People often say that ‘politics is the art of the possible’. But I think that this is too often used as an excuse to tinker with an issue rather than really addressing it.
The reason we’re not still part of Great Britain — and the reason we have a country that is (on paper, at least) grounded in the ideas of rights and consent — is that the founders decided that it was more important to focus on what was necessary, than on what seemed possible.
In a couple of recent posts, Steve made some interesting points about government-assisted suicide and government spending.
But both posts, I think, have this in common: They focus on details, while ignoring fundamental issues. They advocate trimming branches, rather than (as Thoreau advised) striking at the root.
What both posts have in common is that they complain about government agencies that are behaving inappropriately. But the fundamental problem isn’t the behavior of the agencies. It’s their very existence. As Marvin Minsky might put it: The only parts of a government that can be trusted are the ones that aren’t there.
The following responses were originally posted as comments in the venues where the posts appeared. I have combined them here in order to illustrate that the point I’m trying to make isn’t restricted to one particular issue.
1. Government assisted suicide
You’re starting from a false premise, that ‘medicine is supposed to be about healing people’. But that’s a somewhat restrictive — and biased — view. It’s not unlike saying that ‘literacy is supposed to be about reading the Bible’.
Medicine is about intervening in the body’s natural processes. If something isn’t happening naturally (a bone isn’t going to set properly, a tumor is going to spread, a protein isn’t being digested properly), or isn’t happening fast enough (a bacteria has infected the body, inflammation isn’t receding), we can use medicine to address that.
There are lots of such processes that don’t involve healing, but rather recreation or enhancement or curiosity. You aren’t able to relax? We can use medicine to make that happen. You can’t lift enough weight, or run far enough, without getting exhausted? We can help with that. Reality is too boring? We have something for that. In that sense, alcohol is one of our oldest medicines, and no one thinks alcohol is mainly about healing people.
You’re in tremendous physical pain? We can make that stop in at least a couple of different ways, both using medicine. We can block the sensation of pain (e.g., with morphine), or we can stop the overall process that causes the pain, which is living.
The problem arises when the practice of medicine comes under control of the state — allowing some procedures, prohibiting other procedures, or even mandating certain procedures. And that necessarily happens when we start making everyone pay for everything:
Legalize failure
https://granitegrok.com/blog/2018/08/legalize-failure
The central problem in Miriam Lancaster’s situation is that she wasn’t the one paying her doctors. Rather, Canada was paying them. So their fiduciary duty is not to her, but to Canada, and they were acting in accordance with that. In fact, you could make a case for suing them if they had not offered MAID.
Think about how differently this would have gone if their duty was to her — because she was the one paying them — rather than to the country. Also, think about how differently this would play out in the US, if she actually wanted to die, but her doctors — paid by a different government, with different biases — said that they wouldn’t help her with that. Two different problems growing out of a single root: government monopoly over medicine.
The government is responsible for allocating resources that were taken from everyone, on behalf of everyone. (That’s the theory, anyway.) Tax-funded medicine is a zero-sum game. If some people are getting treatment, then others are not. The money spent on her will not be spent on someone else.
From the government’s perspective, would it be better to spend potentially hundreds of thousands of dollars on a risky surgery for someone who is near the end of life, or on dozens or hundreds of other people who are just starting out? The ones just starting out have a lifetime of productivity (which can be taxed) ahead of them, so from the government’s perspective, this is a no-brainer. What is Miriam doing with the rest of her life? Traveling? Entertaining herself? What good does that do the rest of Canada?
You’re acting like it’s possible to have ‘good’ tax-subsidized medicine without ‘bad’ tax-subsidized medicine, but that’s like saying we can have ‘good’ government surveillance without ‘bad’ government surveillance. They’re part of the same package.
Incentives matter. If you change the incentives from “Do your best for the person who is paying you” to “Do what’s best for the government that is paying you”, those will necessarily lead to very different kinds of results.
To be clear, I agree that governments shouldn’t be euthanizing people. Where we disagree, perhaps, is that I think that governments shouldn’t be curing them, either. As we’re seeing in Canada, and will eventually be seeing here, you can’t have the latter without the former.
2. Government spending
> It is worth reminding everyone that the budget problem is always a spending problem,
Yes.
>which almost everyone now knows is a waste, fraud, and abuse problem.
No.
The root of virtually all spending problems is spending money on things for which there is no constitutional authority, or against which there is a clear constitutional prohibition — the most salient examples being money that is taken from everyone in order to benefit some people (see Part 1, Article 10 of the state constitution), and money that is taken from people to be used for purposes that do not protect their rights (see Part 1, Article 3 of the state constitution).
The problems of waste, fraud, and abuse are insignificant compared to the problem of illegitimacy. If government isn’t being used as a tool for wealth transfer, there is no opportunity for waste, fraud, or abuse in programs that aren’t being funded.
For example, apart from very small, targeted, means-tested programs to teach literacy, numeracy, and rationality to anyone (of any age) who wants them, there is no constitutional authority for taking money from everyone in order to benefit parents and their children. There are multiple constitutional provisions that explicitly prohibit the formation of a monopoly like our current public school system and almost everything that it does.
If there is something we shouldn’t be doing in the first place — whether it’s operating the NH public school system, or funding USAID, or maintaining a standing army — the solution can’t be to find ‘better’ ways to fund, operate, or regulate it. It’s to stop doing it. Period. Focusing on waste, fraud, and abuse are, as the saying goes, like rearranging the deck chairs on a sinking ship.
