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?