sexta-feira, 26 de abril de 2013

What Americans can learn from the flawed battle against socialized medicine in Canada

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2076448655_6e428847e7_oIn my recent interview with Sally Pipes about Canadian health care, we discussed how Canada succumbed to socialized medicine. According to Ms. Pipes, calls for government-provided health care began in the province of Saskatchewan in the 1940s. The discussion brought to mind Ayn Rand's own comments on the events in Saskatchewan, which she gave in a talk to doctors in 1963 ("How Not to Fight Against Socialized Medicine"). Her comments remain applicable to the fight for freedom in medicine in America today.

The day socialized medicine went into effect in Saskatchewan in 1962, the doctors in the province went on strike. But though "right [was] on their side," and though they had the "overwhelming sympathy and support of the Canadian people," the doctors quickly surrendered. "They were defeated," according to Rand, "not by the power of the socialists, but by the gaping holes in their own ideological armor."

Said Rand:

[The doctors] 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. . .

[T]he 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 are Rand's]

According to Rand, such a defense actually works in the favor of the proponents of socialized medicine. "[I]f 'service' to the [patients] is our primary goal," she pointed out, "why should these masters pay us or grant us any rights? Why shouldn't they dictate the terms and conditions of our work?"

What the doctors in Saskatchewan were missing was the confident moral assertion of their own rights. Rand put it as such:

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.

Such moral confidence continues to be largely absent in the health care debate today. For example, consider this statement by Docs 4 Patient Care (a doctors' organization committed to fighting Obamacare), found in their "prescription for reform":

Docs 4 Patient Care is an organization of physicians dedicated to the preservation of the doctor-patient relationship. . . .Our primary concern is the health and well-being of our patients. An additional concern is the health and well-being of our country—physically and financially.

Those are certainly legitimate concerns, but what about the concern that government intrusion in medicine violates a doctor's right to practice medicine as he sees fit? There is no mention of this in D4PC's document (despite the good work they otherwise do). The fight for freedom in medicine would certainly be strengthened with its inclusion.

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