The other day my wife discovered that she couldn’t get her yearly eye check-up until September, because her ophthalmologist was booked up that far in advance. Dental appointments need to be scheduled a month in advance, except for emergencies. So do yearly health check-ups. The time-lag for all of these health-related matters has been creeping up year by year.

The reason is simple. While few are talking about it, the population of the United States is growing faster than the number of physicians. Some of this has been disguised/alleviated by nurse practitioners and physician assistants providing some services, but there are more and more areas of the country without physicians, with more than 80 million people in the US living in areas in which access to a primary care physician is scarce or non-existent.

In many fields, higher pay creates more incentives for people to get the training and experience, but in medicine in the U.S., the number of doctors is limited by the number of medical schools and the number of openings for residency positions available. Currently, almost 1,000 medical school graduates every year cannot obtain a residency position, and those numbers are growing. Without successful completion of residency, those medical school graduates cannot be certified to practice medicine.

Residency programs are expensive to operate, and most hospitals rely on federal support, but the number of federally supported positions has been fixed at the current level for several years, which isn’t adequate to provide training for all the M.D./D.O. graduates, particularly since 35% of all current physicians will reach retirement age over the next five years. At the same time, because of the increased work-load, including more and more paperwork, doctor “burn-out” is increasing, and more doctors are retiring earlier and/or cutting back on working hours.

The most obvious result of the high cost of medical school and the shortage of residency positions is that inner city and rural areas are the most impacted. That impact is reflected in the fact that while the U.S. spends more than twice as much on health care per capita as do other high-tech societies, that spending is disproportionately targeted to advanced medical systems and technologies. For all that technology, the U.S. has the highest number of hospitalizations from preventable causes, the highest rate of avoidable deaths, and the lowest life expectancy among the 11 OECD nations… and one of the highest rates of maternal and infant mortality of all developed nations.

Studies from all over the world show that the availability of doctors makes more of a difference in the health of most people than a plethora of high-tech medical technology that primarily benefits the well-off or fortunate, and, not surprisingly, the U.S. also has fewer physician visits per capita than in most other developed countries.

And unless matters change, the situation is going to get worse.

Almost 70% of U.S. households have pets, representing more than a twenty percent increase over the past 25 years. The vast majority of these pets are dogs and cats, but there isn’t a great deal of research on why Americans have become more likely to have pets.

There are studies that show that people who have a pet, especially a dog or cat, are in generally better physical and mental health as they age, as well as surveys revealing that more U.S. households have pets than children. In addition, the market for pet-oriented products and services has grown by 450% over the past 25 years.

But nowhere could I find any studies on why more households have pets. I did find a poll by Morning Consult that reported that pet owners felt their pets helped reduce stress and anxiety, provided unconditional love and support, offered companionship, and provided a calming presence.

Some 75 years ago, President Harry Truman made the observation that, “If you want a friend in Washington, D.C., get a dog.” Having spent almost 20 years in that politico-economic climate, I’d agree.

Every morning, our two dachshunds are glad to see me, and the same is true any time I leave them and then return, even if it’s only fifteen minutes. That kind of spontaneous joy almost never occurs in academia, law, business, or politics and happens but infrequently in the dogless household.

As Americans become more personally and socially isolated [and texting doesn’t reduce isolation] as well as politically polarized, the non-judgmental warmth and welcome of a dog becomes more and more attractive in a world that’s becoming colder, more impersonal, and more demanding. Even our cat is far warmer than most people I had to deal with in politics or that my wife has to deal with in academia.

But that’s just my observation, not a peer-reviewed, statistically grounded psychological treatise, although I’m sure our dachshunds would agree. The cat would likely refuse to take sides, but he’d still settle in beside me while I’m reading.

In some ways, especially after the last few months, I can understand the growing anger in the United States, especially at incompetence.

I don’t like mowing the lawn, and after years of doing it, I hired a lawn service. For years, everything was fine, but the past year has been a bit of a trial, both for me and for the owner of the firm, who’s had to fire people because of their carelessness and their sloppy performance, and in my case, for repeatedly ripping out sprinkler heads, which caused additional damage, and failing to mow parts of the lawn – despite the fact that they’re well paid.

For years, I’ve subscribed to a local/regional newspaper. It used to arrive in my driveway between 6:30 and 7:00 A.M. Now, and for the past few months, it arrives between 7:00 A.M. and 11:00 A.M. or so, and almost one day a week it doesn’t arrive at all but comes along with the next day’s paper a day after it was due – and the subscription price has tripled in the last two years.

Then, there’s the local tree surgeon/trimmer, who turns down work, if he doesn’t like people, or doesn’t feel like it, and the alternative is an outfit that costs more and whose work is problematic to say the least.

I’ve already mentioned the incompetence of the Tovala food service outfit, but I’ve also run into it in the professional area. As some readers may know, the protagonists of The Grand Illusion are not whitebread, but have skin tones in the range of dark honey, and the books take place in a very urban environment – yet one of the covers I got for an audio version showed two very white Caucasians in the middle of a forest (where they’ve never been in all three books) with the equivalent of laser knives (when Steffan and Avraal rely on old-fashioned throwing knives in a society that has no electricity). This was hardly an example of competence, especially when it took three tries to get the cover remotely close to the “reality” of the book.

For professional reasons, I won’t go into the more egregious examples in the publishing field, but I will mention, without more details, the senior editor of an extremely best-selling author who failed to edit the manuscripts and books of other assigned authors for over a year before he was let go. I will note that, in the publishing industry, the terminology is almost always that so-and-so left to pursue other interests. Fortunately, my editor is far more responsible and diligent.

It’s also not just me. My wife ordered a fog machine for one of her spring opera productions – and received an elaborate dog bed. She checked the order and the invoice to make sure it wasn’t her error. They both specified a fog machine and had the right number. The Music Department is now looking for a new secretary/administrative assistant. The previous one left because, among other reasons, she wanted to do a face-to-face job remotely and had the habit of being unavailable, even online.

Our son has had to fire sales associates because they’re unreliable and don’t want to do the grunt-work (like restocking the shelves and storage areas) of the high-end men’s stores he’s in charge of and where they worked.

I’ve never seen anything like the amount of these examples, all within the last few months, nor in these numbers, in more than fifty years, and yet, as we all know, prices have also increased. So who says that incompetence doesn’t pay?

The simple answer is: Because too many people are greedy, careless, self-centered, and stupid.

Virtually every government function is there to protect people from themselves, because while James Madison said, “If men were angels, no government would be necessary,” men and women are far from being angels.

We have a large bureaucracy devoted to regulating and policing the food industry because too many food producers were producing contaminated, spoiled or tainted food, or food with unhealthy or poisonous additives, or using preservatives that essentially poisoned consumers, largely because it was cheaper, and that increased their profits.

We have safety standards for vehicles for similar reasons. We have air pollution regulations because industrial fumes and exhaust once made the air so toxic it killed people, and water pollution regulations because rivers were once sewers that could also catch fire. We have drug regulations so that pharmacists don’t poison people. We have building standards and inspectors so that houses and buildings don’t collapse, as thousands of structures did in Turkey in the recent earthquake, apparently partly because corrupt inspectors were bought off to allow buildings to be constructed that didn’t meet the building standards.

The list of regulatory agencies seems endless, but that’s because every advance in technology also advances the possibilities for the greedy and the unscrupulous to prey on those without the knowledge or means to protect themselves. And because there are so many unprincipled individuals, those regulatory agencies also have to devote resources to assure that they’re not being corrupted as well.

Extensive government isn’t as necessary in lower-tech, low population density societies, where a failure of a building or a bridge harms only a few people. But in our society today, failure of a single bridge can kill hundreds, and damage an entire region economically.

Another reason for regulation is to make sure that cost-cutting doesn’t jeopardize safety.

An aircraft design with flaws, such as the 737-Max, can kill hundreds. Boeing presented the 737-Max to the FAA as a slightly updated version of the 737, rather than one with considerable modifications, in order to reduce the regulatory costs and possible delays.

A design flaw in a mass-produced automobile, such as Ford Pinto, which led to hundreds of deaths, could have been minimized or eliminated by the installation of a plastic buffer pad that cost all of one dollar. The buffer, which Ford tested, was rejected for cost reasons, saving Ford about $4 million over the production years before the gas tank problem was fixed.

So… if you want smaller government, you have two options – accept a far more risky and likely shorter life or find a way to make your fellow humans more responsible and less greedy, careless, and self-centered.

Personally, I’m not fond of the first option, and I find the second a practical impossibility, which leaves me with reluctant acceptance of large government.

The 2023 WGA strike is the labor dispute between the Writers Guild of America — representing 11,500 screenwriters — and the Alliance of Motion Picture and Television Producers. It began at 12:01 a.m. PDT on May 2, 2023. Primarily, the strike is over pay and working conditions. The industry wants to cut down on costs by having smaller writers’ rooms (mini-rooms) or doing without them altogether and relying more on “gig” writers. This isn’t setting well with writers, given that writers only receive about 2% of the total revenues generated out of their work.

While it doesn’t affect me directly and personally, I certainly understand the struggle, because it’s symptomatic of more than just broadcast and cinema media, representing as it does the struggle between “creators” and “packagers.” This dichotomy doesn’t just exist in entertainment; it’s just more obvious there.

There have also been recent incidents in the “book” side of the F&SF industry, where it came out that Disney was refusing to pay royalties to authors whose books had been made into movies. I don’t have that particular problem, since none of my books have ever been turned into movies or television series, but some authors have, and the Disney incident is indicative of just how little corporate CEOs value the ideas and craft behind what they market.

At the same time, I suspect very few F&SF fiction writers make the kind of money that run-of-the mill screenwriters make, but then, we usually don’t have to operate under the deadlines that they do.

Authors published traditionally share certain concerns with the WGA writers, such as how the publishers (i.e., packagers) present their work. Indie authors who publish their own books have greater control over their presentation – but also take on a great deal more work.

I have mixed feelings about the WGA strike, except that I definitely share the strikers’ concerns that the industry “packagers” are minimizing the strikers’ contribution to the final productions, not that it’s anything new.