Freedomain Radio Podcast 10
Hello, and I guess it's time for our afternoon drive. Actually it's closer to evening now, it's 6:15 PM on December 12th, 2005. I'm just on my way home, and I guess the topic for this evening is what happens to government programs after their first, say, decade or two of implementation. I think this is pretty important, because I think it helps to understand just why it's so difficult to get rid of these programs or to help people to understand just how corrupt they have become. Because they follow a particular pattern in terms of what happens to the incentives, and the rewards, and the personalities, and so on involved as they continue to age.
I'll take two examples that I am a little bit familiar with. One is of course NASA, and the second is the creation of the universal healthcare misery scheme in Canada which occurred in the 1960s.
So let's take a look at what happened in Canada in the 1960s. Well, Tommy Douglas, one of our premiers, who I believe was a minister or minister's son was very big on “Let's give free healthcare to everyone because,” you know, “it's just not a good thing for us to have to pay for it all this way.” So he got all of this chugging along, and their then Prime Minister basically kept offering more and more money to the Canadian medical association until it finally collapsed as the Prime Minister famously observed—at least famously to me—when people said, “How on earth did you get the doctors to agree to become indentured serfs?” and he said, “I stuffed their mouths with gold,” which I think is just a wonderful phrase to describe political power. Of course, it's not his gold, so stuffing it doesn't cost him anything, just everybody else who has to pay… So let's just say that we wake up one morning and, you know, in the 1960s in Canada, and lo and behold, we have socialized medicine. Well, what does it look like? Well, I'll tell ya. It looks a whole lot different than it does right now, and it's not just because debt has increased in the intervening years. What happens when you socialize an industry (and we'll just talk about healthcare right now) is: you socialize it, and all the participants in it have habits that have been developed in the free market, which is very, very, very important. So when you first socialize medicine, when you first grab power over the medical system and transfer all of that power to the government, you are inheriting a system wherein both the doctors and the patients (and the other practitioners of course) have had their expectations and work ethics shaped by the free market. I couldn't emphasize how important that distinction is. So you grow up and you're a Saskatchewan kid or an Ontario kid in the 1920s, 1930s, 1940s, 1950s, and you don't go to the doctor. You take care of yourself! Because going to the doctor costs you money. So you take care of yourself: you eat your apple a day, you exercise, you don't overeat, you take care of yourself, because the financial consequences of getting into long-term or palliative care are just horrendous. So, generally you'll take care of yourself. And of course the fascinating thing is, if you look back at movies (or I particularly enjoy newsreel footage) of those years in North America, people were thin! You couldn't see a fat man… for miles! You have a look at any sort of freeze frame, any newsreel footage from the 1950s and the 1940s, the 1960s, even the early 1960s, and there's… no fat people! It really is astounding, just how different our society has become since this stuff all became sort of sucked into the maw of the government.
So patients are used to taking care of themselves, and they are not used to going to doctors. They sort of have lifestyles which have been developed with a huge lack of desire to go to a doctor, because it's expensive. So that's on the one side of the equation. On the other side of the equation, you have doctors who have been, um, conditioned to a work ethic and a level of social responsibility that was developed in the free market. It's all very different. These are doctors who are used to doing house calls; these are doctors who are used to working 60 hours a week; these are doctors who are used to taking deferred payment from people who can't afford it. So, their work ethic, their level of responsibility, their level of commitment to the community, their level of charity, for these doctors, have all been conditioned in the free market.
And these are not habits that you just wake up one day and say, “Well, now I'm socialized, so my entire approach to medicine is gonna change, and I'm gonna start chiseling the system, and…” Whatever. These doctors who are 40 or 50 or 60 years old when they get socialized don't wake up one day and say, “I am now no longer going to try to do the kind of good doctoring that I've done for 20, 30, or 40 years, but I'm gonna become some other kind of doctor.” It's really not possible. If you have a habit of taking care of yourself, of not overeating, of exercising and so on, you don't wake up one morning and say, “Wow! Healthcare is free! I guess that I can just let myself go and let the doctors patch me up!”
So that's sort of one example of why it takes 10 or 15 or 20 years for the problems within a socialized system to really show up. So if you want to find out why it's such a mess in healthcare throughout the world, but particularly in North America now, you really are looking at the effects of decisions that were made 15 or 20 years ago, because it takes quite a while for doctors to come into the system who have known no other system, no more free or more responsible kind of system. And so, given that it takes a while for these doctors to come into the system, the lag of more competent, more dedicated, more responsible people whose work ethics and charity and community sensibilities were shaped in the free market, it takes a while for those people to get out of the system, to retire or to leave the system, and it takes a while for all of the people who have now grown up within that system and have never been exposed to the free market in healthcare, for those people to come into the system and really change it.
If we look at something like NASA, I think that sort of makes a good deal of sense as well.
I remember, I used to listen to — and I still do from time to time —I used to listen to radio broadcasts, it'sHarryBrowne.org (Browne with an ‘E' on the end of it), and he's a very good speaker and a very good analyzer of the free market and the effects of government coercion. One of his shows, I can't remember where or when, was this question. And he was like, “Oh, God, NASA has coasted on the moon landing for like 35 or 40 years, and can we just let it go?” and so on. He couldn't figure out how they managed to pull off the moon landing, and then everything since then has been, you know, such a disaster. I mean, everything since the moon landing for NASA has been pretty much a complete wash. You know, they've got Apollo 13: they have to pull it back with a (laughs) rope almost… You know, they have space shuttles exploding or failing to take off or crashing, they have Mars ladders that fall over on Mars and don't broadcast, they've got space probes that just fly into the middle of nowhere and cease transmitting. I mean, NASA has produced nothing of value for like thirty years, but they've been riding this whole “We put a man on the moon” thing. And if you think about my analysis of the healthcare system and put it in terms of NASA, I think that you'll see that the same thing is gonna hold true: that the people who first entered into the NASA environment when it was put together (and I think this was in the late 50s or early 60s), you know, you had to be a senior engineer to get into NASA, you couldn't be just some kid of grad school (I don't think, anyway). So you had to have had a pretty significant exposure to the free market and to the discipline, and all of that that comes along with working in the free market. And the discipline, and also the lack of politics… I mean the free market has its politics of course, but, you know, they're blunted or limited by the fact that people still have to make money, right? I mean, in the public sector, there's no limit to the carnage that politics can wreak. In the private sector, of course, if politics get out of hand, a company goes out of business, right, 'cause people spend more time fussing about status than they do creating goods to be sold. So you have a whole bunch of engineers and managers coming into NASA from the free market, and these are all guys in their mid- to late forties and up, who've spent 20 years working as engineers in the private sector. So of course they're gonna be good. Of course they're gonna attack the problem of the moon landing with all of the dedication that you would expect from people who are the best that the free market can produce. So it makes perfect sense to me that NASA would have an initial success, followed by a stunningly quick disintegration as these guys retire or get out of an increasingly political organization and go back to the free market, that the initial successes of all socialized institutions make perfect sense to me.
But the fact that they end up in this quagmires, in these morasses, in these heavily political, heavily wasteful, non-service-oriented bogs (laughs) of incompetence, it makes total sense to me, at least. If you take people from the free market, they're great, and then if you move them into the public sector, there'll be a short amount of time where things look great, but basically you're cannibalizing the past, and the system will swamp people pretty quickly and start to move them into political and greedy and predatory and corrupt situations. I can say for sure that this is the case in the mental healthcare field, and of course I have some knowledge of this, just based on conversations with my wife and the fact that we've written a book together; unfortunately, because it's pretty critical of socialized healthcare, it's having a little bit of trouble getting a publisher. But if you look at something like psychoanalysis… Psychoanalysis is, of course, a discipline, a therapeutic discipline, it's the “talking cure,” wherein you get to the truth about your feelings and you, I guess, sort of stop trying to live other people's thoughts and other people's emotions. You then become authentic and your level of happiness increases; your satisfaction from not often existing relationships (which fall by the wayside), but new relationships get much deeper and richer; you can live a more moral life… all of this kind of stuff. This is all stuff that was behind the original intent of psychoanalysis.
Well, of course psychiatrists are doctors, first, as everybody knows, then they go into specialization and into post-graduate work, and they become psychiatrists. So they are the only people (at least in Canada, I think it's the case in the US as well) who are allowed to prescribe drugs for people who are suffering from mental ailments. And, you know, there are certain small number of situations where this is entirely appropriate. I mean, if somebody's about to have a psychotic episode, or somebody needs… is so depressed that they can't even benefit from therapy until their mood lifts a little, then, you know, a short-term course of anti-psychotics or anti-depressants is entirely appropriate. However, when you start to look at things like, you know, a large proportion of children being dosed with Ritalin and other drugs to control their “disorder” (this ADHD, attention deficit hyperactivity disorder, which is complete nonsense. Calling something a “disorder” does not create a physical marker for it. I mean… There's absolutely no physical marker that can determine whether a child is suffering from this “disorder” or not). So you have this thing that has been invented to take the place of, you know, generally absent parents and terrible schools.
So psychiatry — which originally was a sort of course on philosophy and morality insofar as you had to get to the truth of situations rather than just follow your opinions about them — now has degenerated into this mass medical dose-bombing of the population as a whole.
So the way it works (in Canadian hospitals at least) is, somebody will be brought in suffering from a mental illness of some kind (depression, paranoia, anxiety, panic attacks, phobias… you know, this kind of stuff) or you know they have a full-blown neurological disorder (schizophrenia and so on)… So they are brought in, and they get assessed by a psychologist, and then a psychiatrist will wander in at some point and, for five or 10 minutes, say, sort of, “Hey, how's it going? what's new? what are your symptoms?” blah blah blah… And after the therapist has done an hour of work interviewing them (or 50 minutes, at least) writing up what's been going on for them, writing up their case history, phoning people that they visited before (other hospitals and so on), then the psychiatrist sort of bungees in and says, “Well, looks to me like you need drug X, Y and Z,” and then prescribes that drug, writes a prescription, and then bills OHIP, you know, some significant sums of money for what is essentially a 5, or 7, or 10 minute chit chat and a prescription. So here you have a situation where a psychiatry… and I myself have not taken any advice from a psychiatrist, but I certainly had some conversations with a therapist which I found enormously helpful (of course, I took no drugs) and (laughs) it was basically trying to find a way to live my values in a more open and clear way, despite the fact that my values (and yours, too, if you are listening to this, I suspect!) are not exactly copacetic or sympathetic to what most of society believes. So it's tough to live in opposition to what everybody else believes. So, I mean, therapy, to me, is fantastic: you get the right therapist, and you stay off the meds; you work hard at bringing your life goals and your integrity into clearer focus, then that to me is a wonderful thing to do, right? I mean, it's something that decent parents should do or, you know, mentor figures should do, but you know decent parents are hard to find and mentor figures… I mean, I guess I was 38 before I met somebody that I could learn something from in business. So, you know, an original idea behind a profession when it was private, was, “We have a talking cure, it's going to make you feel better.” Well, of course, as I mentioned before, there is a lag, and that lag is, well, you have psychiatrists who are well-trained in the talking cure, who are well-trained in helping people realize more truth about their lives and to live with more integrity and more authenticity and to stop living with fear based on clichés like “You should always love your mother no matter what she's like” and all this sort of nonsense that people get taught all the time. So you have psychiatrists who are competent to do that who use drugs as a last resort, or in specific situations for strong neurological or neuropsychological problems. All well and good, but you socialize it, and what happens? Well, you get people who come out of school and into a system wherein they can bill hundreds and hundreds of dollars for five minutes' work, or they can bill hundreds and hundreds of dollars for an hour's work. Look, these people… they're not easy to deal with! People who come in sometimes off the street into hospitals for mental health issues are not people who have problems with their mother. (laughs) I mean, they are, but that's not exactly how things manifest. They are not people who generally want to explore their dreams and reach new heights in life. These are people who are difficult and argumentative and borderline and… you know, not pleasant to work with. Somebody who was a psychiatrist before socialization has obviously chosen this route and is going to take on these people and try to save their souls to whatever degree he or she can.
And so when they are socialized, there is a tendency toward shorter visits and higher medication… or shorter time with the patients and more medication, but they still have a work ethic and they've been sort of self-selected as people who are interested in dealing with difficult personalities and helping to cure them. But when you socialize it, you have doctors who come straight out of grad school as psychiatrists (and I know, they have some mentoring, and they have this and that… so they have some exposure to people with a little bit of exposure to the private free market), but mostly they are now vaulted into a system where they can either sit down and have a very difficult conversations with very difficult people for an hour, which is exhausting (I mean: for an hour, like eight times a day), or they can have a five-minute chitchat with someone, prescribe them medications, and see 20, 30, 40 people a day, rather than 6, 7, or 8.
And, of course, the other problem is that when you are a psychiatrist, you are supposed to, of course, keep notes about the patient, and the taking of notes when you are dealing with talking therapy is quite extensive. The taking of notes when you are just lobbing pills into someone's gullet… really not so extensive. You know? “Saw this person. Complained of depression. Gave them whatever… Xanax. Or, gave them some sort of drug to make them happier.” It's not really that complicated. So basically you become a pill dispenser, a pill machine. You're not paying for it, your patients aren't paying for it, the taxpayer doesn't have any clue what's going on and couldn't do anything about it even if he did . So what is really going to happen to your motivation in the long run? Which style of treatment are you going to be drawn towards? The easy and lucrative one, would you see pretty immediate effects (like six weeks to eight weeks after the person starts taking the medication, they are going to feel better), or the long, unpleasant and difficult process of actually dealing with people and their issues and trying to get them to be more honest about their lives, and so on.
I can tell you, I know which way I would swing. I mean, I try and live of course with as much integrity as I can, but it would be kind of hard to sort of not feel like a sucker when other people are making 3, 4, 5 times as much money as you are, having much more pleasant days, and basically fobbing off all of the talking therapy onto people who are salaried rather than those who bill OHIP.
I mean, another small example of this, of course, is that… I believe it is at the end of April that doctors cycle their billing times within the Canadian (or least the Ontario) public health care system. So I'll leave one guess open to you, given that doctors have to end their billing cycle at the end of April, and they are only allowed to bill a certain amount to OHIP every year, to the public health care system every year, and they run through that pretty early on, when do you think most doctors take their vacations? When you think most doctors don't come in very much? And if you guessed, sort of, February, March, you would be absolutely correct.
If you are only allowed to bill up to $300,000, say, and as of Christmas, you've billed about $300,000, then you have a choice: you can go in and work for nothing, and take on all the liability and the risk that goes along with… maybe you make a mistake or maybe you just get a hypochondriac loonie who just wants to sue you for funsies… so you go in, and you work for free, and you expose yourself to all that liability for a couple of months, or you kind of scale back, and you kind of don't go in so much, or you don't do so much based on the fact that you can't bill for it anyway. That's sort of one example. Now in the free market, that would be ludicrous: of course, you could just bill for as much as you wanted.
Another example about how socialism, or socialized things, really corrupts the common decency among people is the issue of waiting times. I mean, when there is no competition, a doctor can make you wait, right? Just as if there is nothing but public roads in your area, a traffic jam costs the government precisely nothing.
So if you have to… My wife, for instance, has to go and see a doctor once in awhile. She likes to show up at seven o'clock in the morning, before he does, so that she can actually see him in some kind of reasonable time, because if she gets there at nine o'clock, she's going to be waiting for two, two and a half hours. Because they will get an appointment, but there is no particular incentive for them not to stack up patients in the waiting room like cordwood because it doesn't cost them anything, there is no competition, and all doctors do the same thing because there is no competition. So waiting times is another thing. I don't have that problem with my dentist, because my dentist is private (I mean, you know, as private as things get in the socialist paradise up north). So I don't have to wait for two hours to see my dentist, because if I did, I would complain, and I would say, “Look, if you make me wait again, I am never coming back to you. I'm gonna go somewhere else.” So that's another… I mean, these are all small examples, but I can guarantee you that these particular habits, these particular breakdowns in things like service and dedication and charity and competence and expertise… These kinds of breakdowns did not occur the day after socialization to place. You've got a lot of momentum of competence that comes from the free market which spills over into the public sector, and slowly the public sector drag — the drag of violence and compulsion and the reverse incentives in the public sector — they begin to slow down and drag down the competence and expertise in the newly socialized system, until you end up with this complete quagmire where doctors are incompetent and the drug companies basically pay doctors to prescribe pills, and I mean, you have to wait for two hours, and the waiting lists are ridiculous, and doctors will refer you around so everybody can cash in. I mean, it's not that the doctors are innately bad people, it's just that human beings respond to incentives. Certainly the voters responded to the incentive of free health care, so why wouldn't doctors respond to the incentive of poor healthcare for more money? So I guess what I'm trying to say is, when you are talking to people who are older (and this, of course, is politicians and people who are older; people in power tend to be older), they'll say, “You know, the healthcare system is pretty good! I remember when it was socialized, it wasn't really that much of a change, the system ran really well,” blah blah blah. And they genuinely can't understand why people have so many problems with the healthcare system, because when they first experienced the healthcare system after socialization, it was doing great, and for 15 or 20 years afterwards, it was doing relatively well. And now, for these people who are in power who are older, they're like, “Yeah, it's getting a bit slower, and there are some problems,” but they still have this basically good view. And I suspect that it's because they have not understood that the healthcare system that they bequeathed to us was very, very, very different from the healthcare system they experienced after socialization. This is one of the reasons why violence and compulsion are just so dangerous, and just so horrendous, and just create such an enormous amount of conflict in society.
I mean, the older people in society who don't understand what the hell has gone wrong are genuinely bewildered; to take them through, step by step, everything that went wrong, would take a lifetime of research and communication! They would be dead by the time you came up with a good case! And of course, the people who have only grown up in a socialized health care system, they just take it for granted. They just… “Yeah, you've gotta wait two hours to see a doctor. Yeah, you know, you get medication that maybe you don't always need. Yeah, you know, it takes a long time to get anything done, blah blah blah,” but they don't really have anything to compare it to. I remember Harry Browne talking about the people who remember what society was like before recreational drugs became illegal kind of dying off, kind of getting older. And it's the 1984 problem. As soon as people are no longer around who can remember what life was like when things were free, you don't have a benchmark anymore (Statistical benchmarks don't really mean that much, right?). And then people come up with, usually ex post facto justifications like, “Well, of course healthcare's more expensive now, because there's technology, and blah blah blah,” forgetting, of course, that technology lowers cost in every other field known to man; in fact, that's why you invest in technology, is it lowers cost. But no, “healthcare is expensive because an MRI machine is expensive,” and blah blah blah.
So I would sort of like to submit to you that this problem of the lag, where you still get competent people in the healthcare system, or in NASA, or in other government fields (this is true, I think, particularly in management), and then the decay, the rot, the collapse, the slow collapse of competence in the public health and public sector fields begins to set in, that by the time the rot is fully evident, the people who at one point experienced something different are no longer around, or , in the case of healthcare, people can remember what it was like before socialized healthcare are probably in their 60's and 70's now, and so are completely dependent on socialized healthcare. This is how the noose tightens around freedom all the time.
That's why where society ends up, like how a life ends up, is in the tiny details at the beginning of things. And that's why it's so important not to argue from statistics, and not to argue from the argument from effect, but to use the arguments from consistency and morality (which are available on my blog, and on the Lew Rockwell site as well), to use the arguments from principles. Because if you rely on the argument from effect, most people will say, “Well, you know, it was pretty good for the first 10 or 15 years, and now it needs to be tweaked” and so on, which is not the case at all. You don't want to be like the person who never figured out that smoking is bad, that ends up with terminal lung cancer and now quitting smoking doesn't really help. You don't want to end up supporting or even allowing people to support a system that at its root is founded in violence and compulsion and legislation and politics and this and that and the other. You don't want to oppose that on any other grounds other than violence, because it is the one thing that, still, people have a tough time supporting. I mean, you know, you talk violence in Germany in 1932, and people are like “Yeah, great, we need living room, let's go kick the heck out of Europe!” But in the West, we still have a certain squeamishness (and a sensible squeamishness) against violence. So what I'm suggesting is that, when you go to oppose something like [public] healthcare, or something like “the space program,” and all that kind of stuff, you're not going to get anywhere by talking about, “Well, NASA wasted time, and healthcare is very inefficient, and the free market would be more efficient,” and blah blah blah, because the rot takes so long to really show, and by the time it does show, everybody who could remember what a non-rotten State was is long gone, or is totally dependent on these handouts. So the argument from effect or the argument from efficiency or whatever… they just don't work. All they do is they provoke interesting statistical (laughs) discussions, I guess you could say, but they're not going to change anybody's mind. Now the problem we're faced with, of course, as libertarians now , is that there are so many people who are dependent on the State for their largesse. And the largest group of these, of course, is those who are old (for want of a better phrase). The people who are old vote like crazy. These days, they live forever. They have all the time in the world to write to their congressman, and write to their senator, and write to their local representative… and they have these gray power coalitions that are constantly showering advice and opinions and demands and all of this on politicians. They are in an extraordinarily needy phase of their life, of course, because when you get old and sick, you really can't contribute that much back to society. And I don't mean to say that old people are useless, of course not! But if you're young and… when you're a baby, people invest in your development, and then you can provide a lifetime of working and thinking and contributing and loving and all of that to society… So the resources that are invested into a baby are investments in the future. Resources which are invested into old people are not, which is not to say that they should not be invested, that's up to every individual. But the fact of the matter is that when you are dependent, especially when you're dependent based on an immoral proposition like, “I need healthcare, you young people better pay for it or I'm going to advocate that the government come and throw you in jail,” then you tend to become kind of entitled, kind of hostile to any sort of new ideas or theories (especially those which say, “Listen, you old people failed to defend freedom for us, and so now we're not that sympathetic to your requirements for healthcare and assisted living”). And that is a particular challenge (it could be considered one of the greatest challenges) is the dependency of old people, and to some degree, families without fathers, and all this kind of stuff.
I guess I'd like to talk about that, but I guess I'll have to do it on Thursday, because I'm traveling tomorrow, and then on Wednesday I'm actually speaking at a conference (nothing as exciting as libertarianism, of course), so I really won't have a chance to do any of these podcasts until Thursday morning, which is when I will talk about why I think it would be worthwhile approaching the problem of old people and those who are dependent upon the State, and how we can turn that around. Thanks so much for listening, as always, and I hope you're doing well. Bye.
