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Genuflecting at the Altar of Progressivism
Religion has many ways to remind us of what is important. Rituals provide constant reminders of what is really important, despite what may distract us from day to day. Baptisms, weddings, and funerals are there even for the distracted – we all put on nice clothes and go to those. We profess to be engaged, even if we are not. The more observant of us have rituals even more frequently – church every week, maybe prayers before every meal, and perhaps even more. Rituals remind us. And again, even the unobservant are reminded at major events in our lives. Births, weddings, deaths. Thus, religion cannot be forgotten even by the distracted – whenever something important happens, it’s always there.
The more perceptive among you might have noticed that I’ve been off the Ricochet radar for a while. I’ve been out of touch because I’ve been busy. I just moved. I closed my medical practice of 20 years in Tennessee, and I’ve moved to Hilton Head. So I’ve sold one home and bought another, I’ve closed one medical practice and started another, I’ve taken my kids out of one school and put them in another, and I’ve moved from one state to another. Pretty important stuff. I spoke in church and said goodbye to my congregation in Tennessee.
But then another religion forced it’s way in.
Dennis Prager said something like, “The most vibrant & active religion of the last 100 years is progressivism.” I have found this to be true.
Moving my medical practice has required my observation of rituals involving endless government regulatory agencies, including (but most certainly not limited to): CMS, EFTPS, MIPS, COI, TID, PECOS, NPI, PQRS, DEA, EIN, CLIA, LLC, NPPES, EIN, HIPPA, and so on and so on and so on and so on. And so on.
Before I am permitted to make these changes in my life, I am required to genuflect before the altar of government, acknowledging who is really in charge of my life. It cannot be escaped. I must profess to be engaged, even if I am not.
Aldous Huxley and I find this concerning.
None of this helps me practice better medicine. My patients will not be healthier, my family will not be happier, and I will not be more satisfied with my job – all of these GI’s (my term for Government Initials) are a net drag on my actual goal – providing health care to people in South Carolina. Whatever I accomplish here will be despite (not thanks to) all those GI’s. All my genuflecting is of no help in the realm of reality. I am not a true believer in the religion of government, but that doesn’t matter. Genuflect I must. Or else I will not be permitted to care for sick people.
While my genuflecting does not help me care for sick people, it does help me recognize what is really important in my life, despite all the day to day distractions (like sick people). That the presence of government is as ubiquitous as the presence of air. George Orwell was (for once) wrong. Aldous Huxley was right. Progressivism will not conquer individual liberty with guns and soldiers. Progressivism will become ubiquitous, simply by being ubiquitous. Like Zsa Zsa Gabor was famous for being famous. Resistance is futile. It’s easier to just get along. Keep filling out forms, & maybe we’ll allow you to live your life. It’s easier to just get along. I’ll just hire another secretary to fill out all those random forms.
The lines at the airport anger me – “Look at all these [expletive] sheep! Just standing there, doing as they’re told, for no particular reason, just like sheep! That’s pathetic!” I think all these horrible things, as I stand there, like a sheep. I have a flight to catch. It’s easier to just get along. I’ll just allow a little extra time.
Of course, as long as I set up my new NPI with the EIN assigned to my LLC, PECOS will allow my EFTPS to interface with CMS, and I may be allowed to take care of sick people. That would be simpler that raging against the system. It’s easier to just get along. I’ll just hire a few more consultants to protect me against the government regulatory agencies.
Pathetic. I’m embarrassed. I’m as much to blame as Obama and Pelosi. I have seen the enemy. And he is me.
But golly, all I want to do is take care of sick people. That’s all I really know. It’s easier to just get along. Right?
Pathetic.
Published in General
What you are talking about here is where Trump and virulent NeverTrumper Charles Murray are on the same side. Trump see this and says MAGA. Charles Murray sees this and says we need to practice civil-disobedience. Even on a good day you can get most Democrats to agree that the bureaucratic red tape from governments at all levels have become ridiculous.
Glad to have you back. In spite of the tyranny of acronyms that attempt to hide unpleasant truths do not let as the Romans would say; Illegitimi non carborundum. The sad thing is even this phrase is subject to interpretation.
And then they will go out and vote Democrat again…
Don’t let the bastards drag you down.
I understand.
But it’s easier to just get along. I have more important things to do. I’ll just fill out one more form…
Indeed. I don’t how many times I hear otherwise normal people, say yea the red tape is irritating but someone has to do it. We can’t just leave everything alone, let restaurants poison people, drug companies sell thalidomide, or builders construct structures that collapse, allow Drs to practice, teachers to teach, nurses to nurse, who are not properly credentialed. In fact we could. We don’t need any of it. People can sort it out without government. Limited government pertained to the Feds but it’s a good concept for all levels.
I’ll take that a step further. I would argue that our obsession with credentialing allows for (even encourages) the concealment of incompetence. If you’re incompetent, just keep going to classes until you have even more letters after your name. It’s easier to gain respect that way than through brilliance or hard work. You can command higher paying jobs without demonstrating ability! It’s like magic! And who builds such a system? Those with minimal abilities and maximal need for outside approval – politicians and lobbyists! What a remarkable coincidence!
Pathetic.
Man is that ever the truth.
I envy you surviving all this. I’m not sure I could ever open up another practice again, every aspect of it can be overwhelming. God’s blessings upon you, your family and your patients, old and new.
I haven’t survived it yet. This is rough.
I do concierge medicine (as you do, I think), so I’m particularly sensitive to the difference between credentials & excellence. My livelihood depends on laymen being able to tell the difference – not always easy.
As you point out, this is a difficult transition for my family, my patients, and for me. Your best wishes are appreciated.
I assume you’ve read Murray’s book “We the People”. I thought the first 5 chapters were excellent. The book overall is rather good too. He summarizes well something that many Americans see from different part of our society and work places. I respect Murray. But I also am hopeful that Trump can roll back the regulatory state to an appropriate level.
How about a contrary view?
We are obviously over-regulated, to the point we could lose 10% of them completely at random with minimal harm. However, there is a reason they exist beyond making us bow to DC five times a day. We need some minimum standards to keep people in line and give some confidence that an expert can actually provide a reliable opinion.
No medical regulations? So how should we determine who is and is not a quack? I would prefer not to rely on my next of kin suing (or killing) the doctor who got me killed. Furthermore, I really don’t see the benefit to litigating every standard to death. Having a byzantine code written by judges is not superior to our current code written by bureaucrats.
People waiting in line are sheep? Really? What are they supposed to do, rush the terminal and get sent to jail? If you complain, the TSA dudes will not care. I don’t think many people would weep if the TSA was abolished or privatized.
I know enough people who will take shortcuts that get people killed. I know that some people would refuse to pay their employees, because they know that the grunts don’t make enough money to sue them. We need regulations because there are people who are evil and will kill people out of laziness or greed.
I appreciate the contrary view. I respectfully disagree, however. Let’s consider my partial list of the GI’s (Government Initials) I’m working with now: CMS, EFTPS, MIPS, COI, TID, PECOS, NPI, PQRS, DEA, EIN, CLIA, LLC, NPPES, EIN, HIPPA. There are many others, of course. Those are just off the top of my head. You acknowledge that “we could lose 10% of them completely at random with minimal harm.” I argue that we could lose all of them tomorrow and the quality of medical care in this country would IMPROVE, because doctors and nurses would be focusing on patients.
In the hospital this morning, I saw maybe 10 nurses working on the floor I was on. All of them were looking at computer screens. None were in the room with patients, at least when I was there. Some record keeping is always necessary, but this is very expensive and very dangerous. Nurses should be allowed to care for patients.
Our current regulatory state is not merely expensive and unhelpful. It is dangerous.
We managed to take care of sick people before EFTPS etc existed. We can do so again.
When your doctor is thinking about federal guidelines instead of focusing on YOU, that is dangerous. Mistakes happen.
I acknowledge that regulations may have some benefit at times. However, I argue that the benefits are occasional and small. While the costs are enormous. Mostly unseen, but enormous. The reason I chose Bastiat as my namesake here is that I admire his distinction between the seen and the unseen. The costs of the exertion of government power are often unseen.
Suppose a new set of regulations make it more difficult to open a new restaurant. So somebody decides against opening a new restaurant. Those who did not get jobs at this new restaurant that does not exist don’t even realize that they lost anything. And they don’t realize that they should be angry at whoever voted for the guy who appointed the guy who made up those regulations. Their job just never happened.
For me to simply move 6 hours down the road and do the same job I was doing before has required countless consultants, attorneys, and several months of filling out paperwork. Just to move. Can you imagine what has to happen to develop a new drug? What would be available now if not for the wet blanket of regulation? Hard to say. We’ll never know.
But just because it is unseen does not mean that it is unimportant. It might have saved your life one day. But we’ll never know.
Yes. A thousand times – yes. And higher education is besotted to the point of absurdity with the need for credentials (degrees). One small example: I wrote a book on songwriting that is used as a textbook at several Christian colleges. The course is typically taught by people who have never written a successful (published) song. I, on the other hand, cannot be hired to teach the class at these schools – because I never went beyond a bachelor’s degree. It’s insane.
I hear you. I have developed some new techniques for treating heart disease, and I travel all over the country giving lectures to doctor’s groups, teaching them how to treat heart disease. But I can’t teach a class at my kids’ local high school because I don’t have a teacher’s certificate.
I realize that you are partly playing devil’s advocate, but this is exactly the mindset that got us here. It is not the place for government to set minimum standards unless the government is paying for it. The marketplace is exceedingly more efficient at delivering outcomes than government regulation. There are many examples of industries and professions governing themselves without the government developing and ensuring compliance.
The problem with government is that it isn’t disciplined by the market and so it can impose compliance requirements that utterly fail cost benefit analysis.
No the main role for government in regulation should be in the enforcement of torts through the court system.
It’s an excellent article.
As has been noted before:
Don’t Believe In Free-Market Medicine? Have You Ever Seen the Inside of a Venezuelan Supermarket?
It’s also a fundamentally conservative mindset based in the fallen nature of humanity and the role of government in enforcing law and order. We cannot guarantee that people will make good products, but we can enforce laws on truth in advertising so you know what you are getting and can make an informed decision.
I want examples of businesses that regulate themselves without just taking the easy way out. We’ve seen plenty of companies that just dump stuff in the ground, then go bankrupt and dodge the cost.
So we regulate by lawsuit, then? Good luck getting a lawsuit if you aren’t filthy rich. Remember, the Gawker suit by a former celebrity required backing from a billionaire to succeed.
I think our disagreement is one of scale and scope. I view regulations as an extension of the law enforced by the government. The problem has been that regulations are the first resort of too many politicians, when they should be near the last resort.
Perhaps a medical analogy is apt. No one wants to have their eye removed. Removal of the eye is necessary in some cases, but it is something only contemplated in the most dire of circumstances. If an ophthalmologist advocated eye removal for glaucoma, cataracts, conjunctivitis, or a detached retina, he would be rightly viewed as a quack or butcher. I want to preserve regulation (eye removal) for the extreme cases, and even then only remove the diseased eye. The modern bureaucrat is running around and blinding everyone in reach.
Your discussion of hidden costs should be covered on day one of any regulatory job. It is where you acknowledge that you are not God and can make mistakes.
IT DOES NOT WORK.
Check out DR. Farid Fata.
Medicine was a profession. With a code of ethics. If there was an incompetent surgeon or lazy cardiologist on the staff, he or she soon stopped getting referrals from the family doctors.
The OP is right: “credentialing” is just as likely to protect a quack as to ensure consistent quality.
(sigh) Civil disobedience, unless organized = martyrdom. When you are a normal “don’t tread on me” kind of individual you will not be attracted to organized civil disobedience. And independent individuals figure out ways to make things bearable for themselves which, ironically, enables further encroachments on personal liberty. So you need enough people to reach behind themselves at the same time and feel a wall there to convince them that organized disobedience is all that is left.
@omegapaladin
You presume that liberalism is based on reason– it isn’t. Liberals believe that government is good and since the world is endlessly flawed it needs endless government. The belief in government and the goodness of liberals is pretty much a religion without an Aquinas to inject some Aristotelian thought in it.
There’s degrees. I am a self-employed MD and I cut my practice from 25 to 6 employees in order to minimize exactly the hassles that Dr Bastiat describes. It has cost me about $90,000 to do so, so this is not a small thing, but it is worth it for the quality of life improvement. Dr Bastiat has my utter and complete sympathy.
But we must have some degree of licensing/credentialing of life-and-death professionals and non-biased approval of potentially dangerous drugs. This is a legitimate function of government.
Thalidomide is a good example of why. Thalidomide, a German invention, maimed and killed thousands of fetuses in the UK, Europe and Canada, but only 17 in the USA. This, because Francis Kelsey, an FDA physician, insisted on proof of its safety in pregnancy. The FDA rejected the drug SIX TIMES before the teratogenicity of thalidomide became known and the drug was withdrawn.
The East German equivalent of the FDA also refused to approve thalidomide. Fancy that.
Thomas Quasthoff was not available this morning for comment.
Actually, I agree that liberalism is faith-based. I compare them to doctors who cut out everyone’s eyes when someone gets pinkeye.
However, I think the reason the regulatory policies remain popular has more to do with people being afraid of people trying to rip them off or deliver a horrible service. It’s driven by the same impulse as most laws.
I would be more partial to the argument for some regulations if it wasn’t for the fact that so many of these credentialed and licensed individuals are worthless and create dangers, ever hired a contractor?! I lived in Arizona for four years and I heard horror story after horror story of people who contracted with subdivision builders to build them a chosen model of home on a given lot that they bought. It will only take four months, make that six, you moved in with your parents because your lease extension ran out? Just another four months. Two more. Two More. Two more. They finally move in 18 months past the promised date, it’s the wrong model, the air doesn’t work, the sinks don’t pass inspection, the gas ins’t ventilating, the sewage is seeping into the yard, and on and on.
And yet they are all licensed, all regulated, and the city inspectors have been there through out. I heard various versions of that story from countless families dealing with various developers and contractors.
If any of these regulations that drove the prices up and delayed the time could have delivered a better product, I’d be more partial to that argument. As stated above, good luck suing, half those families I’d talk to were lawyers!
You are not responsible or complicit. You are trapped as much as a Soviet factory worker.
Throwing down your scalpel, pen or wrench may crush you as the system expands, but do your duty and work on getting things better.