How Incompetent Government Bureaucrats Meddle in the Lives of America’s Children

When I began my training in pediatrics in the 1970s, most children diagnosed with cancer did not survive. Today, the vast majority of children diagnosed with cancer are cured.

I pulled out and juxtaposed for effect the above two sentences, which appear at different points within the introduction to the latest issue of Stanford Medicine Magazine. The author was our Dean of Medicine, Dr. Phil Pizzo.

This wasn’t the point of Phil’s article, but ask yourself: How did our country manage to move from the situation described in his first sentence to that described in the second? Who should we thank for taking us from a point where an oncologist could say to terrified parents “It’s cancer, but we can probably cure your child” versus “It’s cancer, your child is probably going to die”?

The U.S. federal government, that’s who.

You mean the free market didn’t transform pediatric oncology? No, it didn’t. There are many brilliant medical scientists in the private sector and I have always given them credit for their life-saving work. But plowing billions of research and development dollars into improving the care of uninsured patients is not good business.

“What are you talking about?”, a government critic might respond, “most children are covered by health insurance”. This is true: With government provided Medicaid, government provided SCHIP and a government provided tax break on employee’s family health insurance coverage, most children indeed have insurance. Without the large pool of potential purchasers created by those federal insurance programs and policies, private sector companies would never invest in finding cures for rare childhood diseases.

But even the government’s expansion of health insurance for children didn’t lead the private sector to fully fund research on cures for children’s cancer. But that was okay, because the National Cancer Institute was there to pour billions of dollars into cancer research until cures were found.

Don’t all those brilliant scientists and clinicians deserve credit? Of course they do, as do the federal loans and state government support that gave many of them the education to maximize their brilliance and built the labs and hospitals in which they did their work.

The audience members at the recent Republican candidates’ debate who applauded at the thought of uninsured people dying may well cheer on the idea of getting the meddling government out of the way so that children with cancer could be free to die early, excruciating deaths. But when the value of medical science is raised with government-bashing candidates for office, their usual response is something along the lines of “of course I wouldn’t cut cancer research.” One wonders therefore why they don’t make sure to always say so rather than demonizing “gubmint” whole cloth. And why don’t journalists, every single time, candidates trash the federal government as universally interfering and incompetent, ask them why they want to live in a society where more parents attend their son or daughter’s funeral instead of their high school graduation?

Author: Keith Humphreys

Keith Humphreys is the Esther Ting Memorial Professor of Psychiatry at Stanford University and an Honorary Professor of Psychiatry at Kings College London. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans, drugs, crime and correctional systems. Professor Humphreys' over 300 scholarly articles, monographs and books have been cited over thirteen thousand times by scientific colleagues. He is a regular contributor to Washington Post and has also written for the New York Times, Wall Street Journal, Washington Monthly, San Francisco Chronicle, The Guardian (UK), The Telegraph (UK), Times Higher Education (UK), Crossbow (UK) and other media outlets.

30 thoughts on “How Incompetent Government Bureaucrats Meddle in the Lives of America’s Children”

  1. Word. I would add that government demand-side subsidies for cancer therapies are no less important than the supply-side subsidies for research. Physicians, hospitals, pharmaceutical firms, and others knew that the money would be there to pay for effective therapies, if these could be found.

    We need to take care of each other. Sometimes this takes government. Is this really so hard to understand?

  2. Also, they psychically intuit that they won’t get cancer, so they can get by with a cheap insurance plan, and it ought to be good enough for everyone else too. The part where their premium goes sky-high if they get sick and actually use the coverage, that is the part that escapes them.

  3. I don’t wish to discount the researchers’ contribution to science, or to argue about what would or would not have happened had the feds not funded such research. However, the fundamental reason that survival of childhood cancer has improved is that children are biologically just more amenable to treatment.

  4. the fundamental reason that survival of childhood cancer has improved is that children are biologically just more amenable to treatment.

    I don’t understand your point. Did the degree to which children are biologically amenable to treatment change between 1970 and today? That seems pretty unlikely, so improved survival must be due to improved treatment.

  5. Indeed treatment improved, from nothing but palliative care in the 40’s to 5-year survival topping 90% for childhood leukemia. However, an equal if not greater amount of resources (proportionally speaking) have been poured into adult oncology, with survival gains in the low double digits.

  6. @ Harold

    We need to take care of each other. Sometimes this takes government. Is this really so hard to understand?

    For some it is clearly impossible to understand.

    This has been another edition of simple answers to simple questions, brought to you by the letters Z and V and the number 42.

  7. More and more I think that decent people with a concern for others are handicapped by a inappropriate model for what a liberal democracy is. It is continually called a “state” and compared to states of undemocratic nature, as an improvement but still a state.

    A far more adequate model for a democracy’s domestic policies is a cooperative where voters own equal shares of the whole. If we imagine a residential cooperative it is easy to imagine how members could choose to provide many amenities in common.

    Of course the glibertarians and such will say a democracy is not a coop. But neither is it a state in the traditional sense. The coop model illuminates aspects the state model is unable to, and in a way where the merits of a proposal are no longer connected with “state” rhetoric. This cancer issue is a wonderful example.

  8. Good post Keith. Just one example of the myriad things our government does that are so easy to take for granted. You never miss the water until the well runs dry.
    Brett? (crickets)

  9. Gus, I’d call “where voters own equal shares of the whole” a really nasty model of democracy, where everything you have is up for grabs.

    Democracy may be the “least worst” for of government, but it’s still a form of government, which is to say it’s a nasty business best avoided except where that’s impossible. If common decisions MUST be made, vote, but best to avoid having to make common decisions, to the maximum extent possible.

  10. Dave Schutz: Also give credit to Nixon for founding the National Institute of Alcohol Abuse and Alcoholism and the EPA. He was pro-science all the way.

    Harold: You are right, and I made a slight tweak in my post to reflect that where I was not clear the first time through. Thanks.

    Anomalous: You have hit the nail on the head, we seem to notice only when government screws up (which of course it does sometimes) but not when it does it’s work well. It’s something I wish politicians who believe in the public sector would talk about more, why we don’t have cholera outbreaks, why our planes don’t keep crashing as do Russian planes etc.

  11. Brett : “best to avoid having to make common decisions, to the maximum extent possible.” L’enfer, c’est les autres. Pity the poor libertarian, trapped in the most prosperous and open society the world has ever seen, deprived of the opportunity to achieve the grinding poverty of the homesteader by his own backbreaking efforts!
    I have problems of empathy here, but set that aside. It’s not right to see the set of possible decisions as fixed, and you can either take them collectively (bad) or individually (good). The space of possible decisions is largely created collectively or in relationships with other people. A decision to make love requires both you and your partner. A decision to investigate laser fusion isn’t one an individual can make unless you are called Bill Gates. A decision to build a bridge or park, etc. Of course, it’s desirable for social and political institutions to create as wide a space as possible for individual autonomy and self-fulfilment; for example, allowing people to educate themselves as much as they desire. A comprehensive taxpayer-funded education system is a great engine of positive freedom. However nobody, but nobody, has being ill as part of their vision of the good, and the big freedom to be aimed at isn’t that to abuse your body or choose your doctor, but health itself.

  12. Surprisingly on the right track here, James. I am less doctrainaire than Brett, though I think the point of view is valid.

    Look, the federal government funds nothing. The people fund everything. If the people choose, via their votes and their elected representatives, to use their tax dollars (or increase them) to fund a research project, then that is certainly fertile ground for the role the federal government can play. However, when the money is short, as now, or in fact, we are spending money the people won’t allocate, then such efforts are in jeopardy. And again, the people through their elected representatives have to prioritize.

    There has been a systemic problem, because of the baseline budgeting and spending approach and the fact that Congress has delegated so much authority and decision making to unelected bureaucrats, that many of us do not feel that the federal apparatus has been responsive, and the proper prioritization has not been occurring. Thus, the bias among Brett, fellow libertaians, and many conservatives against federal solutions in an effort to rein in the fisc. This bias is obviously growing more popular. Efforts by the left to preserve their favorite programs, grants, and to pursue Keynesian solutions to our fiscal problems are running headlong into the momentum building for rational spending discipline.

  13. Redwave:
    When bureaucrats make spending decisions, it’s bad because they are unaccountable, unelectable.
    When Congressmen do it, it’s bad because it’s earmarks, pork, etc.

    How do you then propose to make this sort of decision? ( which research grants to fund, which to reject.)

    Myself, I’d rather not have my Congresswoman spend her time evaluating double blind experiment proposals. Perhaps the FDA could hire some folks to evaluate the proposals for us, and report their recommendations to their supervisors. Hey wait, that’s a bureaucracy!

  14. Redwave,

    May I just point out, for the umpteenth time, that there has been no President in recent times who had less fiscal discipline than George W. Bush. So whatever you think of various proposals, please don’t blame “the left” for fiscal problems.

  15. Bernard, I agree GWB failed to veto a bill during the first 7 years of his administration, and conservatives quite properly took him to task for that. Not sure that absolves a profligate Congress, with both parties at the trough.

  16. James Wimberly responds to Brett by saying “The space of possible decisions is largely created collectively or in relationships with other people.”

    This is a continuation of the discussion http://www.samefacts.com/2011/08/microeconomics-and-policy-analysis/avoiding-wasteful-government-spending/ when the issue was a family dealing with an apparently rabid raccoon in the back yard. Conservatives tend to see the problem in terms of the individual’s private domain, and liberals tend to see the problem in terms of the community in which rabies is endemic in the wild animal population. An individual whose child has leukemia has no autonomy when it comes to creating sufficient demand for new and expensive interventions to treat the disease; if the government has not set up provisions for creating that demand, the parent is powerless. The boundary of the problem space is again seen to be drawn narrowly by conservatives, and broadly by liberals.

  17. Redwave,

    You know, I don’t actually remember conservatives taking Bush to task for his fiscal incontinence. I seem to recall them cheering for his tax cuts, and not uttering any protest at all over fighting wars without raising the necessary revenue. If there were angry lots of angry conservatives who spoke out against this profligacy, maybe you could point me to them.

  18. Brett-
    An interesting issue. Had you demonstrated good faith in addressing the issues raised in previous posts I would take the time to answer your comments. I do not think you participate in good faith. As it is, others will have to raise them, not you.

    It is all I can do to protest what in my opinion is your frequent abuse of your presence on this site.

    Sorry.

  19. The boundary of the problem space is again seen to be drawn narrowly by conservatives, and broadly by liberals.

    Agreed. Or to put it another way sans convenient labels, the solution set is formulated according to whether one is self-regarding or other-regarding. This places different bounds on the problem space as well. It also re-frames Mr Wimberley’s assertion of The space of possible decisions is largely created collectively or in relationships with other people. into terms psychologists use to give us insight on thought processes and reactions.

    Just a thought.

  20. Bernard, obviously you don’t read the WSJ. The editorial page’s drumbeat concerning GWB’s failure to use the veto pen was non-stop.

    Why do you think those who became Tea-Partiers and others abandoned the GOP in 2008? They were delivering the message loud and clear that the party was being held responsible for allowing the Pelosi congress to run wild on spending, never applying the brakes.

    My God, you had to be under a rock or in some kind of daze to miss all that.

    By the way, everyone should read at least one periodical that reflects the point of view opposite their own, just to get regrounded a bit. Besides RBC, I read Newsday everyday, whose editorial position pretty much parrots the ADA line. For most of the contributors here, I prescribe the WSJ, clearly the best newspaper in the world, whose editorial position is reliably in Ronald Reagan territory. It is the one paper I know of that still respects and enforces the separation of news and editorial content (the way the NY Times used to back in the day).

  21. Bernard, the point of my last comment being that if you don’t do some reading to hear directly what the other side is saying, all you will hear are the mischaracterizations of their positions by people like Mark. That’s what leads you to silly, inaccurate, and overtly partisan responses such as he one you made to my earlier comment. Nothing personal, of course.

  22. Redwave-
    As with liberals, there are all sorts of people labeled ‘conservatives’ including nihilists and those who have abandoned every element of a Burkean sensibility. In such a group you can always find exceptions, sometimes significant ones.

    The same is equally true for liberals, progressives, Christians, Pagans, and any other group you want to name. But it is a simple and plain fact that most conservatives were silent as mice with a cat around when the Republican Party carried out its deficit creations, and have also been as loud as banshees over what the Democrats have done. Conservatism has to an almost complete degree lost any intellectual coherence it once had.

  23. Gus, I think you miss the main point of the Snyder story. He didn’t go without medical care, like most of the rest of us would if his dreams came true.

    He had his cake and ate it too.

    He got to promote Libertarianism and he lived it, probably relishing his “freedom” not to buy health insurance, even though as a prominent fundraiser he must have both been paid well and had the savvy needed to navigate the health insurance market.

    Then he ended his life as a “parasite” on the rest of us who are “enslaved” by our health insurance premiums — because that’s where the difference between $400,000 and $34,000 came from, our premiums, deductibles and co-pays, which are all inflated to balance out losses to hospitals like his (even if hospitals overcharge for everything, a good part of that $400,000 had to be for real expenses).

    I don’t know why Think Progress describes his situation as “heartbreaking.” He didn’t die from neglect, it sounds like everything possible was done. Contrast his experience with that of the Cincinnati man who died of an infected tooth a few weeks ago (which WAS heartbreaking, and a truer example of what Synder himself wanted for us).

    Now the hospital’s accounting department, they’re probably depressed.

  24. Redwave,

    If you can find a way to run the country without representative democracy and without bureaucrats please, let us know. Perhaps we could have nation wide popular votes on tens of millions of decisions each year.

  25. Okay, now I read that Snyder had a unspecified pre-existing condition that either made health insurance “too expensive” (what is too expensive is relative, after all) or unobtainable. Still, it seems to me he made a concious choice — until someone can show me that he tried and tried, without success, to get a job with insurance, I’m going to assume he decided to go without.

  26. Ohio Mom-
    I have no idea what Snyder’s thinking was, but I am pretty sure that when he got sick he put off going to a doctor as long as possible because it was so frightfully expensive. It’s what I would do, having had a stroke and so at 63 having pre-existing conditions.

    Later it was too late.

    Libertarians act as if everyone is

    1. very clear headed
    2. Independent of obligations to loved ones
    3. young adults
    4. healthy
    5. makes good money

    That Snyder failed to get decent charitable help from his erstwhile supporters indicates what I consider to be the complete moral bankruptcy of what passes for libertarian thought these days.

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