Principles and Pragmatism

by Don Boudreaux on July 22, 2006

in Cafe Conversation, Politics

In a comment on this recent post, the always-insightful John Dewey says

To the "true libertarians" who would substitute free markets for medical licenses and the FDA:

Why don’t you fight battles you have a chance of winning? The
problem I have with libertarians and the Libertarian Party is that they
take extreme positions on issues based on principle, and ignore
political realities. The American public is not going to accept
unlicensed medical practice any time soon, if ever. Quite frankly,
suggesting that anyone should be allowed to practice medicine makes you
guys look a little kooky, and undermines some of your more acceptable

I believe society has a right and an obligation to protect children
from truly stupid, life-threatening actions by parents. You
libertarians probably disagree. I guess I’m not one of you, though we
agree on many issues.

There’s more here than I have time now to take on — but before I get to my main point, let’s be clear about one thing: to argue against medical-licensing requirements by the state is not to argue that quacks will or should practice medicine.  It’s simply to argue that state licensing is neither the only, nor the best, means of certifying the quality of physicians.

My main point in this post has to do with the important question between pursuing goals that are today perceived as being politically achievable and making a case for an ideal society that is humanly achievable if not politically achievable today or even ever.  My interests largely run along the latter lines.  I am not a member of any political party; I never vote in political elections; and I’ve long ago lost any and all hope of finding salvation in politics.  Politics, in my view, is almost completely responsive to the prevailing public morality and ideology.  As I wrote here, the American Constitution really isn’t written on parchment; it’s in Americans’ hearts and minds.  My goal is to contribute, in the best way that my modest talents permit, to changing ideas over the long-run.

And we would do well to heed the lesson of this observation from historian Richard Pipes (found on page 10 of his book Property and Freedom [Knopf, 1999]): "But men who take pride in their pragmatism often follow trails cleared by idealists."

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Tim Lundeen July 22, 2006 at 2:50 pm

A beautiful quote, thanks!

Dave Meleney July 22, 2006 at 7:56 pm

Libertarians do tend to amaze one with their radical and principled notions…viewpoints you call envisioning "an ideal society." But what often disables their presentation is, in my opinion, not so much their idealism as their penchant for really opting out of the fray we call politics. As you say: "I've long ago lost any and all hope of finding salvation in politics."

Yet…some might consider us very fortunate to be living thru a period of such amazing political victories around the world. While Communism has largely fallen, so to the decades of nuclear face-off, at least for a while…and a massive, though imperfect, liberation of billions of humans from China and India to Indonesia, Singapore, and Ireland. These are massive political victories that we've seen with our own eyes, are they not?

Seems your philosophy keeps you from fully celebrating the political heroes we call Martin Luther King, Lee Kwan Yu, Deng, Yeltsin, Thatcher, Reagan, and Walesa. And it may keep you from inspiring your students to do as these great men have done.

My favorite libertarian historian distributes a list of presidents he calls the "Least Bad Presidents"…. We know the point he is trying to make…. but is it worth it?

JohnDewey July 22, 2006 at 10:38 pm

"Making a case for an ideal society that is humanly achievable if not politically achievable today or even ever" seems to me an admirable goal.

Please know that I appreciate your efforts, and I look forward every day to reading your posts. I apologize for using the term "kooky", which was certainly inappropriate.

Perhaps my objection is more aimed at the Libertarian Party, which seems to believe it can achieve goals which I believe to be politically impossible. I would be happier of the Libertarian Party were a bit more pragmatic or if the Republican Party would be a bit more libertarian.

TGGP July 22, 2006 at 10:43 pm

Some libertarians don't take much of a liking to M.L.K:

Jeff Hummel of the Mises Institute discusses the "least bad presidents", with an emphasis on one in particular here:

JohnDewey July 22, 2006 at 11:16 pm

"To argue against medical-licensing requirements by the state is not to argue that quacks will or should practice medicine."

I guess I don't understand how anything less than the power of the state will prevent quacks from practicing medicine.

To me, licensing of physicians is needed for the same reason that tractor trailer drivers need licenses – to protect everyone else. That doesn't guarantee that some truck driver will not kill a family on the highway, or guarantee that some physician will not prescribe the wrong drug. But I think licensing increases the odds tremendously.

scott clark July 22, 2006 at 11:45 pm

Thanks to Doc Boudreaux for putting John Dewey's post front and center, I had wanted to respond to his comment, but just didn't feel like jamming it in a medical licensing post.

My take on matter, and the reason I take extreme positions is because of the vast array of opposition lined up. The problem with fighting the battles we could win is that there are armies of people making moving the lines in their favored directions. If libertarians fought to get a little more freedom in one particular small area, it would amount to very little against the professional politicians, government employees, lobbyists, special interets, do-gooders and meddlers, who go to work everyday with the express intention of making more rules, more laws, more regulation, to accumulate more power in the hands of the few, to centralize, and to plan the lives of complete strangers. To make any meaningful change at all it would have to be radical change.

And the good doctor hits the nail on the head when he points on that the radical change has to come from the ideas that people hold on to.

blink July 23, 2006 at 1:22 am

This post resonates deeply with me; thanks Dr. Boudreaux. To frame the battle of ideas as you have here and in the linked FEE article is inspiring.

I am intrigued by your comment that you do not vote. Today, it seems, “unapologetic non-voter” and “ogre” are close synonyms. Unfortunately, I have never been able to articulate my reasons for not voting convincingly. Perhaps you could dedicate a future post to elaborating your reasons. How, for example, would you respond to the quip that only by voting does one “earn” the right to complain?

Russell Nelson July 23, 2006 at 2:06 am

John says "I guess I don't understand how anything less than the power of the state will prevent quacks from practicing medicine."

How about this: no customers. Why would anybody seek a cure from a quack when good knowledge about medical providers will be widely available. Once people stop expecting the government to protect them, they'll be a little more cautious, and lower their expectations of doctors. If you're familiar with the term "medical diety", you will understand why I think that outcome is a good one.

Russell Nelson July 23, 2006 at 2:09 am

The most you can do with politics is prevent something bad from happening. You can't cause something good to happen. That role is limited to citizens operating in a free market.

Richard July 23, 2006 at 7:53 am

"I guess I don't understand how anything less than the power of the state will prevent quacks from practicing medicine."

I agree that if the state stops licensing medicine, some amount of quackery will be practiced. The question, as always, is whether more or less quackery will be practiced, and so far, the state' record is not very good.

First off, the state only licenses medicine; items sold as substitutes for medicine (magnets, crystals, herbal remedies, homeopathy) fall outside the regulatory scheme. And the only way to solve the issue would be for the government to regulate everything, just in case someone might see it as a substitute for medicine, at which point more civil liberties fall by the wayside.

Plus, if you look at a lot of advertising for these products, they try to mislead people into thinking that they've gone through a certification process with the FDA, or that, since the government doesn't ban the products, they must work. The quacks are using the regulatory scheme as a reason for people not to look too closely at what they're buying.

Finally, look at the more borderline cases of acupuncture and chiropracty. Despite a complete lack of evidence for the many strong claims made for these treatments, some state governments actually require that all insurance policies offer coverage; even people who believe these are quackery are forced to pay money to cover the cost of their practice. In this case, the licensing scheme has completely failed at its primary objective.

So, will bad medicine be practiced without the FDA? Yes. Is bad medicine practiced with the FDA? Yes. Will there be more or less? Personally, I'd guess about the same. It's easy enough to get access to quack medicine now that I presume that everyone who really wants it is already buying it. So, let's abolish the FDA and licensing of medicine. It doesn't really buy us anything at all for it's costs.

Half Sigma July 23, 2006 at 10:28 am

It seems to me that the ideal society as envisioned by some anarcho-capitalists disregards human nature almost as much as the ideal society envisioned my Marxists.

save_the_rustbelt July 23, 2006 at 11:58 am

There are other ways to license/certify medical practitioners, but the problems are:

1) There is no ground swell for a new system, it is way down on everyone's radar.

2) There would be considerable transition costs and time expended, would this pass any sort of cost-benefit analysis?

It is easy to be a libertarian when there is no chance of your ideas being adopted, sort of a bleacher seat quarterback. I do have sympathy with some libertarian aims, but that battle was lost many years ago.

Don July 24, 2006 at 10:16 am

Moody's. S&P. Fitch.

Why should the practice of medicine be any different to the way that the private market assess creditworthiness among bond issuers?

John Dewey July 24, 2006 at 11:15 am


I'm not sure I understand your point.

I don't think Moody's, S&P, and Fitch regulate the issuance of bonds in the U.S.. I'm fairly certain that the federal government gets involved.

John Dewey July 24, 2006 at 12:53 pm


I was referring to the licensing of physicians in my statement you quoted. Your response seems to be referring to the FDA.

In my opinion, state medical boards perform very well in reducing the incidence of medical malpractice. Their primary weapon is the ability to grant and revoke licenses.

Physicians/surgeons have invested years of effort to acquire the licenses that allow them large incomes. The risk to that investment and to their income from license revocation is so large as to reduce greatly the incidence of malpractice. Elimination of licensing would remove one important financial incentive for doctors to keep up to date and to practice medicine carefully.

The use of magnets and crystals in healing – the examples of quackery you offerred – are harmless actions. The surgical cutting of human bodies and the prescribing of narcotics are not harmless actions. It is the latter actions that medical boards, through their pwoer to license, prohibit quacks from doing legally.

NRG July 25, 2006 at 3:48 am

I'm glad to see you don't vote. I believe if we had a campaign to not get out the vote, people would appreciate what a farce elections have become. Of course, you could be spiteful and vote for Hillary in the next election.

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