The costs of too much choice: How the science of evolutionary development justifies Obamacare

by Alan Cohen

One of the more difficult and technical fields one could choose to study is Evo-Devo, or the evolution of development. Briefly, it is the field that studies how genetic programs determine the developmental process, how these programs evolve, and how the types of programs available constrain the directions evolution can take. For example, if humans were to evolve wings (an essential impossibility for many reasons), Evo-Devo lets us make the clear inference that we would not evolve them as sprouting from our shoulders like angels, but rather as modifications of our arms. Why? Because in all tetrapods (i.e., eptiles, amphibians, birds, and mammals) there is a developmental program to produce four limbs. Limbs can be lost (snakes, whales) and modified for flight (bats, birds), but they cannot be added.

One of the key insights to emerge from Evo-Devo is that developmental programs are highly organized. They have evolved ways to facilitate future evolution, called evolvability. They achieve this using mechanisms known as gene regulatory networks, compartmentalization, and canalization. While the details of these mechanisms are beyond the scope of this post, they have in common that they are ways to facilitate long-term evolution at the cost of flexibility. That is, they standardize the developmental process to give consistent results, but limit the forms that can be arrived at. Again, tetrapod limbs are a good example: if tetrapod limbs were not the result of a fairly standardized genetic module, we would be able to evolve them anywhere any time – the nose could become a hand, we could evolve rows of wings up and down our backs, etc. However, the  result would be chaos. It would be too easy for a minor mutation to mess up development, too easy for the final form to depend too heavily on what gene combinations one has (image if parents regularly “accidentally” gave birth to children with 6 or 10 limbs, just because of  how their genes got combined…), and too hard to control the evolution of limbs as the environment changed and a specific sort of form became necessary. In other words, we gave up flexibility for stability and predictability.

How does all this relate to Obamacare? One key feature of Obamacare is that it gets rid of the free-for-all individual health insurance market, and requires all health insurers to meet some very standardized criteria (accept applicants regardless of health status, minimum coverage levels, etc.). It also requires some of the key features of the plans to be easily summarizable on a comparative table that consumers can use when choosing a plan. In other words, it sacrifices flexibility for stability and predictability. There will be less variety of health insurance plans out there. A highly informed consumer may no longer be able to get some very specific plan that might have been available before. But, for the average consumer, things will be easier to understand, and it will be easier to make a good choice.

Many Americans tend to believe that more choice is always better. But choice comes with costs: it takes energy and time to make a choice. We need good information. Many of the choices might almost never be the right one, but we still need to take the time to know that. Evo-Devo is a form of proof that more choice is not always better – evolution is a pretty hard-nosed force, choosing the most efficient form. And evolution has clearly made the choice to have less choice. Predictability and stability trump freedom in this case.

Of course, these are not black-and-white questions. Current developmental patterns do keep some flexibility, just as Obamacare does preserve some consumer choice. The optimal balance between the two will vary case-by-case.

We can also take the analogy one step further. Consumer choice can be thought of as a process like natural selection, weeding out the worse plans. Regulations on what plans can be offered are like Evo-Devo constraints (gene regulatory networks, canalization, compartmentalization). Before Obamacare, consumers were making their choice among many diverse plans with little in common. Now, they will make a more directed set of choices. And longer-term, they will also make another choice (as voters): to continue with Obamacare, or to revert to a free-for-all market. This longer-term choice is like natural selection on species and lineages rather than individuals. It does an individual no good to be the strongest and the best-reproducing member of an entire species that is doomed to extinction because it cannot evolve to changing conditions. So we will see, in the years to come, how well my analogy holds up: will consumers prefer the predictability and stability of choice offered by Obamacare, or will they revert to a preference for flexibility?

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