proponents and opponents of the change are willing to "pay." Social welfare economics teaches that public policies are optimal when marginal social benefit equals marginal social cost. But that can only happen if the political prices are the same on either side of every political issue. Ordinarily we would expect people to spend a dollar to get a dollar. But for reasons given above, people will understate the value they place on policy changes and in the general case they will understate it a lot. Because of differences in organization costs, information costs, and many other factors, we would never expect the effort-benefit ratios of two opposing groups to be the same. Furthermore, Goodman and Porter discovered that small differences in political prices lead to large welfare losses for society as a whole—much larger, for example, than what we would ordinarily expect to find in the private sector. That leads to: Goodman’s Theorem: Since the conditions for optimality will almost never hold in any political system, optimal government is in principle impossible. If the political price milk producers are willing to pay is greater than the political price offered by the consumers of milk, we will get milk price supports. If the price sugar growers are willing to pay is higher than the one offered by sugar consumers, we will get sugar quotas. We get bad government, or "government failure," not because of bad leaders. We get bad government because of inequality in the political prices opposing groups are willing to pay to obtain benefits and avoid costs in the political system. Health economics Goodman's interest in health economics began with his study of the British National Health Service. It was the first time anyone had used public choice theory to explain all the major features of British medicine. He followed with a study of the 150-year history of the suppression of markets in health care at the urging of the American Medical Association. Regulation of who could practice medicine, regulation of medical schools, regulation of hospitals and regulation of health insurance all followed the AMA agenda, according to the study. In 1992, Goodman wrote Patient Power with Gerald Musgrave. The book shaped right-of-center thinking on health policy—from Newt Gingrich to Paul Ryan—for many years. Its thesis: patients should be empowered in the medical marketplace the way consumers are empowered in other markets. This ran counter to the thinking in