance at all, or get inexpensive but inadequate policies while they are healthy and then turn around to get coverage when they need it. But you can’t have it both ways. The choices are either to abandon anyone who is or has ever been ill or to ask sick people to pay the real cost of their care (estimated on average for the “high-risk pool” as $10K per month). The only way to make the system work is to require that everyone, sick and healthy, pay premiums and that a variety of insurers cover us all. The scope of the government’s potential roles — in insisting on everyone having insurance, maintaining certain standards for coverage, negotiating prices, providing subsidies, offering Medicaid expansion state by state — is all debatable and is being debated as we write. But, this web of interests and entities is what we deal with in health care in the U.S.. It’s complicated, to say the least.
Another important aspect of complex systems that involve multiple human actors is that when one group acts to fix something, other actors who have different perspectives may take action to adjust to that fix, in effect to fix the fix. A group might even expand their responses beyond the scope of the original fix. For example, if the U.S. puts a high tariff on Mexican goods to build President Trump’s wall, Mexico would very likely do the same with respect to U.S. goods and services. Wouldn’t you if you were in their shoes? In this case, Mexico might also enlist allies to follow suit, and then we’re off into a trade war that nobody is likely to win. For example, German officials just said that if the U.S. threatens trade with Mexico and with Europe, then other countries will step in to fill the void. China is already planning to do just that in light of the U.S. pulling out of the Trans-Pacific Partnership.
If the U.S. deports thousands or even millions of people to Mexico (including, by the way, migrants who came from other countries like Honduras) couldn’t that come back to bite this country in terms of destabilizing relationships to the South, not to mention losses to our economy that are just beginning to be talked about? And, here we’re not even getting into questions of ethics, human rights, and the humane treatment of others in all this movement of people around the world.
What does it mean to assert one country’s interests strongly within a maze of international relations and entanglements, and how far can any nation reasonably go in this direction? We may soon find out because nationalism is on the rise in many parts of the world. Microsoft co-founder Bill Gates, for example, sees this movement as a destabilizing force. Nationalism — not healthy patriotism — can create the illusion that a country can act as if it were an island. And, this is not to mention the need for cooperation on problems that are truly global, such as nuclear arms control and responding to climate change.
Further, complex systems, if destabilized, sometimes spin out of control and cannot be fixed easily by anyone. The economic meltdown that started in 2007 with excessive speculation and questionable lending practices (in some respects, not unlike the stock market crash of 1929) is another case in point. Introducing the factor of sub-prime mortgages had effects that were not anticipated by most bankers, economists, and government officials, although some saw it coming. Our point, though, is that once the unraveling started, it had far-reaching effects. Nobody could stop it — at least not for a while — and the economy has only recently been recovering according to many general indicators. Of course, that is little comfort to the people who lost their jobs or their homes during the worst of those years or who have not really recovered.
No one can pretend to understand completely what one change in a system like the economy or the environment will do to the other parts. At the very least, we should listen carefully to the “boots on the ground” (nurses, farmers, teachers, police officers, etc.) who understand specific parts of the system better than any outside analyst ever could. We can also follow “the precautionary principle” and remember that before we make an intervention in any complex system we need to look at the larger picture and ask ourselves: “Does this action have a reasonable chance to make things better OVERALL?” A change might make some things better but other things worse; there will be unintended consequences because there always are. We must realize that we are not in full control when dealing with complex systems, as any emergency care provider can tell us.
George Cheney and Sally Planalp are residents of Moab and part-time professors of communication at the University of Colorado, Colorado Springs.
ByBy Sally Planalp and George Cheney