The Misunderstood 47 Million Uninsured

Over and over again, we are told that there are 47 million uninsured Americans. My own simple-minded Senator, Ben Cardin of Maryland, just wrote me an e-mail note attempting to justify the Children's Health Insurance Program with the opening sentence of "Currently, more than 47 million Americans lack insurance coverage and approximately 9 million of the uninsured are children." Then he and many others claim that health care is too expensive for Americans. We are to uncritically assume, and it appears that most of us do, that the 47 million uninsured Americans are uninsured because they cannot afford adequate or even inadequate health insurance. But, worst of all, this is a play upon our good nature and our concern for the welfare of other Americans, which is supposed to imply that if we wish to be a good person, we must be willing to consent to a partial enslavement of all of us and an extensive enslavement of health care professionals so that 47 million desperately poor Americans will have health care.

Charles, you say, it is outrageous that you equate proposed government-provider systems that would tax us all and then spread the health care benefits over all or some favored sub-group of Americans with partial enslavement of us all. And then you even say that the government regulation of the resulting health care system extensively enslaves American health care professionals. Just because we are going to force everyone to participate in this universal, one provider plan does not make it slavery. After all, we simply want to take care of those who cannot take care of themselves. To which I reply, when you do not allow people to manage their own lives, you have enslaved them. When you will not allow them to own their own life, the liberty to make their own choices, and to pursue their own idea of happiness, you have enslaved them. That you claim to be motivated by paternalism does not even differentiate yourself from the plantation owner of the antebellum South who often claimed he was taking care of those who could not care for themselves.

If there were 47 million Americans without health insurance and they could not afford it, then we would simply be in the situation of earlier times or of much of the rest of the world. But because we have had some respect for individual rights in America and we often claim that we believe in the right to life, liberty, and the pursuit of happiness, Americans have enjoyed a widespread prosperity which has greatly improved the lives of every income strata among Americans and has specifically delivered them the best health care system in the world. We provide a very disproportionate share of the medical innovation and win most of the Nobel prizes in Medicine, as well as those in the sciences, which often also support medical innovations. We develop a disproportionate share of the new drugs. Our medical professionals provide timely care for life-threatening medical problems which puts all of the basic care only and highly rationed higher end care provided by national medical systems in other otherwise advanced countries to shame. Canadians must come to the U. S. for many live-saving operations that Canada will schedule them for only after they are dead. This makes for an interesting approach to reducing the demand for operations which the state system would have to provide manpower and care for. Canada exports much of its medical expense to the U.S.

However, the 47 million Americans without health care insurance is a fraudulent figure. Of this 47 million, 10.2 million are not U. S. citizens. Of course, many of them are Americans, but only in the sense that they are citizens of countries elsewhere in the Americas! But this is not what most people are thinking when this figure is given. So, fewer than 37 million U. S. citizens are without health insurance.

The next important point is that many American citizens who have the means to buy insurance, choose not to do so. 8.5 % of those with household incomes greater than $75,000/year do not have health insurance. Of course, some fraction of these people have so much money that they are fully justified in regarding themselves as self-insured and there is simply no reason to pay a middleman. Bill Gates, Warren Buffet, and even The Donald have no need for health insurance. But, apparently a great many other people making good money do not need it either, although some of them do not have it simply because they are in the midst of changing jobs. There are 9.3 million of these well-off people. Then there are the rest of those who make more than the national average for a household and yet do not have health insurance. Of those households with incomes between $50,000 and $74,999 a year, 14.4% do not have insurance. This is another 8.5 million people. So, 17.8 million people can afford health insurance, but choose not to buy it. Again, many of this group are only briefly without insurance as they change jobs. A large fraction also goes without insurance because they regard themselves as too healthy to want to buy insurance to subsidize the health care of those who are less healthy! This is a manifestation of their pursuit of happiness. I have a nephew who has made this choice.

At this point, we are left with only 19.0 million Americans without health insurance. Of these, once again many are without health insurance only briefly as they change jobs. Some also are eligible for government health programs, but do not apply. John Stossel found that about a third of those eligible did not apply. Americans without health insurance make frequent use of hospital emergency rooms, which are required to provide them with medical care. They also use Medicaid in many instances. So, it is simply not the case that many millions of Americans cannot get medical care. Any implication that this is the case is fraudulent.

There are serious problems with our medical care system, but they will not be improved by making it a national system, if the problems rampant in Medicare and Medicaid can teach us any lessons at all. Or, if we can learn anything by examining the national health care systems of Canada or the United Kingdom. Our problem is that 86% of all American health care purchases are handled by third parties. This means that the patient has little to no incentive to demand cost-effective health care. The result is that little attention is paid to being cost-effective. My mother has a habit of asking medical care givers to justify the high costs of her and my Dad’s medical care and they very commonly are indignant that she cares. They say that she should have no interest in the matter, since she is not paying for it.

Another problem with our system is that it is so geared to the avoidance of legal suits, that one cannot get a straight answer from most doctors about almost any medical question. The profession has decided that certain procedures are to be considered acceptable practice and that if one stays strictly within those practices, then there should be no legal problems. This causes a different set of problems. For one thing, people are highly unique and what is statistically the most likely procedure to be successful, may well be the wrong procedure for a given non-conforming individual. Yet the doctor is unwilling to devise a procedure for the non-conformer, since to attempt to do so means he will have to leave the comfort zone of the accepted common procedure that protects him from law suits. In fact, I have heard of cases in which doctors gave advice they knew was wrong for a given patient, simply so they would remain consistent with convention. There are also cases in which the doctor believes that the chances for failure of a treatment are high and will not provide it even if that treatment is the only life-saving option for the patient. This is because to fail is to be open to a lawsuit.

So, if you actually do care about your fellow man, instead of making fraudulent claims about 47 million uninsured, do something to allow doctors and other medical professionals to really provide medical care without being totally paralyzed by fear of lawsuits. If you really care, let us change the tax code so that Americans will buy their own healthcare plans, be the guardians of their own costs, and be able to choose from many more treatment options which will be made available to them in a timely way.

50th Anniversary of the Publication of Atlas Shrugged

In October of 1957, Ayn Rand's great novel Atlas Shrugged was published. I was not aware of it, being 10 years old. Much of the rest of the world was not aware of it for some time either, much to Rand's disappointment. Not even the truly creative builders of the world, for whom she fought so hard to bring admiration, seemed to take notice of the valiant and revolutionary defense of reason, egoism, happiness, production, and of Capitalism and free trade which she had provided in the 14 years she had labored since the publication of The Fountainhead in 1943. At the recent Atlas Society celebration of Atlas Shrugged in Washington, DC (yes, the heart of the brutal anti-individualist beast itself) on the 6th of October, Barbara Branden made very heartfelt comments on how America's businessmen had failed Ayn Rand and a rational Capitalist society when they failed to rally to the defense of Atlas Shrugged, as most of academia and the media attacked it or ignored it. Fortunately, many admirers of her work came eventually to discover Atlas Shrugged, making it the book most cited after the Bible as the work which has most influenced people's lives in America. It continues to this day to be a best-seller year after year, selling 140,000 copies a year.

While large numbers of people who have read Atlas Shrugged love it, very many of them do not make that love known to many of their acquaintances and family. Her novel clearly rejected socialism in all of its variants and it was clearly not consistent with religious conservativism either. Consequently, both the left and the right rejected it, usually with considerable hatred. Another good fraction in the middle of the political spectrum ignored it because many of them are apathetic about philosophy, history, and politics.

The socialists hate individualism, since no collective, communitarian scheme can accommodate the complex individuality of man. When the individualist claims that the right to his life implies that he has the right to his own body, he must exercise personal responsibility in his own health and its care. This means that he has the right to provide himself with the best medical care he chooses and to either have or not to have medical insurance. Individualists who choose not to use their money for medical insurance, but can certainly afford it, number about 18 million of those 47 million who are said to live in the United States without medical insurance. The socialists want their audience to assume the 47 million to be poor Americans in need of governmentally assured medical insurance. Other individualists want better medical care than the government will provide and they want it when they want it, not 6 months or a year later as is common in the socialized medicine nations. Still others want to smoke or drink without having to pay punitive taxes to a Nanny state. Then we individualists think we know better how to spend our hard-earned income than a democratic mob listening to demagogues lusting for power. We view the use of our earnings as an essential manifestation of our liberty and our pursuit of happiness, as did the Framers of The Constitution. If our earnings and our property are not truly ours to dispose of, then we are not free to manage our own lives. We think the socialist is utterly presumptuous in believing he can manage our lives better than we ourselves can. But, the socialist is a brute who not only thinks he knows what our values should be better than we ourselves do, but that he has the right to hire government thugs to beat us brutally until we give into his vision of what each and every individual life should be. The socialist wants to design a cookie-cutter life for each of us and does his best to use the public schools as his propaganda tool to this end. Commonly, she or he feels very maternal or paternal in helping the great unwashed masses to make the right decisions. This view holds that most people are incapable of managing their own lives and requires that every adult be continuously treated like a child, with no prospect of ever growing up.

The religious conservative is often thought to be essentially the opposing force in our society. However, the religious conservative often shares a substantial part of the vision of the socialist. He holds that every man is a sinner and that every man needs God to help him manage his life. Man is the equivalent of a sheep, a very dumb animal, which requires the constant supervision of the shepherd. Of course, the priesthood is happy to provide the earthly portion of this shepherd function and it is their route to power and paternal presumptions. Again, the ordinary man is a child at best. Now, the government is to enforce seemly behavior according to the Bible, or the Koran, or Jewish or Hindu teachings. So, here again the individual who does not accept the authority of the Bible, the Koran or the dominant religious teachings of his region, is allowed little opportunity to manage his own life. He is thwarted in many ways from exercising his sovereign right to life, liberty, and the pursuit of happiness. The religions almost always frown upon earthly pleasures to a substantial degree. Commonly, they hold prejudices against wealth and property, many aspects of free trade, many of the many joys of sex, and any vision of man as heroic. Commonly, one's sovereignty of body is crimped sexually and a woman's right to make decisions about that part of her body which is a fetus is denied. Commonly, freedom of conscience is limited when such freedom is not consistent with the regional religious teachings. So much for the right to life which must start with the right to manage one's own body and mind. Should one be homosexual, then the freedom to enjoy an equivalent partnering contract to that offered man and wife is denied. Forget about being bisexual, a bigamist, or polyamorous if one expects equal treatment before the law. Such expressions of individuality are denied by old books. No, wait, being a bigamist or more, is actually endorsed by many of the same old books invoked to deny other freedoms, but still the modern religion holds this evil. Go figure.

So, along came Ayn Rand. While very spiritual, it was the spirit of an earthly, rational, productive, and happiness-seeking man that she worshiped. She recognized that man lived by his rational faculty, which was his sole source for understanding reality. She reveled in the accomplishments of mind that many people contributed in their professional careers and thought that the system which most enabled these accomplishments was the Capitalist system of free trade in goods, services, and ideas. Religious tribalism or feudalism and socialism, whether of the fascist or communist varieties, squelched the mind and inhibited man's quest to thrive on this earth. She unabashedly identified the source of man's progress in the fruits of individual minds. She endorsed rationality, individuality, ethical egoism, productive achievement, and the quest for personal happiness.

Politically, a highly limited government, such as the framer's of The Constitution attempted to give us, was necessary if man were to be able to exercise his individual right to life, liberty, and the pursuit of happiness. Unfortunately, Americans have always been ambivalent about endorsing rationality, individuality, ethical egoism, productive achievement, and the quest for personal happiness. More than any other country on earth, we tolerated, and sometimes encouraged these human pursuits, but in early times, ancient religious belief interfered and now, more and more, a cheap desire to escape personal responsibility manifests itself in socialist evasions. Along the way, our Constitution has been reinterpreted to turn a requirement that the government behave consistent with the general welfare into an opening to allow almost any government action restricting the rights of the individual if only it was claimed to be in the name of the general welfare. If this had been the intention of the Framers, why would they try so hard to enumerate the few powers that government had? If this broadening of power was not enough, many others, such as a huge broadening of the mandate to regulate interstate trade has been added. It is difficult to make an argument so convoluted and trivial that it is not held that the government has a power to restrict many human activities based upon the commerce clause. As Judge Narragansett says in Galt's Gulch in Atlas Shrugged, an amendment must be added to the Constitution saying that Congress shall make no law abridging trade and depriving the people of their property. Of course now, we must even buttress our right to free speech, which is cruelly abridged by the McCain-Feingold Act, claimed to be an election reform.

Because of American misconceptions of political freedom, we have a society in which the members are pitted against one another on the basis of the industries they work for, the size of the companies they work for, whether they are management or labor, which quintile of income they fall into, whether they own a home or not, whether they have children in the public schools or not, whether they are man or woman, whether they are heterosexual or otherwise, whether they have bought medical insurance or not, whether they are old or young, and based upon their ethnicity. Because government uses its monopoly on the use of force to take up the part of these various groups against the interests of the opposing group, there are constant battles involving those who seek the unearned and those who seek to defend themselves. These are commonly very messy battles, since they have degenerated into very complex mixtures of the legitimate desire to protect oneself and the dastardly desire to take advantage of others. What could be uglier than parents taking advantage of their children by maintaining a Ponzi scheme social security system? What could be more disgusting than one ethnic group claiming special favors from government and discriminating against other ethnic groups. Shouldn't men be judged by their individual character rather than the color of their skin? The politicians and the media by and large encourage this constant factionalization. It gives them more power and brings them more attention and money. The philosophy is clearly to create conflict and to divide and conquer.

If the individual is ever to recover and then to fully realize his right to life, liberty, and the pursuit of happiness, it will be critical that he understand that man can live in harmony with others only by adapting Ayn Rand's philosophy of Objectivism. If the individual is to be respected, it must be understood that he lives by the product of his rational mind. When no man provides for himself by using force to appropriate the means of their living from others who have produced wealth, income, goods, and services by using their minds, then we can earn the shear joy of living as harmoniously as do the great producers of Galt's Gulch in Atlas Shrugged. By giving us such a life-affirming and inspirational view of the possibility of so much joy in living one's own life and sharing it with worthy friends and neighbors, Ayn Rand has given us a book for the ages. Atlas Shrugged should endure as has Homer's Iliad and Odyssey for showing us man as an heroic and joyous being.

Individuality and Loneliness

There is a constant tension between asserting one's individuality and feeling welcome within a group. In fact, we are all very complex and differentiated individuals and we are also mostly social animals. Many of the most difficult choices we make in life are the result of a tug of war between our desire to be ourselves and our desire to be well-regarded and welcomed by others. In a rational world full of benevolent and tolerant people, the tension in this rope would be reduced, but it would always still be significant with most of the people who may hold the other end of the rope. Of course, they will be different in their capabilities, interests, and values in most cases from ourselves. This is simply a consequence of the complexity and the many differences that exist among people.

To start life, we are different in many ways at birth. We are so complicated at the level of initial biochemistry, that many differences exist between us already. Then, we start experiencing the world and interacting with other people and we each have a unique experience with unique exposures to stimuli from reality. Then, we each make a constant stream of choices in our thoughts and in our actions which have consequences unique to our own life. In the end, there can be no question but that each of us is a highly complex and differentiated individual. This in turn means that if you put any two people on the opposite ends of the rope, there will be tension in that rope. Two sisters at opposite ends of the rope will find times when the tension is great, as will two lovers, two scientists, two farmers, two historians, two philosophers, two friends, two bloggers, two unionists, and two businessmen. The tension is always present at some level.

If we consider even just fairly common traits, we do not find it easy to match two people up on any fairly substantial, yet quite finite set of traits. People have a tendency to be distributed across wide ranges, often along a bell-shaped curve, for given traits. Of course, many people may be close to the maximum of the curve for a given trait, but any two people who are close for that trait may be far apart on the distribution curve for another significant trait. For instance, suppose you are trying to match two people for intelligence, talkativeness, energy level, political beliefs, religious beliefs, and sexual preferences. As we know, it is difficult even with such a limited set of traits to find someone who matches any given individual. In real life, especially if one is looking for a marriageable mate, the number of traits that may be of importance is much greater. We would have to add such items as desire for children, manner of handling money and finances, preferences in homes, driving technique, sharing versus specialization in chores, how to entertain friends, how to interact with each other's family, and how to respond to each other's career needs. Bringing any two lives together is a very challenging task. This is true in many realms beyond that of two marriage partners.

The rope is always under tension. Yet, we are social animals. We want to receive and give affection, we want to exchange ideas, goods, and services, and we want to enjoy and appreciate others who are goal-directed living beings faced with many of the same challenges in life that face us. So, we want to find those to hold the other end of the rope who will not yank us off our feet and will allow us to be the individuals we are. At least, this is what we do if we are rational, because we realize that it is important to also be the individual we are. Less rational people will often try to diminish their individuality to belong comfortably within a large group of people, so they can have any number of people from that group at the other end of the rope without being yanked off their feet. In the Northeastern US and California, many people looking for some large group to belong to will decide to share in the socialist and Europeanized vision of government and society. In the heartland, many people will seek this common ground in a Christian community. In India, they seek it most commonly in Hinduism and the caste system. In Northern Africa and parts of southern Asia, they find it in Islam. Of course, this and other aspects of the common culture in these areas are only a part, though a substantial part, of an effort to reduce the tension in the rope. Most of these efforts involve a considerable sacrifice of individuality and with that a pain of its own.

How much pain there was and how much people had a need to express their individuality has been made very clear by the advent of the Internet and the now widespread communication channels opened between countless individuals seeking to find those who lie on the bell-shaped curve for a given interest or trait near them. For instance, maybe as many as 0.01% of Americans consider themselves to be Objectivists. Despite this small number, there are at least a dozen forums for Objectivists to discuss ideas, each with its own unique flavor. Or, consider the general distain for explicit sex and its public discussion. Yet, the internet is heavily trafficked with hordes of people trying to express their individuality in sexuality which they would never express within their local community. The Internet has become a tool also for finding that mate who might best be a match for marriage. It provides a means to filter through far larger numbers of people than one could ever meet in one's local community or travel to see and it allows people to assert their individuality without as great a risk that it will be discovered at their church, their workplace, or by their political henchmen. So, the Internet has done wonders to redress the constraints put on a person's individuality by the desire to fit in with some group of people without totally suppressing their individuality.

But, there is still that tension of having one realm in which one can be an individual and another in which it is hard to assert that individuality. Yet, oddly, very many of those who try hard to conform in their local community are the individualists of the Internet. Many of them have now been exposed to a higher level of personal expression and therefore freedom on the Internet. As they turn back into their communities, the benefits and the knowledge that have come about other people and their yearnings are bound to have a big impact on the level of benevolence toward individuals and tolerance toward the idea of individuality. This effect will be greater on younger people who came of age on the Internet. Community conformity will be almost certain to diminish over the next couple of decades as a result.

Among many other things, this opens the door for a philosophy for living which stresses individuality. It is also a very strongly positive development because it allows those few people who are willing and able to sustain their end of the rope, when it is under the greater tension characteristic of a little-shared philosophy of life, to meet one another. We Objectivists can at least be a part of a society through the Internet. This Internet society will grow if we practice our rational philosophy rationally. As it does, more and more people who can sustain rope tensions in their local communities of smaller magnitudes will be enticed to become Objectivists. The cost of membership will have to be brought down before a substantial fraction of even the American population will be willing to become Objectivists. If we want Objectivism to become a powerful force in our local world, we must practice both Internet and local community benevolence and toleration. The activation energy for becoming an Objectivist must be decreased, or there will only be a very few Objectivists and too many of them will simply be masochists and contrarians, who will be poor representatives.

Even with the Internet, being an individualist and an Objectivist is a lonely experience. You really must be a strong and resilient person. You must have the strength to bear some rather serious loneliness. Some of that loneliness is the result of already generally being a particularly intelligent person with a strong commitment to understanding reality. That already places you far out on some bell-shaped curves. Then on top of that you reject all the popular philosophies and causes of our time. You reject religion, socialism, environmental animism, tribalism, racism, and simple-minded, relativistic diversity/multiculturalism. You stand out like a sore thumb. You seek company on the Internet then where you can search the entire world and still you find only a small number of individuals you can really admire and whose friendship can be treasured. The cost of loving reality is only exceeded by the cost of acquiring a club to join by denying reality. It remains a fairly lonely business to be an individualist and even more so to be an individualist Objectivist.

Of course, the only real Objectivist is the individualist who expresses his individuality, thinks for himself, lives a productive and creative life, and seeks his own happiness. The orthodox, the cultist, the contrarian, and the masochist do not live the philosophy of Objectivism. They are pretenders or in some cases those who would be carnivores. Life is short and there is much to do. This imposes an economy that dictates against wasting one's time in endless debates with those who will not be convinced by rational argument. One must identify those who treat reality with total respect and ignore those who have other primary allegiances. There are some who distort the findings of science, pick them selectively and in as out-of-context a manner as do the environmental animists while claiming to respect science. This is actually a very fundamental attack on science, one which will totally discredit it, if allowed to go unchallenged.

This attack on science is being carried out very broadly by those environmentalists who falsely claim that there is a scientific consensus that the recent global warming is caused primarily by man rather than by a natural increase in radiation from the sun. But, in some Objectivist forums, there are other attacks upon science. Some are attacks upon quantum theory, which while not yet a completed program, is nonetheless not at fault for the reasons often claimed. Another is an attempt to claim that science has proven that all operations of the mind are now understood in terms of classical physics, classical thermodynamics even! This argument is viewed as a keystone argument that man lacks volition and the mind is really just a very complex program that makes choices. How these choices differ from simple conditional branching in a computer program has not been explained, but these claims have met with widespread acceptance on one major Objectivist forum.

The battle to be true to reality is a never-ending battle and I wonder if I will ever find a reasonable and sustaining number of friends to join me in these battles. If I should not carry the day, at least I will never be defeated! I will be true to my own individual nature and to my primary respect for reality whether I fight alone or with a few magnificent friends. Those who fight under the banner of individuality and reality beside me, I will love.