Health Systems and the Public Interest, Part I

Have you ever wondered why America’s national military academy for Army cadets is located in West Point, New York?

Why not West Point, you might ask? If you ever visited the institution or strolled the streets of the adjacent town of Highland Falls, you undoubtedly noticed that the surrounding hilltop vistas of the lower Hudson Valley are breathtakingly beautiful. In fact, Army instructors such as Robert Weir have become globally renowned artists by painting landscapes of the Hudson River from the grounds of the academy.

Nevertheless, that’s exactly why West Point might strike you as an odd choice for the establishment of a military institution, particularly one focused on education in the science of warfare. Most military training centers, such as the historic Fort Dix in New Jersey and Fort Bragg in North Carolina, were designed to serve as free-standing and relatively isolated facilities. Few civilians have trekked to them to enjoy the natural scenery, and few of them have been concerned about the temptations of nearby municipalities. West Point cadets, on the other hand, are a mere 45 miles from New York City; commuter buses make the trip on a daily basis.

So why West Point? Well, it’s always been there, for a single reason that was once of utmost importance to the nation, but that is now a complete anachronism. And the reason for its continued presence in the Hudson Highlands tells us something about the cause of the inertia in today’s health system.

A Little Military History

Although it was President Thomas Jefferson who officially designated the West Point military facility as a center for education, its origins can be traced back to the American Revolution. At the time, with the British in firm control of New York City and Ontario, Canada, the leaders of the rebellion were greatly concerned that the redcoats would seize control of the entire Hudson River and thus isolate the New England colonists from their southern allies. They feared that the nascent nation could never stand on its own if it was literally split in two pieces by a hostile foreign military force.

So they decided to fortify a string of military installations throughout the Hudson Valley. North of Albany, they seized Fort Ticonderoga and won the Battle of Saratoga. And, on the western shore of a point of the Hudson River where a 150 ton chain could literally be stretched across the waterway to block traffic, they built a fortress.

This is why our nation’s oldest continuously occupied military installation was initially established in West Point: the British Army occupied New York City over 200 years ago, and the fledgling American army needed to stretch a gigantic chain across the Hudson River at that very geographic spot to prevent their advance. But Albany is no longer under any threat of invasion by British frigates, and military technology has advanced far beyond the use of gigantic chains; thus, these reasons are now interesting but obsolete relics of a distant past.

So why have we maintained our national military academy at West Point? Why not move it to a more modern, more cost efficient, and more geographically convenient location? And why not convert West Point to historical parkland, open for the enjoyment of landscape artists, hillside hikers,  and military historians alike?

Why not? The simple answer is inertia … and that may well be in the public interest. Once our national military academy was established at West Point, it put down roots and attached itself to the local landscape. Over time, it seared itself into the heart and soul of our nation as well. A decision by the military academy to vacate West Point would be as startling as the recent decision by General Electric to stop producing light bulbs in the United States, or the infamous decision by baseball’s Dodgers to leave its ancestral Brooklyn home.

The Public Interest

As you probably know, though, only a handful of American citizens are aware of the iconic firm’s decision to close its light bulb manufacturing operations. And although the Dodgers’ departure for Los Angeles left indelible scars on the psyches of native Brooklynites, it did help transform the sport into a truly national pastime, and helped drive our nation’s western expansion. Furthermore, many Brooklyn Dodger fans easily transferred their allegiances to the newborn Amazin’ Mets a few years after Dem Bums headed for California.

So why did GE’s decision barely cause a ripple in American society? Why did the Dodgers’ decision cause so much more anguish? And why would a similar decision by the United States Army to vacate West Point cause such unfathomable pain that it cannot even be seriously debated?

Why? Because we want government to run or regulate organizations that produce some public benefit, and such oversight usually leads to institutional inertia. GE easily ended its light bulb manufacturing activities, for example, because the American public was easily served by other service providers. But the Brooklyn Dodgers, despite being a privately run organization, were marketed as a civic institution; furthermore, they only departed after engaging in serious negotiations with New York government officials for years about moving to a publicly owned ballpark. And the President of the United States is the Commander In Chief of the American military forces, which are wholly owned and controlled by the federal government.

This insight helps us understand the raucous debate involving America’s health care system. If there is one issue on which all sides agree on, it is the fact that the public interest would be served by a system that offers an affordable set of services to all citizens. Nevertheless, it is this very consensus on the perceived public benefit of a comprehensive system that drives the desire for intensive government involvement. And furthermore, it is this very involvement that causes the institutional inertia that bedevils contemporary efforts at reform.

Next week: Health Systems, Part II