ARI’s Point of View on Health Care and a Free Society
Government’s role in U.S. medicine has been growing for more than half a century. What explains this trend and why have opponents found it impossible to stop?
In this article, originally delivered as a talk in February 1963, two years before the passage of Medicare and Medicaid, Ayn Rand develops her distinctive view that philosophic ideas — above all, ideas about morality — have shaped the debate over government’s role in health care.
According to Rand, the welfare state is based on the premise that a person’s need gives him a right to the unearned. We have been moving toward socialized medicine, she argues, because its advocates wield that premise as a moral weapon, while opponents concede the premise and meekly try to appease the push with a “policy of caution and compromise.”
To reverse course, Rand counsels opponents of socialized medicine that they must be willing to challenge this moral framework: “Only a strong, uncompromising stand — a stand of moral self-confidence, on clear-cut, consistent principles — can win.”
Taking that counsel to heart, ARI’s advocacy of freedom — in health care and throughout society — is predicated on the moral principle of individual rights.
How Not To Fight Against Socialized Medicine
by Ayn Rand
(This is a condensed version of a talk given by Miss Rand on February 6 at a meeting of the Ocean County Medical Society, Ocean County, N.J. The membership of that society includes Dr. J. Bruce Henriksen and his associates who, in May, 1962, signed his resolution declaring that they refused to participate in the care of patients under the provisions of the King-Anderson bill or similar legislation.)
I am happy to have this opportunity to express my admiration for Dr. Henriksen and the group of doctors who signed his resolution.
Dr. Henriksen and his group took a heroic stand. The storm of vicious denunciations unleashed against them at the time, showed that they had delivered a dangerous blow to the welfare-statists. More than any other single factor, it was Dr. Henriksen’s group that demonstrated to the public the real nature of the issue, prevented the passage of the King-Anderson bill and saved this country from socialized medicine — so far.
Their action was an eloquent example of the fact that only a strong, uncompromising stand — a stand of moral self-confidence, on clear-cut, consistent principles — can win.
But there are grave danger signs that the medical profession as a whole — like every other group today — will ignore that example and pursue the usual modern policy of caution and compromise. Such a policy is worse than futile: it assists and promotes the victory of one’s own enemies. The battle is not over. The King-Anderson bill will be brought up again, and if the doctors are defeated, they will be defeated by their own hand, or rather: by their own mind.
I want, therefore, to make certain suggestions to the medical profession — on the subject of how not to fight against socialized medicine.
The majority of people in this country — and in the world — do not want to adopt socialism; yet it is growing. It is growing because its victims concede its basic moral premises. Without challenging these premises, one cannot win.
The strategy of the Kennedy administration, and of all welfare-statists, consists of attempts to make people accept certain intellectual “package-deals,” without letting them identify and differentiate the various elements — and equivocations — involved. The deadliest of such “package-deals” is the attempt to make people accept the collectivist-altruist principle of self-immolation under the guise of mere kindness, generosity or charity. It is done by hammering into people’s minds the idea that need supersedes all rights — that the need of some men is a first mortgage on the lives of others — and that everything should be sacrificed to the undefined, undefinable grab bag known as “the public interest.”
Doctors have no chance to win if they concede that idea and help their enemies to propagate it.
Yet the ideological policy of most spokesmen for the medical profession — such as the A.M.A. — is as permeated by the collectivist-altruist spirit as the pronouncements of the welfare-statists. The doctors’ spokesmen declare, in net effect, that selfless service to their patients is the doctors’ only goal, that concern for the needy is their only motive, and that “the public interest” is the only justification of their battle.
The sole difference is this: the voices of the welfare-statists are brazenly, self-righteously overbearing — while the voices of the doctors’ spokesmen are guiltily, evasively apologetic.
Whom can one expect the people to believe and to follow?
People can always sense guilt, insincerity, hypocrisy. The lack of a morally righteous tone, the absence of moral certainty, have a disastrous effect on an audience — an effect which is not improved by the triviality of the arguments over political minutiae. And the terrible thing is that the doctors’ spokesmen give an impression of guilty evasiveness while the right is on their side. They do it by being afraid to assert their rights.
They are afraid of it because they do not believe that they possess any rights — because they have conceded the enemy’s premises — because they have no moral base, no intellectual guide lines, no ideology, no defense.
Consider, for instance, the outcome of the Canadian doctors’ struggle in Saskatchewan. The doctors had gone on strike against the full-scale socialized medicine instituted by the provincial government. They won the battle — and lost the war; in exchange for a few superficial concessions, they surrendered the principle for which they had been fighting: to permit no socialized medicine in the Western hemisphere.
They surrendered, even though the overwhelming sympathy and support of the Canadian people were on their side (except for the intellectuals and the labor unions). They were defeated, not by the power of the socialists, but by the gaping holes in their own ideological armor.
They had been fighting, properly, in the name of individual rights, against the enslavement of medicine by totalitarian-statist controls. Then, under the pressure of the usual intellectual lynching, under the hysterical, collectivist charges of “anti-social selfishness and greed,” they made a shocking change in their stand. Declaring, in effect, that their rebellion was not directed against socialized medicine as such, but against the high-handed, arbitrary manner in which the government had put it over, their spokesmen began to argue that the government plan did not represent “the will of the people.” The ideological kiss of death was a statement by Dr. Dalgleish, the strikers’ leader, who declared that if a plebiscite were taken and the people voted for it, the doctors would accept socialized medicine.
Could they deserve to win, after that? They could not and did not.
Consider the full meaning of Dr. Dalgleish’s statement. It meant the total repudiation of individual rights and the acceptance of unlimited majority rule, of the collectivist doctrine that the people’s vote may dispose of an individual in any way it pleases. Instead of a battle for the integrity of a doctor’s professional judgment and practice, it became a battle over who should violate his integrity. Instead of a battle against the enslavement of medicine, it became a battle over who should enslave it. Instead of a battle for freedom, it became a battle over a choice of masters. Instead of a moral crusade, it became a petty quarrel over political technicalities.
This led to the ludicrous spectacle of the alleged individualists arguing for democratic mob-rule, and the socialists righteously upholding the parliamentary form of government.
Those who doubt the power of ideas, should note the fact that the doctors’ surrender took place five days after Dr. Dalgleish’s statement.
The text of the agreement reached between the doctors and the government, contained the following horrifying sentence: “The doctors fear that if the government becomes their only source of income they are in danger of becoming servants of the state and not servants of their patients.” (Italics mine.)
A more abject statement of self-abnegation could not be hoped for or extorted by the most extreme collectivist.
No self-respecting labor union would declare that its members are “servants” of their employers. It took so-called “conservatives” to declare that professional men — and of so responsible, so demanding, so unusually skilled a profession as medicine — are the “servants” of their patients or of anyone who pays them.
The concept of “service” has been turned into a collectivist “package-deal” by means of a crude equivocation and a cruder evasion. In the language of economics, the word “service” means >work offered for trade on a free market, to be paid for by those who choose to buy it. In a free society, men deal with one another by voluntary, uncoerced exchange, by mutual consent to mutual profit, each man pursuing his own rational self-interest, none sacrificing himself or others; and all values — whether goods or services — are traded, not given away.
This is the opposite of what the word “service” means in the language of altruist ethics: to an altruist, “service” means unrewarded, self-sacrificial, unilateral giving, while receiving nothing in return. It is this sort of selfless “service” to “society” that collectivists demand of all men.
One of the grotesque phenomena of the twentieth century is the fact that the “package-deal” of “service” is most vociferously propagated by the “conservatives.” Intellectually bankrupt, possessing no political philosophy, no direction, no goal, but clinging desperately to the ethics of altruism, such “conservatives” rest their case on a cheap equivocation: they proclaim that “service” to others (to one’s customers or clients or patients or “consumers” in general) is the motive power and the moral justification of a free society — and evade the question of whether such “services” are or are not to be paid for.
But if “service” to the “consumers” is our primary goal, why should these masters pay us or grant us any rights? Why shouldn’t they dictate the terms and conditions of our work?
If socialized medicine comes to the United States, it is such “conservatives” that the doctors would have to thank for it, as well as their own spokesmen who recklessly play with an intellectual poison of that kind.
Doctors are not the servants of their patients. No free man is a “servant” of those he deals with. Doctors are traders, like everyone else in a free society — and they should bear that title proudly, considering the crucial importance of the services they offer.
The pursuit of his own productive career is — and, morally, should be — the primary goal of a doctor’s work, as it is the primary goal of any self-respecting, productive man. But there is no clash of interests among rational men in a free society, and there is no clash of interests between doctors and patients. In pursuing his own career, a doctor does have to do his best for the welfare of his patients. This relationship, however, cannot be reversed: one cannot sacrifice the doctor’s interests, desires and freedom to whatever the patients (or their politicians) might deem to be their own “welfare.”
Many doctors know this, but are afraid to assert their rights, because they dare not challenge the morality of altruism, neither in the public’s mind nor in their own. Others are collectivists at heart, who believe that socialized medicine is morally right and who feel guilty while opposing it. Still others are so cynically embittered that they believe that the whole country consists of fools or parasites eager to get something for nothing — that morality and justice are futile — that ideas are impotent — that the cause of freedom is doomed — and that the doctors’ only chance lies in borrowing the enemy’s arguments and gaining a brief span of borrowed time.
This last is usually regarded as the “practical” attitude for “conservatives.”
But nobody is as naive as a cynic, and nothing is as impractical as the attempt to win by conceding the enemy’s premises. How many defeats and disasters will collectivism’s victims have to witness before they become convinced of it?
In any issue, it is the most consistent of the adversaries who wins. One cannot win on the enemy’s premises, because he is then the more consistent, and all of one’s efforts serve only to propagate his principles.
Most people in this country are not moochers who seek the unearned, not even today. But if all their intellectual leaders and the doctors themselves tell them that doctors are only their “selfless servants,” they will feel justified in expecting and demanding unearned services.
When a politician tells them that they are entitled to the unearned, they are wise enough to suspect his motives; but when the proposed victim, the doctor, says it too, they feel that socialization is safe.
If you are afraid of people’s irrationality, you will not protect yourself by assuring them that their irrational notions are right.
The advocates of “Medicare” admit that their purpose is not help to the needy, the sick or the aged. Their purpose is to spare people “the embarrassment” of a means test — that is, to establish the principle and precedent that some people are entitled to the unrewarded services of others, not as charity, but as a right.
Can you placate, conciliate, temporize or compromise with a principle of that kind?
As doctors, what would you say if someone told you that you must not try to cure a deadly disease — you must give it some chance — you must reach a “compromise” with cancer or with coronary thrombosis or with leprosy? You would answer that it is a battle of life or death. The same is true of your political battle.
Would you follow the advice of someone who told you that you must fight tuberculosis by confining the treatment to its symptoms — that you must treat the cough, the high temperature, the loss of weight — but must refuse to consider or to touch its cause, the germs in the patient’s lungs, in order not to antagonize the germs?
Do not adopt such a course in politics. The principle — and the consequences — are the same. It is a battle of life or death.