Size Matters

Is the US too big not to fail? For everything there is an ideal size. An enlarged heart will not function as well as one of the ideal size. Giantism is a health risk. Some of the recent losses in the US economy were caused by banks that were too large to be regulated efficiently. Empires don’t survive. Size matters.

It might have been intended as a joke, but one of the most profound comments on this topic was made a while back by Bob and Ray Magliozzi, the car guys. On their radio program, while discussing how to solve the problems of world governance, they said that in order for any nation to function properly it must be small. In fact, they said that the only way for a government to work would be for the citizens to break up into groups of ten. Ten was the ideal number. That way everyone could be heard. Everyone’s rights could be honored. Every nation would consist of ten citizens.

Think about it. How many lives have been lost because of the size of the US Military. The size of the Pentagon Budget has created global harm. In addition, the size of the Black Budget is a major problem. It should be eliminated.

In a nation that is too big, there is no way that citizens can be informed on the complexities of the laws and regulations which impact their lives. Even legislators who vote on the laws are at a disadvantage when a bill is unnecessarily complicated and too lengthy. How many in Congress will have read the nearly 2000 page Health Care Bill before they vote on it? A Bill that is almost 2000 pages in length will most likely be read by Congressional staffers. They in turn will write up a brief — sort of a Cliff Notes for Congress. That’s not the way our forefathers meant for things to be. If the Ten Commandments can be written on an index card, the US should be able to write a health care bill in a few pages.

A perfect example of how complex regulations harm all of us was recently disclosed by Stan Brock during a C-Span interview. He made a shocking revelation. He said that free medical care would be more readily available in the US, if only it was not prohibited in all States except Tennessee. That was shocking — free medical care at no expense to the taxpayer or the patient. Free vision exams, free dental fillings, free medical procedures – unbelievable.

The need for medical services is of crisis proportions — sort of a Perfect Storm. Bad economy, lost jobs, home foreclosures. I started to do the research to prove that Stan Brock was wrong when he said that most States made it almost impossible for volunteer medical personnel from other States to donate their services. Tennessee was the only exception.

I owe Stan an apology. He was right. I was wrong. I had believed that no where in our nation would a doctor be prohibited from rendering free medical care to a sick person. Cause of death — lack of papers of the volunteering physician — sort of a Catch 22 in medical care.

Everyone should research the rules. They are different in each State. My research is not complete but so far this is what it looks like. State Regulatory Boards cave in to the pressure of special medical interest groups. Regulations are written to eliminate competition from out-of-state doctors. A licensed doctor from New York, Massachusetts, or New Hampshire is not permitted to cross the state line and practice in the adjoining Vermont town. In Vermont, the licensing of doctors is controlled by the State Medical Board.

On the other hand, to further complicate things, in Vermont, the licensing of dentists is not controlled by the State Medical Board. The licensing of dentists is regulated by the Office of Professional Regulation, a division of the Office of Secretary of State. The rules for doctors and dentists are different. Rule 4.8 provides for a Transient Practice Permit which allows an out-of-state or Canadian dentist to practice in Vermont for ten days per year. This rule applies only to dentists.

Figuring a way to fix this is not brain surgery, but it might allow a patient to get brain surgery if it is needed. The fix is easy. Medical licensing Boards should honor reciprocity. A licensed doctor from one State should be granted the right to practice in any other State. Red tape and bureaucratic loopholes should be eliminated. Licensing fees for humanitarian volunteers should be eliminated. The lack of reciprocity across State lines denies a patient’s right to choose. Worse, it sometimes denies a patient’s right to survive.

For those who are not familiar with the work of Stan Brock, he is founder of RAM — Remote Area Medical. The original plan was to serve those in remote, jungle areas. Now that the US has become a Third World country, RAM has held several free clinics in the US. News reports have shown people lining up in the dark of night with the hope of getting necessary medical care. Many have had to be turned away.

The need for a Single Payer system is urgent. Until we have a Single Payer system there will be a need for thousands of humanitarians like Stan Brock. On the downside, reliance on volunteer services such as RAM unfairly deprives others around the world of medical care.

In the meantime, the US bureaucracy needs to be downsized and simplified. Only then will heroes such as Stan Brock and the other volunteers be allowed to go about their work of saving lives.

Rosemarie Jackowski is an advocacy journalist living in Vermont. Read other articles by Rosemarie.

16 comments on this article so far ...

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  1. Max Shields said on November 3rd, 2009 at 9:32am #

    Scale is DEFINITELY matters. Remember the dinosaurs?

    However I think there is a contradiction with Single Payer and the general thesis, at least as described in US parlance.

    Nation-states seem to work fairly well when they are relatively small – say, to China, USA, India, perhaps Russia. Size is always problematic.

    It is clear that empires stretch beyond their means. Their energy demands cripple them in the end. The US is finding its might has less and less sway. The world moves on energy. Energy sources rule. Not military (who need excessive quantities of energy).

  2. Deadbeat said on November 3rd, 2009 at 11:21am #

    This article misses the point of the true function of the nation-state as constructed within the confines of Capitalism. The nation-state as constructed by White Europeans was never meant to serve her citizens. Citizens under this construction are subjects of exploitation — just read the Constitution and see that the U.S. still maintains the slavery-inspired Electoral College.

    The problem is not “size”. The problem is function. This idea of “smallness” tends to ignore the complexity of function by offering an infantile remedy.

    This article contradicts itself by first advocating “smallness” but then speaks to the fact that the states have blocked doctors from volunteering their services. Well the states are smaller than the Federal gov’t yet the insurance interest has been able to uses their accumulated power to pit these smaller entities against each other.

    Also if the law is bad why don’t people DEFY the law. Folks sit around and hope that by “changing” the law things are going to be better. IT IS TIME TO BREAK THE LAW. Stop paying your bills, become your own doctor and practice your own medicine.

    Until people are willing to take a RISK and act like dissidents nothing is going to change.

  3. Max Shields said on November 3rd, 2009 at 11:50am #

    Deadbeat, “function”? Small, like many answers is not in and of itself sufficient, but we know that in biology and in physics there are diminishing returns as an organism grows in size; AND THUS complexity.

    Scale shapes complexity and the demands on the whole. That really shouldn’t require much explanation.

    Capitalism is a problem, but scale took the Soviet Union and Mao’s China and collapsed each in different ways both. Neither would fit the definition of Capitalism. The US is experiencing the same drift.

    As far as defying the law, to what purpose? Where is the catalyst? What is the end-game?

  4. b99 said on November 3rd, 2009 at 11:54am #

    The original states of western Europe – France being the principal example, were created out of the need for the emerging merchant class for secure borders for its products, and the protection of assets via tax collection and a military apparatus. The merchant class was quickly overtaking the aristocracy and landed gentry in economic and political power.

    Small states are no panacea. Small states can be just as authoritarian as large ones – the only advantage for others is that the problem is confined. Small entities also have economies of scale problems.

    Large entities have ‘one-size-fits-all’ problems. The solutions for all do not lie strictly in changing size but in networking the system between the several scales.

    The really big states probably do need to be broken up – our country would be better off with seccession – one state on the model of European social democracy, the other could continue to dwell in feudal romanticism.

  5. bozh said on November 3rd, 2009 at 12:57pm #

    rosemarie,
    glad u’ve turned over another stone in search of what ails us and how we can improve life for all.
    I have never thought ab. size of an empire or land being a factor in what happens inside and outside of it.
    Whatever effects of an large empire, i do reconfirm that misteachings by shamans [who obviously had 'visions'] at first and later priests- who at one time were considered divine- and later feudal lords appears- and still does- as our greatest bane that had ever befallen us.

    And much of schooling today and nearly everywhere apears shamanic, feudal, and cultish. And of the media-political talk dwn to us not even to talk.
    For a talk by any human to a group of people to earn the label “talk”, we must sit in a circle.
    In any other arrangement, and particularly a person talking dwn on us from a podium, does not earn the label “talk”. And whatever one wld call such arrangements, it still wld be a shameful act even if most listeners to such a ‘speaker’ wld not espy the sham.

    This is obvious, yet missed. Probably because people are taught to look up to some people. And if one is semantically blind, what is obvious, is often not seen.

    I wld never ever go to a hall or auditorium to listen to anyone on a pedestal talking dwn to me and who invites questions where the lofty person thinks and behaves in a way that stronlgy suggests or even demands that a question can be answered only in one way: his or hers!
    Or even that only one or two or three questions pertain to an issue.
    Such meetings are much undemocratic! Another very common ruse is for a speaker to proclaim that your question does not pertain.
    Such a person thinks elementalistically; i.e., atempts to separate verbally what cannot be separated empirically.
    In reality everything is connected; nothing exists by itself or for itself. And even the ‘stupidest’ question pertains!
    Next time a pol or priest tries this trick on u, let him/her know that u know the strategem! tnx

  6. lichen said on November 3rd, 2009 at 4:54pm #

    Direct, decentralized democracy with the power trickling up from the community level is best. And I agree with secession–there is no damn reason why Hawaii, California, or Alaska should be so tightly bound by such far-away places as Maine or Florida. There can be a few mini-nations created instead, overseen though by a new powerful UN that is one-nation one-vote, without veto or the security council.

    I think what is really too big, though, is the political system–the marriage between the political class, corporations, and mainstream media. Smaller nations still choked by that will not bring any solutions at all, and as we know, smaller nations are not immune to the formation.

  7. Deadbeat said on November 3rd, 2009 at 7:14pm #

    The population centers today are in the cities yet the Electorial College waters down their representation. This slavery era institiution is still present in the U.S. today and elections and representation are still bound by it. I disagree that size is the issue. The issue is POWER.

    There are a lot of advantages to scale that goes away with succession. And even after succession there is nothing from keeping such smaller entities from consolidating in order to reap the benefits of scale. This notion of “smallest” is grounded in frustration from an unresponsive politcal system due to its roots in Capitalism.

    If you confront Capitalism then people will be able to choose the configuration that best work for them.

  8. Max Shields said on November 3rd, 2009 at 8:26pm #

    Not understanding the point or simply objecting to whatever on the basis of whatever seems at play here.

    Scale matters. It is not the only condition, but it is very important (I repeat myself to those who seem never to get it and instead want to argue point not ever made).

    Small local businesses are substantially different in how they operate, and their whole reason for being than large corporate entities. They are each structurally different. One is built to serve a community and the other is built to grow profit at any cost and to do that through mergers, and transnational resourcse mining.

    Both are businesses; and both sell services and goods of one sort or another. One could say they both represent a form of Capitalism; but these forms are decidely different. A community owned business or family owned local business scaled to meet local needs is a very different entity.

    As lichen says, decentralization, local control enables (doesn’t guarantee) grass-roots, bottom up democracy. Mammoth nation-states foster top-down, command and control organizing principles. War is waged as the nation-state must consumer ever more resources, life a cancer gone wild. Sustainability is a word to be manipulated by politico like Obama, while he is clearly a soldier of an ever expansive empire.

    Can a small nation-state be racist. Yes. Can it be anti-democratic. Yes. But the dynamics of local are critical. Discrimination can be guarded against, but when it plays to certain powers, it is hard to do anything more than be extremely vigilant against it.

    Also, smaller states still need to be strongly connected to regions and globally. This has nothing to do with “frustration” and everything to do with looking at a problem and saying what happens when a nation-state expands and it’s resource demands become endless? What would counter-balance?

    The only way to have a chance at any kind of responsiveness is to make that political system responsive on a daily basis. I can have lunch with a city councilor. He’s out in 2 years if he doesn’t respond to issues. Political machines find it harder to gain traction.

  9. Deadbeat said on November 3rd, 2009 at 9:38pm #

    Max Shields writes …

    Also, smaller states still need to be strongly connected to regions and globally. This has nothing to do with “frustration” and everything to do with looking at a problem and saying what happens when a nation-state expands and it’s resource demands become endless? What would counter-balance? and Small local businesses are substantially different in how they operate, and their whole reason for being than large corporate entities. They are each structurally different. One is built to serve a community and the other is built to grow profit at any cost and to do that through mergers, and transnational resourcse mining.

    Once again Max argues absolutes and does not consider the CONTRADICTION of what he writes.

    The issue is not small vs big. That is a false dichotomy. The issue is function, organization and service. Max fallacy is comparing small local business to a large corporate entity. I’ve witnessed small local businesses who don’t give a shit about the community and be in business to merely make profit. There are plenty of real estate “investors” and “slumlord” functioning as “small” business. In addition you can have a larger entities, like ACORN, non corporate; non profit based, that do great service FOR the BROADER community.

    In fact Max would not be here on Dissident Voice spewing nonsence and contradiction if not for the LARGE initiative called the INTERNET and all the hardware and software that has been developed around it. The Internet and the computer industry was not built and developed by small business. It took the kind of SCALE you have in the United States to produce this world wide communication network.

    My argument is that there is no right or wrong size. I’m not arguing for or against big or small. Both has their strength and weaknesses. Which should be acknowleged and critiqued. That is what dialectical thinking is about which Max has in fact made arguments against. What I am arguing is the motivation of these entities. And the motivation of these large corporate entities is PROFIT — Capitalism. And that is what needs to be challenged and overthrown.

  10. Deadbeat said on November 3rd, 2009 at 9:42pm #

    Max writes…

    Can a small nation-state be racist. Yes. Can it be anti-democratic. Yes. But the dynamics of local are critical. Discrimination can be guarded against, but when it plays to certain powers, it is hard to do anything more than be extremely vigilant against it.

    This crap is so ahistorical it is laughable. It took a small community of white folks to distory Tulsa, Oklahoma — a well developed black community aka “The Black Wall Street”. Cut the crap Max and get some schooling.

  11. Max Shields said on November 4th, 2009 at 6:55am #

    There is no “false dichotomy” at work with the fact that size is very much a factor. It is not the only one. It is however an important one.

    Deadbeat calm down. There is nothing ahistorical about what your quoting.

    The comparison of businesses serves as an EXAMPLE of how scale factors in; and it shows that Capitalism can have more than one form.

    Scale plays the same role in our food system, many Federal programs, and of course economic globalization in general. I think the examples are everywhere, exceptions are very rare, but even then, growth (where it is not intrinsic) is deadly to an organism, including nation-states (empire over-reach, etc.).

    Human scale appears to be the most workable, and achieves a level of healthy human living, allows for more transparent governance, and community. Still, this is, a necessary, but not sufficient means of achieving a better societal setup.

    Looking out at the massive US landscape, it seems to beg for smaller, manageable (bio)regionalism, where cultures and economies, and historical traditions all meld to create a clear sense of living in a physically connected world. The human species thrives for this kind of connection, which more and more seems to be deprived because of the way “we’ve” set this society up – particularly over the past 100 years.

    That’s why, while I think a single-payer health care has some merit – in contrast to what has and is being offered, it is a solution, I think, it best suited for a smaller entity, where the benefits are scaled to need, and where the administration is transparent and moves toward a self-regulation. There’s nothing wrong with self-regulation on a smaller transparent scale – in fact it’s far superior to Government regs, that are pervious, and require layers of bureaucracy to administer only to let creep in the sly preditores of the Wall Street/Bankerster class. That’s simply another example of where size becomes unmanageable, and in its unwieldness allows the more vile corrupt to occur.

    Most health care is and should be prevention. It costs very little, and can be administered through families and social unites as well as local agencies (though the less intrusion of agencies who begin to see everyone as a client – the better).

    Living needn’t be complex to be healthy, in fact, it is the reverse which is true. It’s time to re-think what we’ve become from the bottom up instead of layering another ideological mindset on top of this highly pathological and dysfunctional human devised system.

    Recommend John McKnight from the ABCD Institute to shed some light on this.

  12. rosemarie jackowski said on November 4th, 2009 at 11:35am #

    Great conversation going on here.
    bozh makes a good point about how we should talk to each other when in a group. It is something many people never think about, but it is one of my pet peeves. I have been ‘spoiled’ because most of the meetings I have attended in recent years have been meetings with Socialists. They are compulsive about equality would never allow any one person or ‘expert’ to dominate or lead a meeting. When I attend ‘normal’ meetings with other groups, the difference is painful. Having a leader talk down from a podium is the ultimate act of disrespect to the group.

    In fact, my socialist friends will be criticizing my statement in the article about Brock being a ‘hero’. Anytime I use that word they correct me and say that there is no such thing as a hero. I answer by saying that in a perfect world we would all be heroes in our own way.

  13. bozh said on November 4th, 2009 at 1:30pm #

    rosemarie,
    To improve understandings, we cld think of the word “truth” as “truths” and, futhermore, improve the tolerance of and respect for one another by speaking of a truth as truth1 [mine], truth2 [yours], and even as truth3 [obama's] and so on.
    Such a system applies to justice, democracy, cult, freedom, peace, war, etcetc.
    Also our a priori [before experience] acuired feelings, influence how we feel/think [being aspects of one reality] about, let’s say, wars, poverty.
    Wars are so damn easy to endure if one is not in it or doesn’t have a son/daughter in one.
    It is still even easier for civilians not to mind a war if they have not been ever invaded, etc. tnx

  14. Max Shields said on November 4th, 2009 at 3:08pm #

    It seems courtesy is not an ideology. No?

  15. Amanda Frayer said on November 5th, 2009 at 12:56pm #

    The reason the law is different in Tennessee is because Stan Brock and Remote Area Medical changed the law. The law should be changed all over the country, if you ask me!
    Remote Area Medical received written approval just last Monday from the Boards of Medicine, Nursing, Dentistry and Optometry to have an event in Washington DC. This means that volunteering professionals will be able to practice here even though they’re from out of state. This took months of telephone calls, hearings and waiting.
    Local groups and community leaders in Washington, DC are helping to bring a Remote Area Medical Clinic to to the nation’s Capitol early next year. A lot of things have to come together to make an event of this size. If you want to know more about it, email me: moc.reyarfadnamanull@fa

  16. rosemarie jackowski said on November 6th, 2009 at 10:39am #

    Amanda…Yes, it is an issue for the State Legislature. Vermont has a special problem. In spite of the myths about the State, it is really very regressive and right wing. So much so, that articles like mine here, are usually censored and are not published in VT newspapers. The censorship is so extreme that often campaigns are not covered unless the candidate is a dem/repub. The state-wide health care group refuses to use the words “Single Payer” for fear of ‘offending’ someone.

    This brings up another point. Anyone out there want to edit a book titled “Censored in Vermont”? I have no money to pay but listing “editor” on a resume’ might help??? Contact me by phone or e-mail if interested.