There is a lot that I wanted say about the mobility debate but my views are so far out of the mainstream I wasn’t sure where to start.  This post by Matt Yglesias lets me at least say something.

Washingtonian, like other regional magazines I’m familiar with, does an annual “best restaurants” issue which is different from their “cheap eats” issue. They also have a “best doctors” issue, but there’s no equivalent of the “cheap eats” concept for health care. My best guess is that this reflects the authentic structure of consumer demand. People sometimes want a great big fancy dinner and sometimes want a great deal on a bowl of pho, but on health care what they want to know is who’s the best.

I was in a doctor’s office with a relation and we noticed a sign on the wall that requested patients not wear perfume or scented lotions of any kind. Then there was another sign that requested that you not make loud noises. The doctor was also fidgety, awkward and significantly “goofy looking.”

We had a conversation that I’ll paraphrase like this:

Relation: Maybe he has Fragile X

Me: Doubt it, Fragile X usually implies mental retardation

Relation: He doesn’t seem very intelligent

Me: An IQ of 80 would make it unlikely that he would finish medical school

Relation: I guess that’s right

Which is to say several things.

First, “best” was not a relevant consideration. Can order blood work was his defining characteristic. This is especially true with a primary care physician. Besides being loose with the prescription pad its not always clear what a “good” primary care physician is.

Second, people grossly underestimate the extent to which society is sorted. This leads to people being thought of as stupid who are in fact well into the right of the distribution. In turn, this leads to people underestimating the extent of the meritocracy. What seem like gross violations are on a larger scale minor discrepancies.

That having been said my baseline is that a well sorted meritocracy increases the case for redistribution. The biggest problem with redistribution is that you may upset the sorting.

If the sorting is really tight then you can redistribute a lot and not worry about messing it up.

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