The Choice Ahead

To paraphrase Mark Twain, this will be along post as I haven't much time.

Consider tuberculosis, which used to be the leading cause of death. But by 1900 deaths from tuberculosis had fallen to less than half their earlier level. No effective treatment existed for the disease until 1948. But the declining trend continued throughout the early 20th Century, and the downtrend showed no evident acceleration when antibiotics were introduced. The TB death rate was already very low by then anyway.

It turns out that people may harbor the tuberculosis organism without becoming ill. Active disease develops only when they are weakened by other causes. Furthermore, TB spreads most readily in conditions of overcrowding and poor ventilation. Hence the tuberculosis pandemic in the 19th Century was a product of the social conditions of the industrial revolution: workers crowded into stifling tenements, working twelve hour shifts, and continually on the edge of starvation, developed active tuberculosis and spread it to others. As workers won the 8 hour day, and better wages, and housing codes were written and enforced, tuberculosis declined. Biomedicine only stepped in to mop up the residue.

There is a famous analogy in public health, the origins of which are lost in the mist of time. Suppose there is a steep cliff in the town, and people are falling off. At the bottom of the cliff are all the caring, compassionate people who make up the medical industry. As the people hit the ground, the medical workers rush in to stanch their bleeding and truck them off to the gleaming new hospital.

Meanwhile, at the top of the cliff, there is no warning sign or fence. Indeed, people from tobacco and food companies are selling them tickets to jump off. Some people, who work in hazardous occupations, are actually being driven toward the cliff by overseers with whips. There are some good souls up there who are trying to stop the people with addictions from marching toward the cliff, but the police are preventing them from helping.

What is the sensible thing to do? Spend more on the doctors and ambulances and hospitals? Or stop squandering all that money and put up a fence? We do the former because we depend on the market: individuals who have already fallen off the cliff will pay (or their insurers will pay) for treatment; but only society, through its government, will ever pay to put up a fence.

In the 20th Century, we began to build some fences. We established the Centers for Disease Control, the Environmental Protection Agency, the Substance Abuse and Mental Health Services Administration. The federal government took an important role in improving the nutrition of children and pregnant women through the WIC program, school lunches, food stamps and other initiatves; and in making housing affordable for poor families through the Section 8 program and public housing (which has been done wrong more often than it has been done right, but we've learned, and lately we've been doing it better).

Comes now the proposed budget of the current administration. In the name of fiscal discipline, and because we must defend freedom by assuring that rich people don't pay taxes and we have the military resources to invade countries that pose no threat to us, in order to get the government off the backs of the people, all of these violations of the Free Market®, have got to be scaled back and, logic tells us, ultimately eliminated.

It's great news, however, that we have a president who is strong and resolute. You know where he stands.