google blogger on Monday, October 10, 2011
Many areas of modern living are logically incompatible with personal freedom, and self-directed actions by individuals, because many industries are today so complex that many professionals are required to promise to have a client's best interest in mind; to be paid to be selfless, an impossible task.
Governments, military leaders, doctors, economic advisors, and others are today forced to make decisions on behalf of others. A patient cannot be reasonably asked which drug he would like to purchase unless he knows as much as his doctor. Doctors must act in their patient's best interest, and that requires the explicit separation of the doctor's income from his client's payment. It is impossible to have his own best interest (selling the most profitable drug) and his client's best interest (comparing costs to side effects and efficacy) in mind simultaneously.
Today, the healthcare industry is set up in such a way that doctors may as well be selling spaceships to people who know nothing about interstellar travel. They have a financial incentive to recommend the hyperdrive and plasma engine upgrade, and the would be space-traveller has no way to decide what he wants without depending on the salesman for information.
Doctors are in the business of service and guardianship. Guardians agree to act "selflessly," and are necessarily presumed to be more knowledgable, intelligent, wise, or capable than the people they serve. If not, they would not be needed; a patient would pay the hospital to use their equipment to diagnose and treat himself, and would have enough knowledge of international affairs to know when he must jump in his tank and ride off into battle. In 1775, this was possible; each man owned the most advanced weaponry available to any military (muzzle-loaded muskets). And so it was for 18th-century medicine. It was so simple that anyone could do it, and the only drugs available were basically whiskey and willow bark. There was no need to submit to guardian-doctors when the nation was formed; each man was capable of caring for himself and his family with maximum effectiveness. This was a unique time period in human history. Previously, the protection of the king's castle and his knights was required for average people, who were too poor to afford the weaponry of war, or the safety of castle walls. Affordable guns changed that, making the United States, where each man was his own king, a viable possibility.
To live a modern life, we must blindly trust others to make decisions for us, recognizing that we are sometimes unable to balance our needs and wants with the price of their acquisition. We don't know how much to pay for an apple if we can't judge its quality. We must trust someone else to judge it for us, and it is improper for that person to be the apple farmer.
Guardians must perform their duties independent of financial compensation. The relationship between a doctor and a patient he agrees to serve cannot be a trade, because serving others is incompatible with trade. As Alisa Rosenbaum was so eager to tell us, one cannot negotiate a trade and be altruistic at the same time. If either party is truly selfless, he would simply offer what he has as a gift, and refuse anything in return. No one can be paid to hold your interests above his own, lest he return the payment immediately because he has agreed to put your interests first. The payment must therefore be separated in some way from the act of service, and the motivations for serving generated by something other than monetary compensation.
The business of creating drugs, and medical or military equipment is still the domain of men with their own best interests in mind, who hold their own needs above all others. By this process, they accidentally serve by more and more efficiently producing what their neighbors want to buy. Manufacturers, in serving their own needs and wants, create the machines and materials needed by the service professions, which are growing in number as the world becomes increasingly complex. The future of modern society will depend upon our ability to keep those who serve from cooperating and trading with people that produce. Doctors serving patients must not be friends with the drug and equipment manufacturers. Armies protecting us must not have dinner with Lockheed executives.
It is like a pilot who agrees to fly you and your plane to a distant location. He must not only negotiate the price before the flight, he must also get into the plane. If the pilot remains on the ground and directs the plane by remote control, his motivations are no longer necessarily in line with yours. He is free to improve efficiency by taking more dangerous routes, or save fuel by slowing the trip, or save money by reducing the safety features of the plane. Doctors are today unshielded from the moral dangers inherent in flying by remote control, as are military and political leaders, who have promised to have the best interests of Americans in mind, but are prodded by manufacturers at every turn to use their products in ever larger quantities.
To correct the problems of government and healthcare, we must put the pilots back into the planes they have agreed to fly, and separate the duties of their service from the influence of the plane's manufacturer. Doctors must not be paid by drug companies, and must avoid friendship or association with drug company salesmen, just as political leaders must avoid the company of lobbyists and the friendship of the businessmen that supply the wealth government consumes. Both doctors and politicians must not earn income by shifting their loyalty away from those they have promised to serve.
As we progress to ever increasing levels of expertise and division of labor, more and more trust will be put in others to make decisions for us; to tell us what to do because we cannot properly make the decisions ourselves. It stands to reason that all our decisions will eventually be made by other people, and when that happens, we won't really be making any decisions at all, except one -- to allow others to control our lives, and to trust them to avoid abusing us. Primitive men are slaves to themselves, waking to farm their own land, milk their own cows, and tend to their own children. Men of the future will be slaves to each other, each depending more and more heavily on the decision-making of others. In the past, the decision to remove a gangrened limb might be made by its owner. Today, the owner visits another man, and asks to be told what to do. Today if almost anything goes wrong, we ask someone else to tell us how to fix it. The trend can only continue as each of us becomes more specialized, and the machines that support our lifestyles become more complex.
It is imperative that we all understand that it is impossible for any of us to be paid to put others' interests ahead of our own, and if we are all to eventually be in the business of service, it is best to insure that the interests of servants and their masters be aligned as much as possible.
Posted by google blogger at 6:46 PM