Thursday, September 1, 2011

Should the government be "non-consequential" in our lives?

The role of government will likely be the defining issue for the 2012 elections. GOP presidential candidates are trying to out-do each other by promising to make the federal government "non-consequential" as possible in our lives; President Obama continues to make the case that the federal government must play a role in regulating markets and providing help to Americans who can't make it on their own. Polls show that this is not a good time to make a case for government, with the public's trust in government hitting all-time lows.

Like so many other polarized issues today, the role of government has been framed as an either-or, yes-or-no proposition: you are either for "big government" or against it. But the fact is that the federal government already has a hugely consequential--and often positive--role in our lives, intervening in markets in a way that all but the most radical libertarians accept. The real debate is how much--not whether--the government needs to be involved.

Let me illustrate by describing my experiences with government over the past two days. I am writing this blog today from the combined ACP scientific meeting of the Wyoming, Alaska, South Dakota, and Nebraska chapters, held in beautiful Jackson Hole, WY. It is hard to find a more conservative group of "red" states than these four. I am here to talk to the 75 internal medicine physician attendees about the past, present and future of health care reform.

I'll come back to health care reform later in this post, but first, let's go back to Tuesday, when I headed to Dulles airport to catch my flight. The airport was built mainly--you guessed it--with federal dollars. The roads to the airport were paid for by the government. The safety of the airplane I boarded and the pilots who flew it were regulated by the federal government. The air traffic controllers who guided it safely to a wind-buffeted landing between 14,000 foot mountains surrounding the Jackson Hole airport are federal employees.

The cab I caught from the airport had seatbelts and airbag. I paid a bit more for the ride because of these federally-mandated safety features, just as I did for my own car at home. But I am glad to pay more to ride in a safer car, unlike the death traps that my parents drove me around in as a kid.

The airport is located in the spectacular Grand Teton National Park, and within 40 miles of Yellowstone, both owned and operated by the federal government (eminent domain, anyone?). We passed construction crews doing work on the parks' main highway. I imagine they are very happy to have work paid for by U.S. taxpayers.

We arrived in the town of Jackson Hole. Jackson Hole likes to think of itself as a rugged individualist Cowboy town, but its economy is almost entirely based on tourism associated with the national parks and the adjacent ski resort, located on national forest land leased from the federal government. The thousands of gift shop owners, tour guides, waiters, and bar-tenders would be out of work and out of luck if it wasn't for the federal government's presence in the local economy.

I went out dinner, and the steak that was served to me (great beef out here!) had to meet U.S. inspections and safety standards to reduce food-borne illnesses. My GI track is thankful.

The next day, I had to pick up a few toiletries from the local K-Mart. I walked through the store's pharmacy, and saw shelf after shelf stocked with OTC drugs regulated by the FDA, and of course the pharmacist behind the counter could only dispense prescriptions that meet the FDA's safety standards. Much better than the days when snake oil salesmen could sell vile and often toxic remedies from downtown Jackson Hole!

Oh, and right now, I write this blog connected from a PC connected to the Internet. The internet, you know, was created by federal research and development money. And when I speak to the doctors in a few minutes, I would wager that most of them had their graduate medical education paid for by the federal government, make much of their incomes from Medicare, and regularly prescribe drugs regulated by the FDA and avail themselves of medical research conducted by the NIH.

What does this have to do with health reform? Well, if we accept that the federal government has a necessary role in making sure that planes don't fall out of the sky or crash into mountains or each other, in ensuring the safety of the cars we ride in, in owning and preserving some of the most beautiful places on earth as national parks and forests, by buttressing local economies by the tourism created by these great spaces, by regulating the safety of food and drugs, by giving us the enormous benefits of federally funded research and development, then why shouldn't government have a consequential role in ensuring that all Americans have access to health insurance and regulating the worse aspects of the private health insurance market, like turning down people because they are sick? Government is necessary when unregulated private markets can't or won't protect or provide necessary benefits to the public on their own. Too much government can be bad, but too little government would leave us without the demonstrated benefits of having it involved in so many good and necessary ways in our daily lives. Just look at Jackson Hole, Wyoming.

Today's questions: Do you think the government should have an "inconsequential" role in our lives and in health care? If so, would you get rid of FDA, NIH, Medicare, and Medicaid? And can the private market really be counted on to ensure the safety of food and drugs, fund medical research, and provide access to health insurance? How?


ryanjo said...

On your trip, did the government tell the airline what to charge, when to take off, what fuel to use? Did it withhold the passengers' payment from the airline for 25 working days, on a "clean" ticket? Did it periodically threaten to reduce the fare unilaterally by 30%?

When you visited Kmart, were the prices set by government fiat? Did the cashier have to call a 3rd party to authorize selling you your items?

Exactly the point -- our government acts toward the medical profession in an abusive fashion. No other industry or profession is humiliated in this way. But as long as our champions at ACP think this is in our best interests, it can only get worse.

Steve Lucas said...


I have a different perspective on the question. My belief is that even the most conservative person sees the need for some level of government control in any number of areas of our lives.

The problem is that the system has become corrupt supporting the personal and commercial interest over the needs of the public. Howard Dean is now part of the K Street rabble.

Taking two of your examples the FDA and NIH we find that less than 20% of drug ads meet FDA standards. Drugs that have no therapeutic benefits continue to be not only sold, but bought by our government.

A discredited NIH researcher is blocked from applying for grants at one school simply moves to another and is instantly in good standing. Polypharmacy is one of the biggest medical issues we face today, but we have yet to see the head to head or combination testing desired by doctors, and needed by patients.

The constant calls for “tax the rich” is countered with spend what you have wisely. Over 50% of Americans do not pay taxes while less than 33% of Canadians do, and the simple math is if you take all of the income from every American making over $100,000 per year you still could not support the government.

The desire for many people is a more efficient government, not one where those who have control, dictate how those who make, spend their money, or they take it away.

Steve Lucas

Harrison said...


How about just taking some of the money annually from some of the bigger corporations. GE, Exxon, Verizon, Apple -- etc..., none of them paid taxes last year. In fact they averaged rebates or tax credits of over 300 million each.
How much below zero should we lower the tax rates for large corporations?

Maybe it would work if we just raised their rates to zero?
They are making profits at historically high rates, and we are adding to those profits with tax rebates and credits.

And even the suggestion of taking away one of those credits to the oil and gas industry last year was met with rancorous debate and was finally dropped.

There are pretty good reasons that half of the US population is not paying taxes.
It is because nobody counts the payroll tax as a tax, and so that burden which hits the employed earning less than 106,000 per year and not those who earn money off of interest or those who earn in earn in excess of that amount, is not counted.
And because the progressive income tax, which still spares much of what the extremely rich people make because they don't earn money but instead collect it, also spares some of those who don't make much.
Also we have very big unemployment rates in some communities in this country.
California has a 12% unemployment rate statewide, and in pockets of LA it is probably in excess of 40%.
And then there are the over 5 million incarcerated people. We pay taxes for them, but they earn no money. So they are not taxed.
(Another discriminatory system by the way.)

We have a country with a lot of problems.
Being angry with each other isn't going to solve them.
But we may need to argue for all of us to understand them.
I'm quite sure I don't understand many valid things that Tea Party members and the Republican party members simply accept. If I did understand those things, we could maybe agree.
But the civility factor needs to improve, and I'm afraid that the divisions between Fox and MSNBC now perpetuated on Twitter and Facebook and blogs,... well none of that is helping.


Steve Lucas said...


Certainly mentioning a change in the tax code brings out an army of those who place self interest above all else and often the changes they propose do not benefit the greater good. It is also important to remember that with the shift to 401k’s stock ownership and dividend and interest income now make up a larger part of retirement income than in the past.

The level of rhetoric on both sides of the political isle is troubling. I find the purity test issued by some on the right and the left to be counter productive. We need to look at the merits of an issue, not who brought forth the idea.

Today perspective has little or no value, only sticking to a set talking point. Some of the news networks have blurred the lines between reporting and commentary. Kids today often view comedy shows as hard news and take away a skewed view of various people’s positions.

The days of Uncle Walter are long gone and we have no one news person to trust. This vacuum has been filled by those trying to out do one another and politicians providing inflammatory sound bites.

We have reached a troubling time when a news caster cannot repeat a profanity spoken by a union leader.

Everyone needs to step back and stop feeding the fire of intolerance and violence.

Steve Lucas