In late 1987, 18-month old Jessica McClure spent 58 hours trapped in a well. Media attention made it into a national tragedy. Immense resources were spent to rescue her. And the outpouring of sympathy and donation seemed to be out of proportion to the importance of the event. But the far larger number of children at risk from exposure to lead paint would be lucky if people even give them a moment of thought.

This seemingly curious imbalance in care distribution has been called the identifiable victim effect or the proportionality effect. Although the number of lives involved is small, Jessica was certain to die if not removed from the well, and she comprised 100% of the risk group. The risk of lead paint, on the other hand, is less certain and the probability of death is far lower than 100% even though more lives might have been saved or improved. In other words, people worry more about the proportion of risk reduced than about the number of people helped.

But this human tendency has significant implications on societal resource allocation. Jessica’s situation is much like the one faced by a family with a dying loved one. It is natural for the family to spare no resource to save the life of a dying family member. But society cannot afford to spare no resource to save all dying patients. Yet most of the health-care dollars are spent on saving far fewer life years among adults with acute and/or chronic illnesses than on the infant population with preventable diseases.

The explosion of health-care cost is a prime example of the proportionality effect at work. Whatever its emotional or psychological basis, the effect is strengthened by the logic of collective action. In other words, it is easier for small single-interest organized groups to gain political support because they have much to gain at the expense of the collective interest and are more willing to pool their lobbying resources. Large unorganized groups with diffuse interests usually lose out for lack of pooled resources (see Collective Action).