Last night, Obama and Boehner engaged in a game of political "dueling banjos". Though they played from opposite sides of the aisle and lent their own flairs to the proceedings, their music was far more similar than different. This isn't surprising since both sides are stuck between a rock and a hard place - they need to cut federal spending, but they need to do it in a way that won't cause every military family and every family with a member that receives Social Security and Medicare from voting them out of office. Trouble is, our government is spending roughly 50% more than what it takes in right now, which means it would collect just enough this year to pay for its obligations for Medicare and Social Security if that was all it spent money on this year. Since our troops are still deployed overseas and the Department of Education is still a going concern, that's clearly not the case, which is why we're now playing debt limit football. Now, it goes without saying that, like any good libertarian, I firmly believe that we'd be far better off without government-funded medical care, government-mandated retirement, and with a much smaller defense footprint. However, saying that we're in favor of cutting spending isn't enough, even if it is a fantastically good idea - most people love cutting spending, provided it's not their spending that's cut. Go ahead, ask a Republican to cut the defense budget, and I dare you to ask a politician of either major party to vote to make serious cuts to Medicare and Social Security. it's not like the largest demographic segment in the United States is about to collect on those programs or anything, nor do retirees vote more than the rest of the country. Right. So what do we do? Raise taxes by 50% so our federal tax receipts are finally within sniffing distance of our federal outlays? Well, that's one option, if you don't mind stealing more productive labor from the American people by force and don't mind pushing the economy into a back alley and clubbing it repeatedly. Alternatively, we could actually address the structural problems that are leading to this mess in the first place. It's time for a bad car analogy. Go back in time to the '30s, '40s, or even the '50s. Back in the day, hand-built cars were considered marks of luxury and refinement. Why? Because they were built to a higher standard than any factory-assembled car of the time. Craftsmen would labor away on each car, ensuring that the doors shut just so, that the paint was free of scuff marks, that all of the lights worked, and so on. Hand-built cars were, by and large, far more reliable, far better built, and far more solid than anything any factory could produce. This remained true until computers reached the factory floor. Nowadays, there isn't a hand-built car in the world that can hold a candle to the build quality of a car assembled using modern, robot-driven production techniques. Not one. It doesn't matter which brand you pick, either. You could compare the reliability and build quality of a shed-built TVR against a mass produced Jeep Compass and that Jeep Compass would beat it hands down in overall build quality and reliability. It wouldn't be close. When you start comparing against Toyotas, Hondas, and other brands known for their reliability, the gap becomes insurmountable. So what happened? Automation techniques improved, that's what. The human eye, hand, and mind has limits. The mind gets bored. Eyes get tired, hands get sore. Robots and computers, on the other hand, don't suffer from these maladies. In the '50s, assembly lines were mechanized, which gave one man the strength of ten, but it still left decision-making and build quality up to each individual human line worker. Though that's still true today, it's a far more abstract process than it used to be. Compare this, which aped the production methods of the '30s, with this. See any people working the spot welders in the last one? Heck, see any people at all? Guess which method produces more reliable and consistent manufacturing results? Right. So what does this have to do with medicine? Well, imagine a world where, in the '30s, everyone decided that, since hand-built cars were built so much better than factory-built cars, the only cars allowed on the road would be hand-built cars. The result, at least according to 1930's thinking, would be safer cars, safer used cars for those who had to buy them, and safer roads for all. Why should anyone be forced to purchase sub-standard automobiles? What would this world look like? Would cars be cheaper as time passed, or more expensive? How would demand for additional cars be met? How many people can hand-build a car? How far would car production technology advance? That's the world of modern medicine today. We have technology - oh, do we ever! - but it all has to be delivered by hand. Everybody gets to see a doctor. Everybody gets to see a nurse. Everybody gets their prescriptions from a pharmacist. At every step of modern medicine is a warm, caring human touch... or, at least, a cold, indifferent, and overworked human touch. There simply aren't enough doctors in the world. There can't be enough doctors in the world. It's physically impossible. In short, we have the technology to do some amazing things with medicine, but we lack the ability to distribute that technology efficiently. The solution? First, we need to acknowledge as a society that cheap, mediocre medical care for all is a heck of a lot better than pretending that we can provide everyone expensive, top-notch medical care, because we can't. I don't mean we lack the political will - I mean there are only so many hours in the day and so many patients that doctors, nurses, and so on can see at a time. It doesn't matter how you physically shuffle paper money around or how much you toss into the system; if the capacity isn't there, it isn't there. Once we acknowledge and accept that, and once government releases its stranglehold on the medical establishment and grants it the ability to push forward from that acceptance, we'll find all sorts of repetitive tasks done by hand that could be done far more reliably by machine. Many prescriptions, for example, could be dispensed by computer - most prescriptions aren't mixed and manufactured by hand in the pharmacist's shop anymore, so why pretend otherwise? Once we free up the medical establishment from its 19th century distribution model and encourage it through capital investment and purchase of more economical medical care to push forward into the 21st century, medical care will be much cheaper and a significantly smaller drag on federal outlays than it is today. Once it is, it'll be much easier to cut without killing grandpa. Who wants to vote to do that? In short, the federal government, the FDA, and the rest of the government apparatus that has our medical establishment locked in pre-industrial methods of distribution must let go and must remove the regulations and perverse economic incentives that prevent the medical community from advancing forward. It won't do a thing for this week's debt limit fight, but it's the only way we'll be able to move forward with 2022's or 2032's. |