We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
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Thursday, August 20. 2009
Just one humble thought about the government's apparent desire to control the purse-strings of medical care, and then to hire "experts" - our betters, no doubt - to ration it "rationally" (ie on an amoral, communitarian utilitarian basis) to cut costs:
It's our money. All of the government's money is our money. If we didn't make it, they wouldn't have it.
What went wrong in American history such that a government could even imagine making such personal decisions for us, with our own earned dollars?
Yes, I know that I am politically naive. I intend to remain that way.
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Dollars aren't wealth. They're tickets to say what the economy does next, presumably something for you.
If the government takes them from you, it's just so that you don't buy anything at the same time that they want to, lest prices be bid up.
You get them by supplying something somebody values more than the dollars, when you value it at less than the dollars.
What the government then takes is your work.
I am curious, would you abolish practitioner licensing and regulation, drug approval laws, prescription laws and all drug laws in general? These all represent areas where the government intervenes in deeply personal medical decisions. I'm less sure about these areas than I once was, but I bring this up because this seems to be where you're leading when you say that what went wrong in American history is that "government could even imagine making such personal decisions for us."
As a commenter in my blog correctly points out, we aren't actually debating a free market versus government medical system. We already have a system that is permeated by market distortions that inflate both the costs to consumers and the incomes of stakeholders in the medical industry.
A fair number of libertarians are more circumspect about the proposed government changes for this reason. They are not under the impression that what we have now represents, in any way, true market allocation of resources. Some believe that barring the politically impossible, genuine restoration of a free market system, government might be able to make improvements over the current government regulated system.
Personally, I think Brad DeLong offered a decent outline for changes a couple of years ago. Even 'Objectivist' economist Arnold Kling has stated that some of these ideas (single payer over $50,000) are not so bad.
I think I like you. However, I often think that you have drunk the Kool Aid along with the good stuff. Of course, sometimes the federal government gets something right - like the CDC. But for each CDC, they do 20 things stupid, expensive, self-serving, and wrong.
I will make two points:
1. As "mental health professionals," I believe that one of our goals ought to be to maximize self-sufficiency and independence for people - not dependency and entitlement. I have never understood the source of the slushy form of "compassion" in our profession. Most of my schizophrenic patients in the charity clinic have full-time jobs, for heaven's sake.
2. In the Maggie's Farm tradition (not "Libertarian" - American), I believe that any government actions ought to place individual freedom and self-determination as the largest Constant in any equation. Otherwise, what's the point of America?
I'm still curious about your take on existing regulation of medicine. From your response, I really can't tell what you think. Should the government leave the pharmaceutical industry unregulated? Should the government determine which drugs we should take or which providers are permitted to provide services? I'm not being facetious. I don't think it's easy to determine how much government regulation would be best.
Just one other matter--the issue of slushy compassion. I understand the problem of infantilizing and fostering dependency, but I plead guilty to a form of compassion that is less due to my profession than my adult conversion to Christianity. I don't think there is anything slushy about it. I'm firmly committed to service to others as my part in the unfolding plan for salvation. I have no interest in undermining anyone's growth or emotional maturation, but to the extent that you might think me misguided, it would be my faith that you should blame, not the field of mental health. I also accept that believers can be called in different ways to speak about the world. Sometimes we may seem at odds, but I do believe that the Lord's plan is much more complex than any of our individual parts in that plan.
I am wondering about your use of the words, "I am guilty..." of compassion. I understand your context as it relates to Dr. Bliss's comments, but do you have to apologize for being compassionate? What other profession demands compassion more that psychiatry? You shrinks are dealing with fragile minds and people who are looking to get back to normalcy. Dr. Bliss states that she does not foster dependence or entitlement. What shrink does? That is anathema to your profession and should not have to be stated. But on the compassion thing, what brought you into the field of psychiatry? Indifference, cruelty? Those are the antonyms of compassion. I daresay you had compassion from the start and that your faith has deepened it.
As for regulations.... what if there were no regulations on doctors? Drugs? Too frightening to think about no regulations.
I'm happy for you that Dr. Bliss thinks she likes you. I know it warmed the cockles of your heart. It was important for this special interchange of unregulated ideas.
I think you take yourself way too seriously, Dr. X. Especially when it comes to your faith. How do your patients feel about all that? Have you, do you, explain from where you're coming from with them?
It's not so much "the government" doing this. It's your own fellow citizens, who think they deserve more control over the value of your labor than you do.
I'm starting to think that one of our most horrible mistakes in recent decades was concluding that the government should be in charge of ensuring minimal health care to all citizens (via EMTALA etc.). As long as the supply of health care to indigents was handled by charity, it was clear that anyone who wanted to offer it was required to offer it without strings attached.
Now, a day never goes by without my hearing or reading the argument that, because "we" supply healthcare, "we" have a right to interfere in your decisions about your own health, because they cost "us" money. But do you have a choice about accepting this wonderful free gift? Of course not! "We" are going to give it to you whether you like it or not, so get used to hearing new rules about what you'll eat and how you'll live.
"...would you abolish practitioner licensing and regulation..."
You know, I might. The above is a result of the "closed society" mentality that strikes all professional groups. Each professional group, to protect its 'turf' HAS TO HAVE LAWS PASSED in order for them to be a 'professional' society, and force others who would do the same to become members of their closed society. (I'm NOT saying this is necessarily bad per. se., its just the way it is today. Laws and enforcement impose order.) So I, as a 'professional' in a closed 'society' can prevent others from performing work unless they are a member. One can rail against the machine all they want, but unless they can come up with a larger, more influential group to have the rules (laws) change in their way, the laws of the first group prevail. The ultimate result of this is the closed group can set the price and terms that they will provide a service, and can prevent and punish others from performing that service, or in some cases, even from providing critical information or tools for performing the work (call them a trade secret, eh?) (it would be too dangerous (to have that tool)!)
Of course, all of the above is really "for your own good". You, of course, since you are not a member of our closed society, are an irresponsible person, and therefore, if you perform any activity outside the laws of our society, that makes you a criminal who MUST be punished. (Whether you are trained or not. If you haven't paid your dues, you are not a member. Case closed.)
Many progressives and a fair number of religious people have embraced the idea that what's "yours" is really either society's or God's because society and/or God provided it in the first place.
Certainly we all prosper from an orderly society with opportunity to create and earn wealth. We all prosper by God's gifts to us. It's rather presumptuous, though, to say that those are reasons to ask us to cough up all we have and accept what our betters think we need.
I might be "what's mine is God's" more easily except that some of God's self-appointed collectors-disbursors seem about as altruistic and efficient as some of the gummint's team.
God only asked for 10% and a chance for the poor to glean the remains of the harvest.
If God had not made poor people, he would not have to ask us for 10% of anything. Maybe God needs practitioner licensing and regulation because he's not doing so good with the poor people he made in his image. Sad stuff. So is the fact he has failed in smiting. The God Regulatory Board should take away his license to smite. Too many tyrants have killed too many people on this planet. F in smiting, God.
Mad Magazine long ago had a page on religion, which concluded that while religions disagree about what God is like, they all agree that God likes money.
I feel the need to make a couple of quick comments.
First, some seem to be making an argument for equivalency between regulation and control of personal medical decisions and monetary control over the health care system. That takes the discussion in the wrong direction.
Regulations that set standards or qualifications are not necessarily bad (and it's too bad the concept doesn't extend to voting rights).
However, much regulation is ill-conceived and the law of unintended consequences is seen all too often. Of course, government interference in health care has created many market distortions. That statement does not mean that the absence of standards or qualifications should be the norm. Such an argument is a call for anarchy.
Second, health care reform as it is being contemplated by the Democrats today is about control over the individual and not about health.
Dr. Bliss is right on the money when she says "government actions ought to place individual freedom and self-determination as the largest Constant in any equation." That is what resonates with the majority of Americans. It is also why consumer directed health care principles make the most sense.
The purpose of an intelligent regulatory framework is to provide a framework where free people can make informed personal decisions. If combined with (i) transparency into prices, processes and quality, (ii) portability (which would effectively eliminate pre-existing condition issues and (iii) financial reform (e.g. HSAs), then health care would be revolutionized.
A major problem is that politicians feel like they always need to be doing something. Someone has an accident or makes a bad decision and the politicians feel like they need to regulate or legislate to remove the perceived risk.
This is insanity and it shows complete ignorance of how policy decisions should be approached and made.
We should pass the Protection from Politicians Act. It would have two major features. The PPA would permit politicians unlimited ability to do away with needless regulation, to cancel antiquated programs, to reduce taxes and to carry out only those few powers that are specifically delegated to the federal government by the Constitution. The second feature would limit the number of new policy decisions to no more than one every two years. That would let Congress make up to 50 policy decisions every 100 years (and that may be too much).
Now, all I want is for Congress to leave my body alone and do no more harm.