NEITHER SIDE in the health care debate is capable of stepping back and seeing the system in its totality. It’s a verticalized system designed to be as expensive as possible, centered around institutions. Expensive institutions (universities) create the chief health care providers (doctors). The doctors then go to work for similar giant top-heavy institutions, called hospitals, whose motivating credo is to utilize as much advanced technology as possible. The system builds-in expense and cost, and it builds-in scarcity. There are never enough giant hospitals and never enough doctors to serve the entire population without denied access and long lines. Switching to a government-run system won’t change this situation. The solution, it seems to me, is to free up the system and horizontalize health care, by cutting down the artificial monopoly of doctors and hospitals. Maybe by having an interim category between nurse and doctor, without the hyper-brains and hyper-technology, and without the enormously expensive hyper-education, which sets up the artificial scarcity of “experts.” Open up the market for health care and allow a wide range of low cost clinics to proliferate. Drop the “one-size-fits-all” mentality geared toward treating the symptoms and effects of disease, allowing alternative ideas which focus on causes and lifestyles into the equation. These are stray thoughts. What we know for certain is that the present system isn’t working. A 2,800-page law requiring tens of thousands of regulations, with corresponding expansion of bureaucracies, is hardly the solution—there’s too much regulation and bureaucracy already.
America fights war in the same way it provides health care: as expensively as possible, with the focus on enormously expensive bureaucracies, hierarchies, and costly advanced technology. Our trillion-dollar force was sent to Afghanistan to fight—and has found failure against bands of low-rent fanatics, who exist and fight with no supporting superstructure of expense whatsoever. The horizontal has outmaneuvered the vertical.
The situation of book publishing and literature in this country is similar to that of war and health care. Once again, enormously expensive vertical institutions—the “Big Six”—operating in as costly a fashion as possible, with large high-rent offices in the planet’s highest rent city, manned by “experts” who are the products of hyperexpensive, questionable education which has only served to enforce a “one-size-fits-all” narrow-minded mode of artistry. American literature, based within the Big Six and within equally overlarge educational institutions, has tied itself to this monopoly mindset—and as a result has stagnated. As I experienced when I ran the Underground Literary Alliance, those who question the system are ostracized and banished from the high priests’ sight.
Signs of hope exist in the form of horizontalized low-rent pop writers, operating like insurgents under the radar—writers like J.A. Konrath and Barry Eisler, who are defeating the monolith of monopoly at its own game.