1 Boring Old Man

There is great irony here. Karl Marx envisioned Communism to deal with the abuses of Capitalism. But the Russian Immigrant Ayn Rand, fleeing the abuses of Communism, created an equally idealized scheme of Capitalism that had a part to play by proxy [via Greenspan] in almost sinking our ship [with] ideology-driven "hunches" that were tragically wrong…

Capitalism is a different matter. I agree with the idea of Capitalism myself. The market is where man does his business. I remember visiting Yugoslavia and Russia back in the early 1970’s – in the heyday of Communism. They may have had it as a creed, but on the streets, I’ve rarely visited more capitalistic places. The people were constantly shopping though goods were limited. They had more money than "stuff." Wandering through the Gum Department Store [a mammoth building in Moscow run with booths like a flea market], I witnessed a stampede of shoppers when a booth opened up with shoes. There was a buying frenzy like I’ve never seen before or since [in spite of the fact that all the shoes were the same, including the size]. And the bartering on the streets was equally frantic [we had the most valuable commodity of all, worn-in American jeans]. The marketplace is just an essential piece of the stuff of being human – in the old USSR, in a Maasai village of dung huts in Africa, in your local Target Store.

But there are exceptions, places where the marketplace idea doesn’t work so well. You can’t barter for safety. Individuals just can’t do much about crime, so we have government run Law Enforcement Agencies. And ironically, those places where the marketplace concept needs tweaking also include the Stock Markets and the Commodities Markets. They are too complex, too opaque for the average Joe – so we have watchdogs to make sure that the criminals are kept in check there too. Well, we used to have such things. Hopefully they’ll come back soon. Another place is retirement. Left to their own devices, people don’t plan for retirement well on their own, particularly people with limited resources. The pressing needs of "now" are way too strong to plan for "later," so we have Social Security and Medicare for the needs of the elderly [or the otherwise disabled].

Now we’re in the midst of taking on a Bear, a really Big Bear – Medical Care in general. And it’s going to be a really huge mess. No question about it. Medical care changed in the twentieth century, came into it own actually. While there had been advances in the past, the twentieth century brought us insulin, antibiotics, immunizations, I.C.U.s, preventive medicine, anti-inflammatory drugs, cardiovascular surgery, the list is beyond endless – mind boggling in fact. In the industrial age, the age of "companies," medical insurance became a way of paying people. Medical care constructed itself around the surety of being paid by insurance. As the cost of care escalated, the cost of insurance rose, and insurance companies began to negotiate the costs – leading to something called "managed care" [a misnomer because it was neither]. That has deteriorated into the current chaos. There’s a dichotomy that is insoluable. People want the least expensive insurance and the most comprehensive care – mutually exclusive categories. Medicine operates under the ethic of never turning away the sick, but these days many of the sick have no resources to pay for treatment. There are a jillion problems – malpractice suits, inadequate coverage, administrative nightmares, enormous waste. It’s a hopeless tangle, getting worse daily.

One thing we’re not going to do is nationalize the whole system – socialized medicine like England. That’s just not the American Way. What we’re planning to do is require that people be insured, just like we require that drivers have insurance for their cars. That means that we’re going to have to delve into "regulating" insurers, drug companies, care providers, hospitals, patients, etc. We’re going to have to decide what is too little care and what is too much – and cut costs. We’re already doing that with Medicare and Medicade, and it’s not exactly an easy system to navigate [I volunteer in such a system]. Moving that to all of Medicine is going to be a nightmare of untold magnitude, and it’s going to ripple through our collective psyche for years until we get it right.

Is it worth it? Sure. Sick people can’t function in a free-market medical economy, because they can’t negotiate. They’re too sick and at the mercy of the system. They can’t even plan. Medical caretakers can’t really negotiate either without abandoning the essential medical ethic [called the Hippocratic Oath, "Do no harm"]. So, in our idiosyncratic way, we are going to come closer to the idea of a true Social Democracy. In my mind, that means government involvement in the areas of life where Capitalism and the free market economy just don’t work. To me it’s part of "life, liberty, and the pursuit of happiness."