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Notice: The fol­lowing article is Copy­right 1993 by Leonard Peikoff and is being dis­trib­uted by per­mis­sion. This article may be dis­trib­uted elec­tron­i­cally pro­vided that it not be altered in any manner what­so­ever. All notices including this notice must remain affixed to this article.

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.

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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.

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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.

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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.