I agree with both Bob and Nospam, more so with Nospam. When
something's not working, like health care or pensions, there is a role
for government.
Let me take the issue of health care.
Okay, as I understand it, a bone marrow transplant sometime works.
Now, when you have leukemia that seriously, when it's at that point
when these kinds of options are being considered, nothing is
guaranteed to work. You might make it and you might not. In a bone
marrow transplant, they take out your own bone marrow, keep it under
near-freezing conditions, zap your body with heavy duty chemotherapy,
really poison is what it is, damn near kills you, but not quite,
hopefully kills all the cancer cells, let it wash out of your system,
and then transplant back in your bone marrow. It might save your
life.
The insurance companies classified this as experimental medicine and
refused to pay for it. That was true at the beginning, but they kept
saying it, kept saying it, kept saying it. It became merely a
convenient way not to pay, and one which they stuck with.
So, if I was a member of Congress or maybe a state legislator, I'd
have no problem voting that bone marrow transplants are to be viewed
as standard medicine and will be covered by insurance. Gee, Doug, you
might be thinking, that's an awfully specific thing to vote for. Yes,
it is. It's in the category of, if the insurance companies are going
to micro-manage doctors, then we're going to micro-manage them. So
instead of new treatments being ten years delayed in being covered,
then might be only five years delayed. And we might make an
occasional mistake along the way. That's okay. Something might be
covered that truly is still experimental. It doesn't mean your
particular doctor has to do it, merely that it's available to be
covered.
It would be much better if the whole thing was more decentralized and
people could sue insurance companies. How did we ever get in this
incredible state of affairs where you cannot sue an insurance
company? You can sue a car repair place over a bad transmission job,
but you cannot sue an insurance company over a decision that is
absolutely life or death to you!?! 'Oh, they're not telling what care
you're going to get, they're just telling what they're going to pay
for.' I think that classifies as a distinction without a difference
I've read that there's a law from the early 1970s that protects
insurance companies from a certain type of lawsuit, and they've really
made hay out of it, and it's become part of the status quo. The
Democrats had their Patient Bill of Rights, and it was a tepid little
half-measure. I want to be able to sue easily and rapidly while it
still counts. And it seems like this is something libertarians should
be wholely behind, it's almost necessary for their kind of market to
work.
Okay, three (two and a half) areas where I disagree with libertarians,
and one where I agree:
1) 'The idea of the National Endowment of the Arts for a believer in
liberty . . . ' I generally agree, just give us space and we will
make our own art. So the difference between housing, health care, and
art? Well, you can get by without art for a while, so we can afford
to have a more chaotic market, but you can't really get by without
housing or health care for a while.
So, from the prospective of a city and a park, we generally merely
want the park to be open for people playing guitar or for someone to
set up a political table next to a sidewalk, as long as you don't
block the sidewalk, etc, etc. But if no one has used the park for a
while, we might (modestly) finance "Shakespeare in the Park" to prime
the pump so to speak, to demonstrate what can be done. And I
generally sup****t smaller parks, maybe connected with bike paths,
rather than a few big parks. That is, I'm much more pragmatic, it's a
question of what works (even if we might not initially or fully
understand why), than any particular ideology.
2) I heard a conservative/libertarian talking on C-span how he's very
happy with the school experimentation currently under way in New
Orlean schools.
Then later it occurred to me, I'm not against government-sponsored
schools, I'm against authoritarian schools. I'm against the
regimentation of learning, which is something we as humans do so
easily and so naturally.
Now, here's what might work, 15 kids, 3 teachers. What you're doing
is that you're avoiding the dynamic of one adult under siege. It's
also more of a tribal thing. And, oh yeah, I do not need to learn
algebra on your schedule, and I do not need to read your assigned
books, certainly not past simply trying the book. You are there more
as a coach and to appreciate the talents I have right now (the step of
faith that people are naturally learners and naturally want to grow).
That is, Mr. Rogers would make a great one of these teacher/coaches!
Of course, this is not on the political radar and would probably be
very expensive (unless perhaps it was done partially using community-
oriented volunteers).
3) I agree with Bob that often you get bad service, from employees
who do not want to be there. And it's rather remarkable that so many
businesses are able to stay in business with such indifferent
service. If you go into a restaurant by yourself, you pretty much
have to order a drink or else you're going to be categorized as a poor
tipper (even though I am a good tipper, in fact, I have worked as a
waiter myself!).
But I blame the system primarily. In different context, this person
would be an engaged, energetic individual. It's the regimented
cor****ate environment. It's kind of a declining spiral, things not
working, more control-nut-ism, more disengaged employees, etc.
4) It should be much easier for entrepreneur****p and to start a
business. Something like a 'Doing Business As' registration and fee
is just stupid. To some extent, it is the sheer number of
regulations, and they just drain away energy. So if you're opening a
dry cleaning business, the main core issue is the use and disposal of
the solvents, that should be regulated, and nothing else. If you're
opening a restaurant, the main core issue should be the sanitation of
the food, that should be regulated and nothing else (although your
employees should be able to easily and comfortably sue you for fraud,
even if they're mistaken, and this process should add to
transparency).
And there might be a role for government in micro-lending, again
perhaps to prime the pump and to demonstrate what's possible. Banks
are so much all alike, and I don't think that it's all so rational,
it's rather the herd instinct.
-Doug
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