Progress with a small ‘p’ is like a certain kind of good story, one with a clear beginning, middle and end, where things are left better in some way than they were at the beginning. A protagonist is faced with a problem or challenge – the beginning – and takes action and faces challenges – the middle – until a state in some way better is achieved – the end.
An example – and it is typical of such small ‘p’ progress that the example is small and personal – is my front porch. The Beginning: the 1940s vintage concrete slab that lead from the driveway to the small concrete porch had been lifted a good 4-5 inches by walnut roots, making it something of a trip hazard. The porch itself is ugly, if inconspicuously so. The Middle: plans were made – we could take out the concrete path and replace it with brick (after removing the ancient walnut tree that caused the uplift) and clad the porch itself in matching brick. It would be much more level and attractive. Of course, this involved Plot Complications: hiring professionals to take down the tree, gathering bricks (with Craig’s list, and a lot of elbow grease, bricks are ‘free’) and taking out the slab (21 year old son, a strapping, clean limbed and clean living young man, volunteered and did it, Abe Lincoln style), cleaning out the offending roots, for which the 13 year old son volunteered. (Daddy is pushing 60 hard – my sledge and axe swinging days are behind me. To 21 and 13 year old suburban punks, it sounds like fun – which it is, in small doses, when you’re young).
The End, which I’ll need a week or two more to finish, will be a pretty and more useable front walk and porch.
That’s how small ‘p’ progress works. Somebody notices a problem or opportunity, enlists the aid of others in finding and executing a solution, and then executes it. Having fixed one thing, people will then have the opportunity to work on something else. Multiply this process by millions and spread it over centuries, and you have accounted for much of what sane people mean by progress – things getting a little better over and over again. Small ‘p’ progress doesn’t solve, and doesn’t pretend to solve, giant problems. But it gets a septic tank put in, a road paved, a house built and a garden laid out. It is of such things as these that real progress is made.
Small ‘p’ progress is the only sort of progress that works. Capital ‘P’ Progress, on the other hand, doesn’t have a Beginning, a Middle and an End. Problems to be addressed by believers in Progress are always described in the most vague terms possible: the problem is Injustice, or Oppression, or Bigotry or some other amorphous and fluid thing. No end is really an end, but is rather only another step on a road to – someplace. A Progressive is in favor of making Progress without making much of anything else.
Example – and it is typical of such capital ‘P’ Progress that the examples are large, the goals vaporous but high-sounding, and the end indefinite and unmeasurable – health care reform. Eight years ago, something like 42 million Americans did not have health insurance, and the cost of health care was increasing every year. Note that often the problem or challenge was phrased, not as “how do we provide health insurance to these 42 million people?” but rather as “Healthcare is broken and we must do something!”
It was continually asserted that one way healthcare was broken was in ever-increasing costs. Note that ever-increasing costs are also characteristic of education, and of government in general. Somehow, schooling and government are not characterized as broken, at least, not by the same people who describe medical care that way. No serious attempt at controlling education or government expenses is ever made. In those cases, the only solution is to add more money – this is the simple historical fact.
Thus, the year the ACA took effect, when we had our annual health insurance review at work (we’re an odd company – we bring in a pro every year to explain to us what’s going on with our health insurance), the woman whose job it is to understand what’s going on mentioned in passing that there were, effectively, no cost control measures in the ACA. Events have since shown this to be true. Just as with education and government in general, the solution to increasing costs is to merely shovel more money at the problem. This creates a moral hazard, to put it mildly- why not see how high you can raise prices, when the buyer is likely to pay you no matter what? That’s how you end up with $60K/yr undergrad education and $1,000 hammers. Under what theory would healthcare be any different?
We start with a gigantic ill-defined problem, propose actions which do not address even the problem as defined, and end up – where, exactly? With better healthcare, in general or in particular? How? For whom? The number of uninsured people has decreased less than a third, leaving nearly 30 million uninsured. Costs continue to rise. And this is setting aside that only the seriously math impaired could believe this model is sustainable.
There seems to be a counterexample for every example of improvement. For example, the people in my company were well satisfied with our insurance coverage, yet had it yanked out from under us and changed into something we like less. This seems to be a common occurrence. We weren’t being asked to sacrifice for the common good – there’s no logical connection between making coverage people were happy with illegal and providing coverage to the uninsured. If there were, then all those union and government plans exempted from the ACA rules would need to change as well – and they weren’t. (1)
A practical person in favor of small ‘p’ progress would first ascertain *why* people don’t have insurance, to see if, in fact, people not having insurance is ever or always a problem that can or should be solved. Maybe it’s a bunch of different problems, maybe it changes over time for different people. Maybe some people don’t want to pay for health insurance. Maybe there are lots of different causes that cannot be addressed with a blanket solution. Small ‘p’ progress could be made by identifying and addressing as many different problems as could be addressed with comparatively small projects with definite ends. At that point, we’d stand a better chance of seeing what, if anything, is left that requires vast action.
But such an approach would never be tolerated, even though it has worked – it is very nearly the only thing that has ever really worked – repeatedly throughout history. The mere existence of healthcare is the result of some medieval men and women deciding to care for the sick right there in front of them, organizing others to help, getting some buildings, and – caring for the sick. The descendants of these men and women brought this concept to America, where it spread. That’s how we get so many Mercy or St. Mary’s or St. Luke’s Hospitals, Methodist, Baptist and Jewish Hospitals, and how the major clinics got founded. As we got richer, collectively, and technology improved, hospitals became more professional – and more expensive. (Something rarely noted: if we would accept 1960s level health care, then providing it to all uninsured people would be a simple and cheap program. It’s the fancy stuff that costs, almost all of which has been developed in the last 60 years.)
But as in all things made by man, even the best things, healthcare falls short. It is rarely noticed that it mostly fall short where it has fallen away from its roots. The poor are made to wait in the emergency rooms of the county hospitals, when the Sisters of Mercy used to take in everyone who showed up; fancy clinics with state of the art care charge vast sums to whomever can pay them, drawing their customers from distant lands – a feature as much of English socialized healthcare as of American private healthcare.
In a flat moral universe, failure to be perfect is perfect failure. Thus, America can have the best health care for the largest number of people of any nation in the history of the world, which it objectively does, yet that’s not good enough. (2) The methods by which we got the best healthcare in the world have not produced perfect healthcare, and thus must be abandoned in favor of methods that brought the world Soviet health care (3).
To the true believers and useful idiots, the ACA is Progress. The ACA *IS* affordable healthcare, and opposing or even questioning the concrete law is, to them, hating the poor and wanting them thrown out on the street to die. It simply doesn’t matter what the details are, or even if they actually do anything that they were sold as doing. Pelosi understood her audience when she said we’d need to pass the law to see what’s in it. To supporters, the ACA was not just some bill that would do some particular things in good or poor ways – the ACA was in fact affordable healthcare itself! For doers, for the little people who make small ‘p’ progress every day, such a claim is sheer insanity. But years and years of government education and concomitant social pressure has made the insane seem real to an alarming number of people.
Finally, the small people doing small things that add up to big improvements over time require the freedom and rights to do those things. My little porch project is improving my house, yes, but also my neighborhood. Judging by comments I’ve gotten while laying bricks out front, these little projects can help inspire others to undertake their own little improvements. It’s not much, but, over time, a million such projects end up making for a prettier, neater place to live. Capital ‘P’ Progress invariably consists of forcing many people to do things they would rather not do. To Progressives, this trade-off is invisible: millions of small acts are wiped out in order for a big thing to happen, in the same way that the $20M spent by a million individuals $20 at a time is invisible, but the $20M in tax dollars spent on some pet project or other is a triumph. To a Progressive, there is simply no trade off at all! Individuals are assumed to waste their money, while sweetness and light rule government expenditures.
Orestes Brownson’s observation about the inappropriateness of government schools applies here as well: such behavior would be acceptable under the premise that the wisdom of the nation resides in its leaders, but is wholly unacceptable in America, where the nation is founded on the principle that the the wisdom of the nation resides in the people.
- For the sake of this example we’re pretending the ACA isn’t just a massive governmental power grab. Described that way – honestly, in other words – it works just great.
- Healthcare is not fungible. Getting your health care at John Muir or Stanford medical center is not the same as getting it in a county hospital, let alone the same as getting it in a clinic in Brazil.
- And before throwing Sweden out as the counterexample, note that wealthy Americans go to the Mayo Clinic, or John Hopkins or Stanford when they want the best care, not to Stockholm. Follow the money.
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