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HEALTH CARE IS NOT A RIGHT
by Leonard Peikoff, Ph.D.
Delivered at a Town Hall Meeting on the Clinton Health Plan
Red Lion Hotel, Costa Mesa CA
December 11, 1993
Good morning, ladies and gentlemen:
Most people who oppose socialized medicine do so on the grounds that
it is moral and well-intentioned, but impractical; i.e., it is a noble
idea -- which just somehow does not work. I do not agree that
socialized medicine is moral and well-intentioned, but impractical. Of
course, it *is* impractical -- it does *not* work -- but I hold that it
is impractical *because* it is immoral. This is not a case of noble in
theory but a failure in practice; it is a case of vicious in theory and
*therefore* a disaster in practice. So I'm going to leave it to other
speakers to concentrate on the practical flaws in the Clinton health
plan. I want to focus on the moral issue at stake. So long as people
believe that socialized medicine is a noble plan, there is no way to
fight it. You cannot stop a noble plan -- not if it really is noble.
The only way you can defeat it is to unmask it -- to show that it is the
very opposite of noble. Then at least you have a fighting chance.
What is morality in this context? The American concept of it is
officially stated in the Declaration of Independence. It upholds man's
unalienable, individual *rights.* The term "rights," note, is a moral
(not just a political) term; it tells us that a certain course of
behavior is right, sanctioned, proper, a prerogative to be respected by
others, not interfered with -- and that anyone who violates a man's
rights is: wrong, morally wrong, unsanctioned, evil.
Now our only rights, the American viewpoint continues, are the rights
to life, liberty, property, and the pursuit of happiness. That's all.
According to the Founding Fathers, we are not born with a right to a
trip to Disneyland, or a meal at Mcdonald's, or a kidney dialysis (nor
with the 18th-century equivalent of these things). We have certain
specific rights -- and only these.
Why *only* these? Observe that all legitimate rights have one thing
in common: they are rights to action, not to rewards from other people.
The American rights impose no obligations on other people, merely the
negative obligation to leave you alone. The system guarantees you the
chance to work for what you want -- not to be given it without effort by
somebody else.
The right to life, e.g., does not mean that your neighbors have to
feed and clothe you; it means you have the right to earn your food and
clothes yourself, if necessary by a hard struggle, and that no one can
forcibly stop your struggle for these things or steal them from you if
and when you have achieved them. In other words: you have the right to
act, and to keep the results of your actions, the products you make, to
keep them or to trade them with others, if you wish. But you have no
right to the actions or products of others, except on terms to which
they voluntarily agree.
To take one more example: the right to the pursuit of happiness is
precisely that: the right to the *pursuit* -- to a certain type of
action on your part and its result -- not to any guarantee that other
people will make you happy or even try to do so. Otherwise, there would
be no liberty in the country: if your mere desire for something,
anything, imposes a duty on other people to satisfy you, then they have
no choice in their lives, no say in what they do, they have no liberty,
they cannot pursue *their* happiness. Your "right" to happiness at
their expense means that they become rightless serfs, i.e., your slaves.
Your right to *anything* at others' expense means that they become
rightless.
That is why the U.S. system defines rights as it does, strictly as
the rights to action. This was the approach that made the U.S. the
first truly free country in all world history -- and, soon afterwards,
as a result, the greatest country in history, the richest and the most
powerful. It became the most powerful because its view of rights made
it the most moral. It was the country of individualism and personal
independence.
Today, however, we are seeing the rise of principled *immorality* in
this country. We are seeing a total abandonment by the intellectuals
and the politicians of the moral principles on which the U.S. was
founded. We are seeing the complete destruction of the concept of
rights. The original American idea has been virtually wiped out,
ignored as if it had never existed. The rule now is for politicians to
ignore and violate men's actual rights, while arguing about a whole list
of rights never dreamed of in this country's founding documents --
rights which require no earning, no effort, no action at all on the part
of the recipient.
You are entitled to something, the politicians say, simply because it
exists and you want or need it -- period. You are entitled to be given
it by the government. Where does the government get it from? What does
the government have to do to private citizens -- to their individual
rights -- to their *real* rights -- in order to carry out the promise of
showering free services on the people?
The answers are obvious. The newfangled rights wipe out real rights
-- and turn the people who actually create the goods and services
involved into servants of the state. The Russians tried this exact
system for many decades. Unfortunately, we have not learned from their
experience. Yet the meaning of socialism (this is the right name for
Clinton's medical plan) is clearly evident in any field at all -- you
don't need to think of health care as a special case; it is just as
apparent if the government were to proclaim a universal right to food,
or to a vacation, or to a haircut. I mean: a right in the new sense:
not that you are free to earn these things by your own effort and trade,
but that you have a moral claim to be given these things free of charge,
with no action on your part, simply as handouts from a benevolent
government.
How would these alleged new rights be fulfilled? Take the simplest
case: you are born with a moral right to hair care, let us say, provided
by a loving government free of charge to all who want or need it. What
would happen under such a moral theory?
Haircuts are free, like the air we breathe, so some people show up
every day for an expensive new styling, the government pays out more and
more, barbers revel in their huge new incomes, and the profession starts
to grow ravenously, bald men start to come in droves for free hair
implantations, a school of fancy, specialized eyebrow pluckers develops
-- it's all free, the government pays. The dishonest barbers are having
a field day, of course -- but so are the honest ones; they are working
and spending like mad, trying to give every customer his heart's
desire, which is a millionaire's worth of special hair care and services
-- the government starts to scream, the budget is out of control.
Suddenly directives erupt: we must limit the number of barbers, we must
limit the time spent on haircuts, we must limit the permissible type of
hair styles; bureaucrats begin to split hairs about how many hairs a
barber should be allowed to split. A new computerized office of records
filled with inspectors and red tape shoots up; some barbers, it seems,
are still getting too rich, they must be getting more than their fair
share of the national hair, so barbers have to start applying for
Certificates of Need in order to buy razors, while peer review boards
are established to assess every stylist's work, both the dishonest and
the overly honest alike, to make sure that no one is too bad or too good
or too busy or too unbusy. Etc. In the end, there are lines of
wretched customers waiting for their chance to be routinely scalped by
bored, hog-tied haircutters some of whom remember dreamily the old days
when somehow everything was so much better.
Do you think the situation would be improved by having hair-care
cooperatives organized by the government? -- having them engage in
managed competition, managed by the government, in order to buy haircut
insurance from companies controlled by the government?
If this is what would happen under government-managed hair care, what
else can possibly happen -- it is already starting to happen -- under
the idea of *health* care as a right? Health care in the modern world
is a complex, scientific, technological service. How can anybody be
born with a right to such a thing?
Under the American system you have a right to health care if you can
pay for it, i.e., if you can earn it by your own action and effort. But
nobody has the right to the services of any professional individual or
group simply because he wants them and desperately needs them. The very
fact that he needs these services so desperately is the proof that he
had better respect the freedom, the integrity, and the rights of the
people who provide them.
You have a right to work, not to rob others of the fruits of their
work, not to turn others into sacrificial, rightless animals laboring to
fulfill your needs.
Some of you may ask here: But can people afford health care on their
own? Even leaving aside the present government-inflated medical prices,
the answer is: Certainly people can afford it. Where do you think the
money is coming from *right now* to pay for it all -- where does the
government get its fabled unlimited money? Government is not a
productive organization; it has no source of wealth other than
confiscation of the citizens' wealth, through taxation, deficit
financing or the like.
But, you may say, isn't it the "rich" who are really paying the costs
of medical care now -- the rich, not the broad bulk of the people? As
has been proved time and again, there are not enough rich anywhere to
make a dent in the government's costs; it is the vast middle class in
the U.S. that is the only source of the kind of money that national
programs like government health care require. A simple example of this
is the fact that the Clinton Administration's new program rests squarely
on the backs not of Big Business, but of small businessmen who are
struggling in today's economy merely to stay alive and in existence.
Under any socialized program, it is the "little people" who do most of
the paying for it -- under the senseless pretext that "the people" can't
afford such and such, so the government must take over. If the people
of a country *truly* couldn't afford a certain service -- as e.g. in
Somalia -- neither, for that very reason, could any government in that
country afford it, either.
*Some* people can't afford medical care in the U.S. But they are
necessarily a small minority in a free or even semi-free country. If
they were the majority, the country would be an utter bankrupt and could
not even think of a national medical program. As to this small
minority, in a free country they have to rely solely on private,
voluntary charity. Yes, charity, the kindness of the doctors or of the
better off -- charity, not right, i.e. not their right to the lives or
work of others. And such charity, I may say, was always forthcoming in
the past in America. The advocates of Medicaid and Medicare under LBJ
did not claim that the poor or old in the '60's got bad care; they
claimed that it was an affront for anyone to have to depend on charity.
But the fact is: You don't abolish charity by calling it something
else. If a person is getting health care for *nothing*, simply because
he is breathing, he is still getting charity, whether or not President
Clinton calls it a "right." To call it a Right when the recipient did
not earn it is merely to compound the evil. It is charity still --
though now extorted by criminal tactics of force, while hiding under a
dishonest name.
As with any good or service that is provided by some specific group
of men, if you try to make its possession by all a right, you thereby
enslave the providers of the service, wreck the service, and end up
depriving the very consumers you are supposed to be helping. To call
"medical care" a right will merely enslave the doctors and thus destroy
the quality of medical care in this country, as socialized medicine has
done around the world, wherever it has been tried, including Canada (I
was born in Canada and I know a bit about that system first hand).
I would like to clarify the point about socialized medicine enslaving
the doctors. Let me quote here from an article I wrote a few years ago:
"Medicine: The Death of a Profession." [*The Voice of Reason: Essays in
Objectivist Thought,* NAL Books, c 1988 by the Estate of Ayn Rand and
Leonard Peikoff.]
"In medicine, above all, the mind must be left free. Medical
treatment involves countless variables and options that must be taken
into account, weighed, and summed up by the doctor's mind and
subconscious. Your life depends on the private, inner essence of the
doctor's function: it depends on the input that enters his brain, and on
the processing such input receives from him. What is being thrust now
into the equation? It is not only objective medical facts any longer.
Today, in one form or another, the following also has to enter that
brain: 'The DRG administrator [in effect, the hospital or HMO man trying
to control costs] will raise hell if I operate, but the malpractice
attorney will have a field day if I don't -- and my rival down the
street, who heads the local PRO [Peer Review Organization], favors a CAT
scan in these cases, I can't afford to antagonize him, but the CON boys
disagree and they won't authorize a CAT scanner for our hospital -- and
besides the FDA prohibits the drug I should be prescribing, even though
it is widely used in Europe, and the IRS might not allow the patient a
tax deduction for it, anyhow, and I can't get a specialist's advice
because the latest Medicare rules prohibit a consultation with this
diagnosis, and maybe I shouldn't even take this patient, he's so sick --
after all, some doctors are manipulating their slate of patients, they
accept only the healthiest ones, so their average costs are coming in
lower than mine, and it looks bad for my staff privileges.' Would you
like your case to be treated this way -- by a doctor who takes into
account your objective medical needs *and* the contradictory,
unintelligible demands of some ninety different state and Federal
government agencies? If you were a doctor could you comply with all of
it? Could you plan or work around or deal with the unknowable? But how
could you not? Those agencies are real and they are rapidly gaining
total power over you and your mind and your patients. In this kind of
nightmare world, if and when it takes hold fully, thought is helpless;
no one can decide by rational means what to do. A doctor either obeys
the loudest authority -- *or* he tries to sneak by unnoticed,
bootlegging some good health care occasionally *or,* as so many are
doing now, he simply gives up and quits the field."
The Clinton plan will finish off quality medicine in this country --
because it will finish off the medical profession. It will deliver
doctors bound hands and feet to the mercies of the bureaucracy.
The only hope -- for the doctors, for their patients, for all of us
-- is for the doctors to assert a *moral* principle. I mean: to assert
their own personal individual rights -- their real rights in this issue
-- their right to their lives, their liberty, their property, *their*
pursuit of happiness. The Declaration of Independence applies to the
medical profession too. We must reject the idea that doctors are slaves
destined to serve others at the behest of the state.
I'd like to conclude with a sentence from Ayn Rand. Doctors, she
wrote, are not servants of their patients. They 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 battle against the Clinton plan, in my opinion, depends on the
doctors speaking out against the plan -- but not only on practical
grounds -- rather, first of all, on *moral* grounds. The doctors must
defend themselves and their own interests as a matter of solemn justice,
upholding a moral principle, the first moral principle: self-
preservation. If they can do it, all of us will still have a chance. I
hope it is not already too late. Thank you.
--------------
Copies of this address in pamphlet form are available for $15 per 100 copies
or $125 per 1000 copies from: Americans for Free Choice in Medicine, 1525
Superior Ave., Suite 100, Newport Beach, CA 92663, Phone (714) 645-2622, Fax
(714) 645-4624. Copies of Dr. Peikoff's lecture, "Medicine: The Death of a
Profession" may be purchased in pamphlet form for $2.50 each (catalog number
LP04E) from: Second Renaissance Books, 110 Copperwood Way, P.O. Box 4625,
Oceanside, CA 92052, Phone (800) 729-6149. (Quantity discounts are also
available: $1.85 each for 10-99 copies, catalog number LP66E, $1.50 each for
100-499 copies, LP77E; $1.25 each for 500-999 copies, LP88E; and $1 each for
1000 copies and over, LP99E.)
Also available from Second Renaissance is the pamphlet "The Forgotten Man of
Socialized Medicine: The Doctor," containing articles by Ayn Rand and
Leonard Peikoff. (Catalog number AR10E, $2.95)
Additional information on why national health care programs don't work is
available from: Objectivist Health Care Professionals Network,
P.O. Box 4315, South Colby, WA 98384-0315, Phone (206) 876-5868, FAX
(206) 876-2902. This organization publishes a newsletter on health care
and distributes a copy of it in their health care information package.
--------------
Almost ten years ago, Leonard Peikoff predicted that our medical system
would be dismantled. Looking at the young people in the crowd,
he remarked:
"If you are looking for a crusade, there is none that is more
idealistic or more practical. This one is devoted to protecting
some of the greatest [men] in the history of this country. And it is
also, literally, a matter of life and death---YOUR LIFE, and that of
anyone you love. Don't let it go without a fight!"
From "Medicine: The Death of a Profession" by Leonard Peikoff from
concluding remarks from 1985 presentation with Dr. Michael Peikoff.
--------------
Dr. Leonard Peikoff, author of *The Ominous Parallels* and *Objectivism:
The Philosophy of Ayn Rand* was a long-time (30 year) associate of
the novelist/philosopher Ayn Rand and upon her death in 1982 was
designated as her intellectual and legal heir. He received his Ph.D.
from New York University in 1984 and taught at Hunter College. Over
the years, he has served in the capacity of professor of philosophy,
lecturer and chairman of the board of the Ayn Rand Institute and is
currently one of the principal lecturers and instructors of the
Objectivist Graduate Center. He has lectured extensively at such
prestigious speakers' forums as Ford Hall Forum in Boston on several
topics including philosophy and current events. Additionally, outside
of academia, he has taught courses on philosophy, rhetoric, logic
and Objectivism audio version of which are available from Second
Renaissance Books listed above.
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