Government Efforts That Work

I read an editorial yesterday that defended government controlled health care on the grounds that “throughout the civilized world, there are a handful of areas where governments fill needs better than free markets: fire protection, police work, education, health care.”

That is, as a friend of mine would say ‘a mighty big statement.’ Taking each in turn:

Firefighting. It is true that privately run firefighting prior to the 18th century was a questionable affair, providing support to those who paid, and letting others deal with the fires themselves. Firefighting has developed wonderfully over the past two and a half centuries. But, several points need to be considered before we draw an analogy between the benefits of government controlled fire fighting and government controlled health care.

No firefighter would suggest that we abandon preventative measures such as types of materials used in construction, installation of sprinkler and fire suppression systems, building codes for adequate exits from buildings, and other protection and safety features for remote buildings. While local and state governments do set standards for some of these applications, these governments do not own or mandate the prices of any of these activities. The free market does, in fact, set the price on building materials, construction costs with or without various types of fire suppression capabilities, and the various safety features found in public, commercial and some residential buildings. Furthermore, the Federal government does not provide or directly oversee fire fighting – except on military facilities and in some federal complexes.

So, while ‘government’ does provide fire protection, it is very much a local affair, and it is very much a process that is heavily dependent on both individual and commercial involvement.

Police work. As with firefighting, until the last two hundred years police forces world-wide had at best a mixed reputation for providing real security to the general population. Police work and public security is also an excellent example of just how difficult it is to actually expect government to provide a comprehensive solution.

The courts have routinely held that the police are not individually and specifically responsible for your safety. In short, there does not need to be a police car outside your building. And if you are mugged or attacked, the police did not fail to do their jobs. In short, there is a spectrum of security and depending on where you look on that spectrum you will find different people responsible for security. On one end is your own security. The courts have routinely found that you are responsible to look after yourself. The very large security industry (Brinks, ADT, etc.) attests to the fact that a large number of private and commercial interests recognize that the police cannot and will not provide security ‘before the event.’ That is your – the owners of the store – responsibility and you must accept it. If you have any doubt, walk into Tiffany’s and look at the security.

It is also easy to imagine the tangle of laws that would result if some of the authorities of the police were transferred to commercial operations. While there might be efficiencies in having some police activities handled by commercial enterprises, the law, and associated legal complexities weigh against it.

At the other end of the spectrum – national security – is strictly the purview of the Federal government and the Department of Defense (DOD). And while the DOD performs admirable service, it is neither cheap, nor is it always efficient. It is also fair to say that no one has found another way to provide national security without a national level force.

In the middle of the spectrum there are a host of agencies that provide a wide range of services. Most of them are at the state level and below: state police departments, sheriff offices, etc., while a few are at the Federal level: FBI, DEA, etc.

To compare this very complex structure, which is not without its problems, and is very costly and often inefficient, with a federally controlled health care program is, in fact, an interesting idea. Imagine if you will, a federally controlled, centralized security organization responsible for every aspect of our security, from DOD down to the local police all inside the same department. Imagine a department that spends well in excess of a trillion dollars per year, with offices in every town in the country, as well as larger offices in every county seat and state capital, trying to centrally manage not only national defense but also local security, procurement of aircrafts and ships as well as the allocation of assets for ongoing criminal investigations, patrolling, acquisition of new vehicles and gear, training, administration and the like. Further, it would allow various Federal organizations to have access to all local information, facilitating investigation. Does all that sound like a good idea?

Education. Education is clearly a place where there are both highs and lows in the history of government provided services. Certainly within the US public education was responsible for a substantial improvement in literacy among the poor and the growing middle class in the 19th and early 20th centuries. But public education in this country has overwhelmingly been a local affair, with quite vigorous protests among parents (rightly so) when state governments have interfered, never mind the federal government. Education is one arena in the public domain that is very much a concern that the citizenry wants to be able to impact directly – not through representatives or bureaucrats.

Education has also benefited from aggressive competition from private schools, which has forced public schools to improve their curriculum, as well as providing parents with options other than the public schools, even when their taxes must still be paid.

It is also worth noting that until just a few decades ago there was no federal agency that oversaw public education and since the creation of the Department of Education there has not been a dramatic improvement in the quality of education in this country.

VA Hospitals. As for the editorial’s claim that the VA hospitals provide truly superb service, that is a statement that must be qualified. As a veteran myself, with many friends and relatives who are also veterans, I read that report when it first came out and, with my friends, asked: what VA system are they talking about? VA support can be very good, but like military medicine, it is contingent upon several things, the most important of which is simply this: the system works very well if you really need help. Major problems receive major care. Minor care and preventive care is usually another situation entirely. The other key item with the VA is that there is usually an understanding that cost isn’t an issue (at least at most VA hospitals) once you have been seen by a Doctor or Nurse. Would a federally funded, universal health care plan be a generally unconcerned about costs as the VA is?

A second issue is simply this: anyone who has seen the VA hospital system when it fails to respond well would want to know what would happen if that system, which currently services several million Americans, were expanded in size by a factor of 100? How may bureaucratic processes remain efficient when expanded?

The rise of truly representative democracy is in large part responsible for making fire protection, police work and public security, and public education more responsive to the needs of the general populace. But it has not been easy and has demonstrated that governments have limits. It is noteworthy that these three government efforts – police, firefighting, and education - have three key elements in common:

1) All involve government actions at the local level where there is a real ability to force the government to respond with immediate action, not delay it until another budget cycle.

2) All involve immediate personal concern to the citizenry; no one defers police protection or fire protection, and few people debate the need for adequate education; one of the issues with health care is the tendency for healthy young and middle-aged people to defer health care coverage, and preventive care.

3) All have involved commercial complements or, in the case of education, private alternatives. Again, because the government activity is at the local level, the feedback and response cycle is real and immediate, which results in real response and improvement in the government operations.

Further, they have not enjoyed unalloyed successes. One of the key reasons they have succeeded is that there has been continual local involvement that has forced these various activities to improve.

It is easy to point at certain ‘government functions’ and paint them with a broad brush and claim that, by analogy, they prove Federal government health care would work. The facts are a bit diferent.