Let’s start with a little game.
Fill in the blanks:
Government interventions over the past four decades have yielded a cascade of perverse incentives, bureaucratic diktats, and economic pressures that together are forcing [_____] to sacrifice their independent professional [_____] judgment, and their integrity. The consequence is clear: Many [_____] from my generation are exiting the field. … Governments and [_____] administrators hold all the power, while [_____]—and worse still, [_____]—hold none.
Now take a look at the original:
Government interventions over the past four decades have yielded a cascade of perverse incentives, bureaucratic diktats, and economic pressures that together are forcing doctors to sacrifice their independent professional medical judgment, and their integrity. The consequence is clear: Many doctors from my generation are exiting the field. Others are seeing their private practices threatened with bankruptcy, or are giving up their autonomy for the life of a shift-working hospital employee. Governments and hospital administrators hold all the power, while doctors—and worse still, patients—hold none.
I am a 30-plus-year educator, therefore, this paragraph jumped out at me since many of my professional complaints match this almost perfectly, leading to my version:
Government interventions over the past four decades have yielded a cascade of perverse incentives, bureaucratic diktats, and economic pressures that together are forcing [teachers] to sacrifice their independent professional [education] judgment, and their integrity. The consequence is clear: Many [teachers] from my generation are exiting the field. … Governments and [school] administrators hold all the power, while [teachers]—and worse still, [students]—hold none.
But there is an irony to all this: The paragraph is in a piece at The Cato Institute and the doctor penning the complaint cites Ayn Rand toward the end; thus, it is intended to be a slam against Big Bad Guv’ment.
The flaw is that in the piece itself, the real problem is not government, but that government fails to be government—”perverse incentives, bureaucratic diktats, and economic pressures.”
In the U.S., we have a quasi-Libertarian but mostly flawed idealism toward wealth, capitalism, and the misleading free market that has twisted “government” to mean something akin to totalitarianism (in the 12-year-old sort of way Rand fumbles in her garbled attempt at fiction writing and populist philosophy).
As a stark comparison facing us now, police are meant to protect and serve, but when a policeman shoots and kills a 12-year-old or a policeman strangles to death an unarmed man selling cigarettes, we do not have evidence that justice is a flawed pursuit, but that the current system fails justice.
Government as a hand of the market and government as bureaucracy—that dynamic is crippling medicine and education in the U.S. However, the reality is that government in the U.S. is mostly a servant of the rich and powerful, and not a mechanism of the public good—the potential purpose of democratic government because we are the government, not some dictatorial tyrant.
Public funding should be a pooling of resources by a people in order to insure the life, liberty, and pursuit of happiness of each individual; it is not a competition between society and each individual (the Romanticism of Emerson and Thoreau) but a symbiotic relationship between the two (John Dewey): by contributing to the public good, I also contribute to my own individual liberty.
The free market (“perverse incentives,” “economic pressures”) and bureaucracy (“bureaucratic diktats”) have never and will never achieve equity. The market creates inequity, and bureaucracy paralyses most everything, notably the pursuit of equity.
Government rightly functioning would insure that experts (such as doctors and teachers) who serve the public good are free to practice that expertise—not bound to the whims of the market, not fettered by bureaucratic mandates.
Publicly funded must precede (not supplant) all other commitments of a free people—public education, universal health care, highway system, just legal system, etc. Demonizing government (we the people), idealizing the market—both are insuring that the U.S. will never achieve equity, never reach the promise of democracy and freedom.
Government fails when it fails to be government, and people governed fail that government when they fail to understand that government is their collective will.