Size Matters

Size Matters

Time to downsize the USA

By Rosemarie Jackowski

Is the US too big not to fail?   For everything there is an ideal size. An enlarged heart will not function as well as one of the ideal size. Giantism is a health risk.  Some of the recent losses in the US economy were caused by banks that were too large to be regulated efficiently. Empires don’t survive. Size matters.

It might have been intended as a joke, but one of the most profound comments on this topic was made a while back by Bob and Ray Magliozzi, the car guys.  On their radio program, while discussing how to solve the problems of world governance, they said that in order for any nation to function properly it must be small. In fact, they said that the only way for a government to work would be for the citizens to break up into groups of ten. Ten was the ideal number. That way everyone could be heard. Everyone’s rights could be honored. Every nation would consist of ten citizens.

Think about it. How many lives have been lost because of the size of the US Military.  The size of the Pentagon Budget has created global harm.  In addition, the size of the Black Budget is a major problem. It should be eliminated.

In a nation that is too big, there is no way that citizens can be informed on the complexities of the laws and regulations which impact their lives. Even legislators who vote on the laws are at a disadvantage when a bill is unnecessarily complicated and too lengthy.  How many in Congress will have read the nearly 2000 page Health Care Bill before they vote on it? A Bill that is almost 2000 pages in length will most likely be read by Congressional  staffers. They in turn will write up a brief – sort of a Cliff Notes for Congress. That’s not the way our forefathers meant for things to be.  If the Ten Commandments can be written on an index card, the US should be able to write a health care bill in a few pages.

A perfect example of how complex regulations harm all of us was recently disclosed by Stan Brock during a C-Span interview.   He made a shocking revelation. He said that free medical care would be more readily available in the US, if only it was not prohibited in all States except Tennessee. That was shocking – free medical care at no expense to the taxpayer or the patient.  Free vision exams, free dental fillings, free medical procedures – unbelievable.  

The need for medical services is of crisis proportions – sort of a Perfect Storm. Bad economy, lost jobs, home foreclosures.  I started to do the research to prove that Stan Brock was wrong when he said that most States made it almost impossible for volunteer medical personnel from other States to donate their services.  Tennessee was the only exception. 

I owe Stan an apology. He was right. I was wrong. I had believed that no where in our nation would a doctor be prohibited from rendering free medical care to a sick person. Cause of death – lack of papers of the volunteering physician – sort of a Catch 22 in medical care.

Everyone should research the rules. They are different in each State. My research is not complete but so far this is what it looks like. State Regulatory Boards cave in to the pressure of special medical interest groups.  Regulations are written to eliminate competition from out-of-state doctors. A licensed doctor from New York, Massachusetts, or New Hampshire is not permitted to cross the state line and practice in the adjoining Vermont town. In Vermont, the licensing of doctors is controlled by the State Medical Board.  

On the other hand, to further complicate things, in Vermont, the licensing of dentists is not controlled by the State Medical Board.  The licensing of dentists is regulated by the Office of Professional Regulation, a division of the Office of Secretary of State.  The rules for doctors and dentists are different.  Rule 4.8 provides for a Transient Practice Permit which allows an out-of-state or Canadian dentist to practice in Vermont for ten days per year. This rule applies only to dentists.

Figuring a way to fix this is not brain surgery, but it might allow a patient to get brain surgery if it is needed. The fix is easy.  Medical licensing Boards should honor reciprocity. A licensed doctor from one State should be granted the right to practice in any other State. Red tape and bureaucratic loopholes should be eliminated. Licensing fees for humanitarian volunteers should be eliminated. The lack of reciprocity across State lines denies a patient’s right to choose. Worse, it sometimes denies a patient’s right to survive.

For those who are not familiar with the work of Stan Brock, he is founder of RAM – Remote Area Medical. The original plan was to serve those in remote, jungle areas.  Now that the US has become a Third World country, RAM has held several free clinics in the US. News reports have shown people lining up in the dark of night with the hope of getting necessary medical care. Many have had to be turned away. 

The need for a Single Payer system is urgent. Until we have a Single Payer system there will be a need for thousands of humanitarians like Stan Brock. On the downside, reliance on volunteer services such as RAM unfairly deprives others around the world of medical care. 

In the meantime, the US bureaucracy needs to be downsized and simplified.  Only then will heroes such as Stan Brock and the other volunteers be allowed to go about their work of saving lives.

Rosemarie Jackowski is a peace activist and an advocacy journalist living in Vermont.

Her e-mail address is

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