The financial crisis; no playoffs in college football; teachers cheating on standardized tests; the accelerating income gap between the rich and everyone else; America's poor healthcare results and expensive costs. What do all these things have in common? They were caused by the same thing: poorly aligned incentives.
Incentives are the primary reason people, and just about all other living things, behave in a particular way: offer a child a cookie to clean his room; he cleans the room because he wants the cookie! easy-peasy. Unfortunately, most things are not so easy.
Take, for example, health care: your doctor can maximize his income, keep his multiple country club memberships and get his wife that new Mercedes S-class, not by providing the best possible care, but by ordering the maximum number of procedures, in the optimal sequence, at profit maximizing time intervals.
For instance: a parent calls a pediatrician about a child with an ear infection. Both parent and doctor are very familiar with the child and confident in the diagnosis. The doctor has two choices: (1) immediately call in a prescription for an antibiotic because she has seen the parent and the child many times, is familiar with the case & symptoms and both of you are certain that this will be the first course of treatment; or (2) have a nurse answering service take the call, insist the parent bring the child to the doctor's office, examine the child, conduct two (rapid and standard) strep-throat tests, and order a follow-up visit in greater than or equal to 14 days.
Take a wild guess why the answer is always 2.
When you look around the world it begins to make sense. When a decision maker has different incentives than those impacted by the decision, bad things can happen: CEOs pad their own pockets; money managers have portfolios that look more like gambling than investing; Atlanta school teachers change answers on third graders' tests; the list goes on and on.
If we can figure out ways to do this better; to ensure that what's god for that doctor is also what's good for the patient and society in general, we'll be a lot better off.