DB’s Medical Rants

Most debates over health care involve different world views. Most honest observers will admit that free market solutions have problems and that governmental solutions have problems. Our world view generally leads us to choose one of these views - probably based upon which solutions induce worse externalities.

David Mamet is a a well known playwright often considered a “liberal.” I parenthesize liberal because the term has become vague. He has a wonderful essay in the Village Voice - David Mamet: Why I Am No Longer a ‘Brain-Dead Liberal’.

He has some wonderful quotes which I hope stimulate you to read the entire essay.

John Maynard Keynes was twitted with changing his mind. He replied, “When the facts change, I change my opinion. What do you do, sir?”

I must remember that one.

The play, while being a laugh a minute, is, when it’s at home, a disputation between reason and faith, or perhaps between the conservative (or tragic) view and the liberal (or perfectionist) view. The conservative president in the piece holds that people are each out to make a living, and the best way for government to facilitate that is to stay out of the way, as the inevitable abuses and failures of this system (free-market economics) are less than those of government intervention.

I took the liberal view for many decades, but I believe I have changed my mind.

As a child of the ’60s, I accepted as an article of faith that government is corrupt, that business is exploitative, and that people are generally good at heart.

What a great summation of complex issues he provides! I would argue that some government is corrupt, because power corrupts. I would argue that the goal of business is success (usually financial) and thus it will exploit if it can. So what should we do?

I’d observed that lust, greed, envy, sloth, and their pals are giving the world a good run for its money, but that nonetheless, people in general seem to get from day to day; and that we in the United States get from day to day under rather wonderful and privileged circumstances—that we are not and never have been the villains that some of the world and some of our citizens make us out to be, but that we are a confection of normal (greedy, lustful, duplicitous, corrupt, inspired—in short, human) individuals living under a spectacularly effective compact called the Constitution, and lucky to get it.

To which I can only type Bravo!

The Constitution, written by men with some experience of actual government, assumes that the chief executive will work to be king, the Parliament will scheme to sell off the silverware, and the judiciary will consider itself Olympian and do everything it can to much improve (destroy) the work of the other two branches. So the Constitution pits them against each other, in the attempt not to achieve stasis, but rather to allow for the constant corrections necessary to prevent one branch from getting too much power for too long.

I marvel in his observations.

As I read this essay, I am reminded that many of the problems in health care come from government involvement. Our payment system is corrupt. The RUCC is corrupt. Medicare is corrupt. Why you might ask? They must become corrupt because they have power and we all know that power corrupts.

The only reasonable solution to health care is to keep both business and government at bay. Patients know what they need in most cases. We should develop a system which allows physicians to bargain with patients. We should decrease regulations.

Will this lead to some abuses? Of course it will. We will always have abuses because we have “normal (greedy, lustful, duplicitous, corrupt, inspired—in short, human) individuals” involved. Patients will try to take advantage of physicians and vice versa. Some physicians will act more altruistically. Some patients will not try to “game the system.”

We may need methods to settle disputes, but we need that for all life in our democracy.

We need to let patients pay for services without the constraints of our current highly regulated irrational system. I believe that Mamet understands this in general (although I do not pretend that he has considered this concept with regards to health care.)

But then I neither trust the government nor the insurance industry. I do generally trust human beings, although I remember what Benny Binion (the famous casino operator) said, “Trust everyone, but always cut the cards.”