Idealism and the Illusion of Government Beneficence
A close relative of mine was recently diagnosed with cancer and has begun aggressive treatment at the Mayo Clinic. I was discussing the situation with my grandfather and mentioned the shock we all felt when we discovered how pricey cancer treatments are. A seven-week course of radiation at the Mayo Clinic, or most any other cancer treatment center for that matter, runs well over $200,000. Chemotherapy adds an additional $120,000 to the bill. Confronted with this information, my grandfather immediately launched into a tirade on the crookedness of the health care industry: Greedy doctors and hospitals in cahoots with miserly insurance companies and pharmaceutical interests, only concerned with profits and the almighty bottom line. Setting aside the fact that the Mayo Clinic happens to be a non-profit entity, I agreed with him that the high cost of cancer treatment, and medical care in general, is frustrating, but told him that I'd much prefer the frustrations of the private health care market to the inefficient, unaccountable bureaucratic nightmare that characterizes government-administered health care, e.g. the Veterans' Affairs Administration and their shameful neglect of our nation's heroes.
It probably won't surprise any readers to learn that I am a Republican and my grandfather is a Democrat, and while there's much we do agree on at critical points our fundamental difference in worldview causes us to reach radically different conclusions on questions of public policy. We each have our bogeymen. For my grandfather there exists a deep-seated suspicion of "big business," while I have a kneejerk skepticism regarding the supposed beneficence of "big government." To his credit, my grandfather was appalled when I explained to him the current scandal involving the VA, but he seemed skeptical when I suggested that the government is just as prone to corruption and wrongdoing as are the evil private businesses he loves to hate. "People are dishonest and prone to corruption. It's a universal tendency, even in government." I told him. "Especially in government!" I could tell that he was completely unable, or perhaps unwilling, to see my point.
This conversation got me thinking. Why are so many people are willing to place their faith in government, over and over again, despite mountains of historical evidence demonstrating that government tends to become more inefficient, corrupt, and oppressive the more powerful it becomes? I'm sure there are many great conservative thinkers who can and have offered a better explanation than I can, but based solely on first hand experience with Progressive-minded folks in my own life, this is what I've concluded.
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Many people, Progressives in particular, seem to view government as an objective, disinterested entity. Since government is by definition a representative body, they reason, it is not a thing unto itself. It simply exists to carry out the will of the people. This is an appealing notion, since most people like the idea of genuine benevolence and hate the idea that a good deed might be motivated by a self-serving ulterior motive. I am reminded of philosopher Emmanuel Kant's focus on the moral importance of authentic good will. A lot of people assume that the actions of government, unlike those of private enterprise, are motivated by this kind of good will towards its citizens. The moral weight of this assumption cannot be overstated.
Thus with something like health care, a person who views government in the above way will like the idea of a single payer system, where the government manages and administers health care as public service, everyone has access to the same pool of resources, and no one is denied care based on their ability to pay. This just seems nicer than the for-profit model (or even the private, non-profit model), in which hospitals and doctors are motivated not by sheer good will towards patients but by the desire to make money or at least cover their bottom line. And because it seems nicer, many Progressives conclude that this is the way it should be. Profit motive and fiscal solvency shouldn't be a factor in something like health care! Everyone should have access to the highest quality care at the lowest price, period.
I don't disagree in the least with this view . . . in theory. The problem arises when this ideal conception of government-managed health care buts up against reality. In reality, government is NOT an objective, disinterested party; a mere vessel of the people's will and servant of the people's welfare. A government is a body made up of self-interested, self-serving human beings and a locus of immense power. What makes government power particularly prone to abuse and corruption is that it is power that easily evades accountability. People may find it distasteful that profit is ultimate goal of private enterprise, but they overlook the fact that the selfish desire to make money is one of the only ways to ensure good service to others. A government bureaucrat has no individual motive to perform well in their job, since it's virtually impossible to fire a government employee and their professional progress is not linked to demonstrable outcomes. In other words, it all comes down to incentive, and in government there is no incentive to perform well.
One need not search far to find scores of recent examples testifying to this point. Remember the GSA scandal? (http://www.businessinsider.com/whats-the-gsa-scandal-2012-4) The Secret Service prostitution debacle? (http://www.cnn.com/2012/10/19/us/secret-service-prostitution-scandal/) How about the EPA pornography imbroglio? (http://dailycaller.com/2014/05/07/epa-employees-not-fired-for-watching-pornography-stealing-money/) And of course unless you are like my grandfather and your only source of news comes from the good folks at ABC, NBC, and CBS, you are aware of the ongoing IRS targeting scandal, the unresolved Benghazi situation, and the outrage at the VA. All of these examples illustrate what happens when you grant "public servants" access to virtually unlimited money and power with absolutely no mechanism of oversight or accountability.
This is why, as a conservative, I will always cast my lot with the free market over and against big government. I harbor no illusions about the benevolence of mankind. When power and money are involved, most men can unfortunately be relied upon to behave badly. Free marketers and capitalists are no angels. The advantage of the free market, however, is that it harnesses what is a less than admirable human trait and channels it into something that benefits others. When a private business is awarded a contract or secures the patronage of a customer, they are motivated to provide good service and perform well because they know that if they don't, they might not get paid or they might lose out on repeat business. Because they want to make money, they have an incentive to perform well. If they abuse the public trust or act unethically, there are generally significant economic consequences (unless, of course, the business in question has gotten into bed with the government, in which case all my points about the corruption of government and the unaccountability problem apply). In the government, you make money and continue to receive bonuses and promotions regardless of whether you do your job well or even at all.
We've all heard the saying, "the customer is always right." Americans LOVE that saying. In our culture, the customer is king. Having worked several jobs in customer service, I can say firsthand that many people abuse this concept and are terrible customers. They are demanding, rude, and unreasonable in their expectations. Even so, nine times out of ten even these worst of customers will still get their way; managers will defer to them. This is because businesses know that it's better to patronize the bad customers than run the risk of losing business or suffering from negative word-of-mouth feedback.
Ever try this tactic at the DMV or with any other government entity? How well did it work out? Did you get the sense that the person behind the counter was concerned in the slightest about resolving your issue or helping you out? Did you feel that the "public servant" standing before you was really working for you, or concerned that their bad treatment of you would result in any kind of negative consequences for them? No? Well there's a reason for that. There's a reason that the people who doctored patient appointment records at the VA hospital in Phoenix have been placed on "administrative leave" and not fired. There's a reason that Hillary Clinton can say, "what difference does it make??" in the wake of four Americans killed on US soil in Benghazi, Libya. Our Congress can convene all the special committees it wants and ask all the right questions and the bureaucrats called to testify will continue to plead ignorance, or forgetfulness, or downright dismissive defiance. What the American people won't get are any real answers or any real accountability.
So back to the conversation with my grandfather and the issue of my relative's medical bills. Yes, it would be wonderful if we lived in a world where everyone had access to the best care by the best doctors and there was no corruption or waste and it was all free or practically so. This is the promise our government makes to America's military: you serve us, and we'll serve you. Instead, we have vets dying of cancer while waiting for basic diagnostic services, and culpable employees who may never be held accountable. We have an American GI who put his life on the line in Afghanistan sitting in a Mexican jail because our president lacks the courage and conviction to flex a bit of diplomatic muscle.
My relative is facing steep medical bills, to be sure, but he also knows that he is getting something for his money: he is getting the best care possible. He is getting a team of doctors whose job it is to see him through from start to finish, to pay attention to the details of his case, to do all in their power to restore him to wellness. You can be sure that no one at the Mayo Clinic will take his money and then forget that he exists, or consign his name to a secret wait list. This is because they are getting something from him as well: His money is providing them with the opportunity to further their mission as a center of medical excellence, research, and education. That is their motive, their incentive, for taking good care of him.
It's such a simple concept, really, yet one that eludes so many. I suppose one can never underestimate the power of idealism, and the willingness of government to feed on this idealism as means to retain and amass power.
