This is a response to a recent Op-Ed in the Wall Street Journal sent to me by a friend, along with a quote from a political science professor he once had that stated, "the number one goal of ANY bureaucracy is NOT to achieve it's goal but rather to perpetuate itself and grow." I ended up getting a bit carried away in my thoughts on the subject. Greg states that his life experience certainly validates this claim, and I think few in this country would be willing to take issue with that remark. Still, I think it provides an excellent framework to view the health care debate through in hopes of finding some reasonable middle ground, which sadly is some very scarce real estate right now...
I would agree with the notion that once created, bureaucracies, like any other organization (or organism for that matter) have a goal of sustaining themselves, and in many cases, growing. However, I would argue the point that none truly seek to achieve their goal. Do I feel that the people at the DMV are sitting there saying to themselves, "We must get these registrations processed! How dare these people be forced to wait!" - certainly not. But in institutions where there is a moral imperative (health care, for instance) I would say there is a great deal of passion for the work at hand. Having worked in such a bureaucracy at the Rhode Island Dept. of Health, I can say with firsthand experience that from top to bottom, most (certainly not all, but I what organization could claim this?) of the folks that I have had the pleasure of working with are passionate about what they do.
While I see a danger is bureaucracies growing without check, I also see a danger in the large corporations dominating our country growing without check. Were all insurers local, small businesses (or even regional, there is a certain economy of scale necessary in such a business) I would see less of a need for government to balance the odds. But when corporations grow to the extent where they dominate markets, and become their own private bureaucracies where people are just numbers and dollar signs (I'm not saying it would be any different for a government plan) I see the need for the government to offset this imbalance. Corporate dominance is just as, if not more frightening to me than big government. I have witnessed its effects very acutely in the last few years. The notion of a free-market America where entrepreneurs can flourish and passion and ideas abound is under serious threat from big business in this country. Corporate influence in Washington has exploded since the late 1970's and has reached a fever pitch in the last few years. Our country cannot expand into new industries and technologies because lobbyists block legislation required to make those new industries competitive (solar panel production comes to mind). When new ideas do break through, they're bought out and added to these companies portfolios to increase their market price.
The true America, the independent America, middle-class America is being choked and squeezed for all its worth by a multitude of corporations, and the government in turn responds in its typical manner of expansion and regulation. This game has been played throughout history, but only this decade on such a grand scale.
My liberal leaning acknowledged, in the wake of a catastrophic financial collapse brought on by deregulation, my trust is won only marginally by a public option for health care. In my mind, while concern over government expansion is legitimate, the government nevertheless still answers to us, the voters. Corporations answer only to shareholders, whose primary interest is only profit.
There is a classic and historic concern for checks and balances in government, but we have reached a point where government must weigh as a balance to business. I do not support the one-sidedness of a single-payer, fully-nationalized system such as the British NHS, rather a system more modeled on that of France, but with greater market freedoms that will ensure the U.S. can continue to do what it does best, namely advancing the use of medical technology. Yes, France, that friend that everyone loves to hate. The inspiration for 'Freedom Fries' and other Euro-phobic nonsense. Their health care system is arguably the best in the world. Does this mean we should mimic it? Certainly not, but I feel that we can take a cue from our brie-eating friends across the pond and adapt their system to meet our needs.
Despite the constant fear of a 'government takeover', this takeover would impinge upon only an estimated 5% of the current 'corporate takeover' that we now enjoy. The public option is just that, an option. The key is balance, because in the escalating battle between big business and big government, my biggest fear is either one declaring victory.
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