Today’s comments do not have so much to do with medicine as they have to do with the various twisted ideas that come out of those witches Sabbaths of stupidity and hypocrisy known as “tea parties.” That tea parties are anything more than a collection of disaffected white racists who bemoan their perceived loss of privilege is a difficult position to defend. However, through the vulgar taunts and the vicious looks comes a number of complaints that have a pedigree pre-dating the Obama presidency and which have held together the right wing consensus through a number of presidential administrations. Some of those complaints emerge from a theory of society and economics. That theory maintains that government action, or any collective action for that matter, which stymies the free working of “the market” is illegitimate and guaranteed not only to fail as economics but also to undermine the sacred values of a democratic state.
Unfortunately, there is no easy way to distinguish between one set of regulations and another. To bring medicine back into the conversation, if the principle of open competition were to operate freely in the medical sphere, as I, for one, believe it should at least to a greater degree than it does, state regulation of physicians would be an unacceptable encroachment on freedom of choice. If I want to consult a physician who treats on the basis of the latest nutritional and herbal knowledge, why should I be denied the freedom of doing so? Considering the vast uncertainties upon which medicine is based, it is curious that there are not more disagreements among medical professionals. But medicine as conducted in this country is a series of closely monitored practices based on what is considered to be the best science. Even so, science, if it is science and not dogma, must be an open-ended practice ever laboring toward new paradigms. However, the track record of American medicine has not been one of toleration for alternative views or practices. All one needs to do is consult the history of chiropractic or the oppression suffered by lay midwives. The only way that medicine is able to exert any power is through the monopoly granted it by the state. But if competition effectively sorts between those who succeed and those who fail, why not allow the market to decide who stays in business practicing medicine and who does not?
Of course, to a degree I am playing the devil’s advocate. I suppose even hounds of the tea party breed would bark loudly and lustily if it was suggested that the state cease licensing and regulating the practice of medicine. But why? Well, I suppose it might be argued that some things are so well settled that it only stands to reason that the state has an obvious basis for intervening. The fact that this last insight should be applied to medicine and should not be applied to the provision of medicine would seem to me to be a failure of imagination. Reasonable people can come together and through their consensus determine that some things will not be subject to the whim of fate. “The market” in reality is only another way of saying “fate” or “chance.” At the risk of offending some religious believers, an analogy could be made between this fear of regulation and the refusal of some individuals to accept medical treatment on the basis that it upsets “God’s plan.” Medical treatment may not work and some social regulation may be misconceived and fail to produce its purpose. Neither of those two possibilities should mean that we avoid taking the most advantageous action when the opportunity arises. If the tea parties were operating out of a sense of wisdom and not vitriol, their medicine would be a lot easier to swallow.
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