Thoughts on Cato University Lecture II: "The March of Freedom, 2500 B.C.- 1775 A.D." by Tom Palmer

“From now, we will be able to look back and tell our children that this was the moment when we began to provide care for the sick and good jobs to the jobless…… this was the moment when the rise of the oceans began to slow and our planet began to heal…… this was the moment when we ended a war, and secured our nation, and restored our image as the last, best hope on Earth. This was the moment, this was the time when we came together to remake this great nation so that it may always reflect our very best selves and our highest ideals.” -Barack Obama, Minneapolis, June 3, 2008.

One thing that often irritates me about progressives is their vision of some perfected future, crafted in their latest folk hero’s image. A desire to improve people’s material condition is admirable. However, there often seems to be a Messianic tinge to the movement, that strikes me of naiveté, and worse, apocalyptic ambition. Such idealism scares the hell out of me, because I know that to carry out a plan to eliminate all war, strife, pollution, unemployment, or other ills, there would have to be some pretty colossal interventions. I guarantee that I much prefer the world I live in now to the one they’ll have “perfected” for me.

However, after listening to Tom Palmer’s excellent speech, “The March of Freedom, 2500 B.C.-1775 A.D.,” he convinced me that libertarians often make a similar mistake. Now, it is true that, over the past few hundred years, technological advances, industrialization, and liberalization have led to significantly improved living conditions around the world. However, too often, people tend to view history as a trajectory, in which we started out as dim-witted barbarians, endured various stages of despotism, all until the clever Europeans instituted constitutional rights with the Magna Carta. In this model, the dominant intellectual discourse continues to progress until now we are America and so can you. This libertarian-scented progressiveness has a few problems, which Palmer implied in his lecture, in which he provided a comprehensive historical account of the campaign for liberty:

1) Liberty, small-government, and personal autonomy are not new concepts, nor are they found exclusively within the Western tradition. Palmer mentioned a quote (I cannot find the source) of a University of London professor who says “Freedom is uniquely Anglo-Saxon. Other languages do not have a word for the concept.” This European exceptionalism is dead-wrong, according to Palmer. For example, in 2300 BC, Urukagina of Mesopotamia (modern Iraq) enacted a judicial code that allowed for private property rights, limited taxes, and a restriction on state monopolies.
The semi-mythical Chinese figure, Lao Tzu, has been revered by Daoists since at least the 4th century B.C. for such teachings as:

“If you want to be a great leader,
you must learn to follow the Tao.
Stop trying to control.
Let go of fixed plans and concepts,
and the world will govern itself.

The more prohibitions you have,
the less virtuous people will be.
The more weapons you have,
the less secure people will be.
The more subsidies you have,
the less self-reliant people will be.”

2)Some of today’s most authoritarian governments are thoroughly modern. Palmer points out that Iran is not some old-fashioned theocracy rooted in classical Islam. It is actually a bizarre amalgam of European fascism, Marxist economics, and Islamic-themed romanticism.

3)Freedom is not the only cherished value. Research indicates that freedom is an important factor in average happiness and prosperity, at least in a cross-sectional studies. However, some people seem to think, that, so long as we establish private property rights, there would be no more pollution or extinction of species. I’m skeptical. I also agree with many of the behavioral economists in that freedom my allow some of us to make short term decisions that lead to life-long regret, which can actually decrease our overall well-being. Some people just can’t handle their freedom. It’s still their prerogative to ruin it.

4) Some people will always crave power; thus power must always be checked. Just because people establish a truly free society, does not mean that the society is any less (or more) fragile. Some great civilizations were conquered. Others were spared by pure luck (Palmer describes the case of Ögedei Khan, who, in 1241, was just about to expand his huge empire to Austria, Germany, Italy, France, and Spain, when he got poisoned and died). And it’s not only central power that poses a threat. If some monster decides to unleash a pandemic, or build an increasingly-easier-to-develop nuclear weapon, G-d help us, because freedom will not (and this notion of an individual's power to initiate harm presents an enormous conundrum to libertarians, as we oppose individualss losing their privacy or agency). This fear means that we can never have a ribbon cutting ceremony, marking the beginning of our new earth. Vigilant oversight of power is not a battle to be won, but a continuous war of attrition. When we all die, the next generation of watchmen will simply have to take over. And others will have to watch the watchmen.

How Libertarian Doctors Think?

Now, I am not much of a "reductivist," in that I don't believe that people's personalities can be neatly decoded based on their political philosophies. What people feel about the proper role of government does not necessarily translate to how they may view private interactions. For example, although I am a libertarian, I am an ardent proponent of private charity and volunteerism, and I abhor the notion of "Social Darwinism." However, I do wonder whether or not libertarian doctors may tend to approach clinical situations a bit differently than do other physicians. I'll use an example from medical school.

In Los Angeles, we have tons of under-employed actors. When they aren't discussing the Stanislavsky method at Psychobabble, many come to our medical school to act as "standardized patients" or "SPs" They are given a scenario, in which they must pretend to be the dying/angry/unknowingly-HIV-infected patient, and we med student poindexters must learn how to speak with them properly. We usually have a tag-team approach, in that one student will start the "interview" until our professor calls "time-out." We then provide feedback to the student on how the interaction went, until the next student goes, taking over as the "same medical student."

One time we had an SP whose scenario is described as follows, (The patient does not really exist and is a caricature):

PAUL CASSIDY
Paul Cassidy is a computer engineer, now off work on disability, who is coming to the orthopaedic clinic today for another opinion about his chronic low back pain. He has agreed to talk to a medical student about his history before seeing the attending physician. Two years ago, he was in a car accident in which 3 lumbar vertebrae were crushed (L2, L3, and L4). He underwent spinal fusion at that time and, following a lengthy hospital stay, extensive rehabilitation. He continues to have back pain that prevents him from returning to work. He is upset that his previous orthopedist has not been able to find any additional physical complications to explain his persistent and chronic pain. (He has had x-rays and CT scan recently which show no evidence of pathology beyond his post-surgical changes.) Your task is to elicit Mr. Cassidy's concerns and history. If you have some ideas about ways he can manage his pain, you may choose to explore that with him in the later part of your interview.

"Mr. Cassidy" entered indignantly, clutching his back in pain. He was clearly frustrated by his myriad previous physicians' inability to properly help him, and insistent that the doctor find the proper pathology and treatment. He tossed out his words with a bit of bitterness, but generally remained polite. He explained how, in the past few years since the injury, he has not worked, maintained any hobbies, nor visited any friends. He has since moved back in with his mother, and basically does nothing all day. He would really like to start work again, but he is just waiting for his pain to be fixed. His only source of income is his monthly disability check.

My peers treated Mr. Cassidy with respect and empathy. They said things like "that sounds really tough," "It must be so difficult to be going through such a hard time," and "we will do everything we can to try to fix this problem." They asked him about all of his symptoms, and took a detailed history of his long ordeal. I was genuinely impressed with my fellow med students, some of whom have shockingly good interviewing skills.

When it was my turn, I similarly expressed empathy for Mr. Cassidy. I understood he was angry, and didn't take it personally. I fortunately have never experienced the inconceivable misery of chronic pain. I am aware that I likely would have behaved no more congenially, had I been the one in the patient's seat. Thus, my problem with the situation was not Mr. Cassidy's anger, but his maintenance a life of chronic anticipation. He was waiting to engage in the world again after until he was healed, and everyone presumably considered it cruel to suggest to Mr. Cassidy could possibly end up living with his pain forever.

So I finally said to Mr. Cassidy,

"Sir, we are going to pore over your charts, and try to see if there's anything that may have been overlooked. We will make it a priority to find the best analgesic for your pain. However, I do want to address something that may be a bit difficult, yet necessary, as you seem to have put your life on hold since the accident. I want you to consider the possibility that the pain may never go away, and that, no matter how hard we try, we may not make any meaningful changes to reduce your pain. Pondering that possibility, do you think that you may approach life a bit differently, that you may feel motivated to resume any of your old activities?"

Anarchy struck. The patient stood up, shouting rapidly, "You're telling me, that I'm coming here, just to hear that I'm stuck with this? That I have to live like this for the rest of my life? You call yourselves doctors, and you're saying that you can't help me?"

Mr. Cassidy wasn't the only one disappointed by my performance. During feedback, My peers said that I was too harsh, that my bluntness shattered Mr. Cassidy's hope, and only further deepened his despair.

I don't disagree. But, given another chance, I would likely re-enact the scenario in the exact same way. I felt that I owed it to Mr. Cassidy to consider the full scope of potential outcomes. I don't want him to miss out on life. Without anticipating his unfortunate reaction, I would initially be more fearful of acting dishonestly with my patient, rather than allowing for unnecessary worry.

Similarly, in our scenario with the dying patient, while I mentioned that statistics can't be predictive of any individual case, I still said that I'd look up the average prognosis for someone with his condition. For the obese patient with Type II diabetes, I didn't blame the patient, but I also didn't blame industrial food manufacturers for his plight. Ultimately, I believe that empathy must be balanced with honesty, respect for the patient's autonomy, and a realistic belief in the role of personal responsibility. And I wonder if that makes me a particularly libertarian (almost) doctor.

Thoughts on Cato University Lecture I: "Why Freedom Matters" by Tom Palmer

Tom Palmer gave an overview of the mission of Cato (which he calls "Central Atlantic Treaty Organization." Now I'm scared that the Democrats might abolish the think tank sometime soon, arguing that it harms workers). He makes an excellent point about the common criticism of Cato, in that it can't be trusted because it "has an agenda." For one, he mentions, "Everyone has an agenda, and every question you ask expresses your agenda." Reading studies from think tanks that claim to perform "objective social science research," to me, is at least more time consuming, because I always have to spend a few minutes figuring out what their ideology is. When Cato has a policy proposal, they've already done me the favor.

If any of you ever attend Cato presentations in D.C. and are annoyed by the first of two lecturers who might go on about market failures, the moral obligation of governments to help people, or how guns kill children, Palmer explained the reason for that. He mentioned that Cato likes to invite their "toughest and strongest" opponents on an issue, because the only way to demonstrate to themselves and to the audience that the institutes's ideas have merit is to answer to thoughtful, cogent criticism. This leads me to respect tremendously not just the institute, but also its guests. I couldn't imagine myself speaking in the lion's den of the Center for American Progress or People for the American way. Props to any populist or conservative willing to speak to a primarily libertarian audience.

At one point, Palmer explains that people often associate "libertarians," with their "genetic hybrid," "libertines," presumably referring to those people who would want small government, just so they could have access to call girls and cannabis. Most libertarians I know just want to choose their kids' schools or prevent some township from seizing their house- in other words, pretty mainstream. But, I do wonder if there is a cultural difference between libertarians and other folks, not so much in terms of their relative pursuits of wild lifestyles, but in terms of how they approach situations that have nothing to do with government interference. Today, I'll give a med school example of what I mean, in another post.