“Regulated, Mild and Peaceful” Servitude

Advanced Western countries are very regulated societies, covered by what Tocqueville forecasted would be “a network of small complicated rules, minute and uniform.” When you notice something strange and annoying, there is a good chance that some regulation is the culprit. I recently found another example in an obscure health regulation (“Raw Medical Test Results Right to Your Inbox Spark Confusion and Concern,” Wall Street Journal, September 14, 2023).

If you have registered on your doctor’s health portal, you will find there the results of any medical tests such as blood test or scan at the same time as it is electronically transferred to him. You will also get an email or a text warning you that the new results are in. It is often convenient, but not always:

[Dr. David Gerber, a Dallas-based oncologist] said he’s had patients learn about a cancer diagnosis from a smartphone notification in the middle of a business dinner, while reading a bedtime story to a 3-year-old, and during a rush-hour commute. One patient’s spouse went to the emergency room for an anxiety attack after misinterpreting her husband’s CT scan.

And there is no way the technician can ask you if you want to receive the results at the same time as your doctor and check a box on her computer. She, and perhaps the software coder, could be guilty of a federal violation and liable to a $1-million fine.

This is part of a 2016 federal law, the 21st Century Cures Act (as brilliantly named as the recent Inflation Reduction Act), dreamed by benevolent politicians and designed by conscientious bureaucrats. They apparently did not understand that if there is a demand for such immediate information, competitive (and often greedy) hospitals and doctors would certainly find a way to offer it to their customers (called “patients” in the jargon of pre-consumer societies, from a Latin root meaning “sufferer”).

That is just a small part of the big picture. The Code of Federal Regulations contains close to 1.1 million references to prohibitions or mandates and more than 188,000 pages.

I am not claiming that the grass is greener elsewhere than under “this sort of servitude, regulated, mild and peaceful” (quoting again from Tocqueville’s Democracy in America). Arbitrary despotism like in, say, China, Russia, or India is certainly worse for most people and, to add insult to injury, less conducive to general prosperity.

My doctor told me that, when physicians’ notes were not automatically available and probably hand-written, physicians used some standard abbreviations: for example, FLD meant “funny-looking dad.” (The implication is less funny if the annotation reflected the doctor’s disapproval of the father’s lifestyle!) At any rate, easy access to the notes of your doctor or your child’s doctor has some benefits. There are also benefits in being reasonably sure that your toaster won’t melt down, that your computer will not randomly swallow your articles, that your cartridges will go bang when hit from behind by the striker or hammer, that your life insurance company will pay in 50 years’ time, and that your grocery store will stock bread tomorrow; but none of that requires special laws and regulations.