The Gunk Club

I had thought there was an almost infinite amount of health reform debate on the web -- but I was sort of wrong, because it seems that about 25% of it is the work of Dr. Paul Hsieh, the co-founder, most prolific author, and most furious reposter of the group FIRM (Freedom and Individual Rights in Medicine). So hey, I like freedom, and I'm real big on individual rights -- what's not to love?

Oh, right. Gunk. FIRM's other co-founder is Lin Zinser, JD (if you squint hard enough, it looks like 'MD'), who is an employee of the Ayn Rand Institute (scroll to the bottom) in charge of "outreach to professional communities". In fact, almost all links going to and coming from FIRM's web presence go to magazines and communities associated with Ayn Rand's philosophy, Objectivism. But hey, I like philosophy. No philosophy could possibly be made of gunk, could it? It couldn't, under any circumstances, be positively dripping with gunk, now, could it?

The gunkiest part of Objectivism, first theorized by Russian-American exile Ayn Rand during the height of the Cold War (she served, actually, as a friendly witness to the House Un-American Affairs Committee, which kicked off the Red Scare), is its ethics. Objectivist ethics are founded on what they call rational self-interest, with an emphasis on the self-interest. One of her most famous characters, John Galt, makes this oath: "I swear — by my life and my love of it — that I will never live for the sake of another man, nor ask another man to live for mine." In another of her novels, The Fountainhead, when architect Howard Roark feels that the vision of the building he's designed has been altered, he blows it up, regardless of the fact that he didn't physically build it and doesn't own it.

"Rational" self-interest is what Objectivists like Hsieh and Zinser are talking about when they publish articles like "Health Care is not a Right" or insist that "the law must respect the individual rights of doctors and other providers, allowing them the freedom to practice medicine. This includes the right to choose their patients, to determine the best treatment for their patients, and to bill their patients accordingly." The vision of a doctor as someone who serves others out of love for humankind, or in order to create a more perfect society, never enters into the equation: doctors have the skills to heal, and they exchange them for profit. That's all. If it is more profitable for doctors to enrich themselves by treating a few people and ignoring the rest, then they should do it -- they have to do it, it's their moral responsibility.

What is most infuriating, though, about Objectivist self-interest is that it willfully ignores the contributions of others towards creating the very privilege that gives doctors their special knowledge and skills. Paul Hsieh got his MD from the University of Michigan, and Lin Zinsler attended not one but two state schools -- taxpayer funded, socialist education -- but even if they had been private school graduates, and hadn't received any government loan options, scholarships, or other community support, they would still be constantly dependent on the rest of us for day to day survival. Paul Hsieh is a radiologist -- he spends his days, I would guess, with complex CT, MRI, X-ray and other scanning machinery, each having hundreds to millions of parts, each part requiring its own manufacture, its own raw materials, and its own know-how. It is incontrovertable that one of those miners, manufacturers, plastics assemblers, or welders is uninsured or underinsured. That without the labor of people who Objectivists look down on, and intentionally refrain from helping, they would be unable to perform the tasks that bring them such pride and wealth.

Saying that doctors should have 100%, individual, self-interested control over who to treat and when is counter to the Hippocratic oath, which promises that "in every house where I come I will enter only for the good of my patients." To accept public funds and support for your own medical education, and then claim that public health care is immoral, is what we call the classic, creamy-style, industrial grade gunk.