Thursday, June 19, 2008

Dr. Paul Hsieh- Free-Market Healthcare Activist

I've just started circulating a version of this letter to my fellow
physicians in Colorado and submitted it to "Colorado Medicine" which
is the bimonthly magazine of the Colorado Medical Society. They've
printed two of my pieces in the past, so I'm hoping they'll print this
one in their July/August issue.

The following is a slightly edited version suitable for a general
audience. Please feel free to forward this to any interested parties.

By the way, here are a couple of positive response I've already
received from physicians whom I have never met. There are probably
people out there who support many of our ideas, but who feel they are
in a lonely minority. As we activists continue to speak out on
various issues, we may find that we have more supporters than we
realize, both among Objectivists and non-Objectivists.

You know that you're doing something right when one of them quotes Ayn
Rand back at you...

1) "Excellent letter! ...I strongly support your ideas. I have also
read your great dissertation in 'The Objectivist Standard' to which I
subscribe… Keep up a great work! Always remember Ayn Rand's maxim: "He
who fights for the future lives in it today". Thank you so much!"

2) "Once again thanks for so eloquently expressing the views of the
'silent majority'!"

Paul Hsieh, MD
Sedalia, CO
Co-Founder, Freedom and Individual Rights in Medicine (FIRM):

"Universal Health Care: The Wrong Prescription"
By Paul Hsieh, MD


Now that the 2008 election season is shifting into high gear, health
care is poised to become an important political issue again.
Unfortunately, most of the discussion assumes that "universal health
care" is a desirable goal and that the only question is how best to
achieve this aim. I wish to argue the exact opposite -- that the very
goal of "universal health care" is unethical and antithetical to core
American values. Hence, "universal health care" should therefore be
rejected by Americans voters.


The first question to consider is whether there is a "right" to health
care. That single question more than any other drives the rest of the
policy debate.

Is health care a "right"? The answer is "no" -- health care is a
*need*, but not a right. The two are not the same. A right is a
freedom of action one possesses, such as the right to free speech.
Rights impose no obligations on other people, other than the negative
obligation to leave one alone. Rights are not automatic claims on the
goods and services produced by others -- that is just state-sanctioned
theft. In particular, one man's need does not give him an automatic
claim on his neighbor's assets. If a man is hungry, he doesn't have
the right to take a can of soup from his neighbor's pantry. A man's
rights only imposes the negative obligation on others to *not* violate
that right. But it does not impose a positive obligation on everyone
else to provide for all his needs.

To illustrate the crucial difference between a need and a right,
consider a child who has contracted a fatal disease through no fault
of his own, such that he would die without a bone marrow transplant
from his next-door neighbor, the only person who was a fortuitous
match. That child's *need* does not constitute an automatic *right*
to his neighbor's bone marrow. The neighbor is of course free to
voluntarily choose to donate some of his marrow, and most people in
that situation would happily do so. But if for whatever reason he
chooses not to (e.g., religious reasons, fear, or personal
preference), we must respect his right. We would never condone the
government strapping that man down and forcibly taking his marrow from
him without his consent.

This distinction between a need and a right is not unique to health
care, but is just an application of a broader principle. A drowning
child might need another's help to live. Again, I (and nearly every
other decent person) would gladly offer voluntary assistance if I
thought I had a reasonable chance of success. But there is no legal
obligation for a random passerby to help. The child can ask for help
out of voluntary charity, but he cannot demand it as a matter of
*right*. And if a random passerby saw that drowning child and chose
not to act, we must respect that right. If it turned out that he was
a strong swimmer and could have saved the child with little risk to
himself but deliberately chose not to do so, then we could hold him up
to moral censure. He might then lose his job, his friends, and the
respect of his peers. But (assuming he wasn't the original cause of
the child's danger), we cannot send him to jail for doing nothing.
The law should not (and correctly does not) place a binding positive
legal obligation on a man to save another person's life.

Similarly, the law should not force one man to pay for another's
cancer treatment even if a second person needs it. One question that
is frequently asked is, "Who will pay for the health care of those who
need it, but can't afford it?". The answer is, "Anyone who wants to."
If a patient needs medical care but is unable to afford it, he can
ask for voluntary charity from others. But he cannot *demand* it as a
right. As a physician facing these situations, I've gladly waived my
fee more times than I can count in order to help worthy patients, and
the same is true of nearly every other doctor I know. Americans have
always been very benevolent towards fellow Americans who have run into
adverse circumstances through no fault of their own. We've seen this
in the repeated outpourings of aid for victims of natural disasters
such as hurricanes or earthquakes, as well as for victims of man-made
evils such as 9-11 or the Oklahoma City bombings.

The very fact that such examples tug at the sympathies of ordinary
decent Americans also means that those Americans will be forthcoming
with voluntary charity. I fully support giving to charities that are
consistent with my values and priorities.


This approach works in both directions. For instance, what would I do
if I developed a deadly illness and needed, say, $500,000 worth of
medical treatment but couldn't afford it?

My answer is as follows: My life is my own responsibility. Others
may choose to voluntarily help me if I am in need, but they should not
be legally *required* to do so -- i.e., they should not be forced by
the government to help me against their will or punished by the
government for failing to help me.

Hence if I needed expensive medical care, I might borrow money from
family and friends. Or I might ask for charitable donations. Or I
might try to enroll as a volunteer for an experimental drug trial for
my condition.

But I wouldn't hack into my neighbor's bank account and steal the life
savings he was planning to use to pay for his kids' college education
and his own retirement. Nor would I steal $500 from a thousand of my
neighbors. Nor would I ask the government to take it from my
neighbors by force. Those actions would all be morally wrong.

Similarly, if my next-door neighbor were the only possible matching
bone marrow donor to cure my rare disease but he didn't want to donate
any to me for whatever reason, I wouldn't strap him down and take it
from him by force (or have the government force him).

Of course, I would prefer to live rather than die of a terrible
disease. But I wouldn't want to live if it costs me my integrity and
my self-respect. A man can't "save" his life at the price of
sacrificing his morality, since morality is the very means that a man
survives as a man.


Some claim that the government should guarantee "universal" health
care to promote the common welfare of all citizens. This view is
wrong, because it is based on a serious misunderstanding of the proper
role of government.

The purpose of government is to protect individual rights -
specifically to protect individuals from the predations of others who
would use force to deprive men of their rights to life, liberty, and
the pursuit of happiness. This includes protecting Americans from
external enemies who would wage war on us as well as from internal
criminals who would use force to steal, murder, rape, etc. The
purpose of a government is to create and enforce conditions where men
and women can freely and voluntarily exchange ideas, goods, and
services to their mutual benefit according to their best rational
judgment, without fear that someone else will try to forcibly rob them
of those benefits. Man's essential nature requires that he uses his
reasoning mind to create the values necessary for sustaining his life.
Hence, the basic and fundamental purpose of a government is to protect
a man's right to the free use of his mind and his corollary right to
voluntarily trade with others for the products of their thought and

When a government ceases to protect individual rights and instead
becomes one of the chief violators, then it undermines the very reason
for its existence. It would be akin to a government claiming that "we
need to protect the freedoms of Americans from enemies abroad", and
then imposing a military draft on young Americans to fight in a war
(violating those draftees' freedom and rights in the process).

The same is true when the government attempts to guarantee health care
as a "right". This can only be done by forcing providers to treat
patients on the governments' terms and for the governments' prices,
and also forcing citizens to pay for others' medical care against
their will. This is inherent in any system of "universal" health
care. When providers and citizens help patients from voluntary
charity, then these can be acts of tremendous kindness and nobility.
But when the government forces those same actions in an attempt to
manufacture an alleged "right" to health care, then it violates the
actual rights of physicians and citizens alike.


"Universal" health care is morally wrong, because it incorrectly
treats health care as "right" rather than as a need. This necessarily
results in a system of immoral forced positive obligations that
violates genuine individual rights.

In contrast, free market reforms have been shown to bring down health
care costs, improve quality, and increase access, while respecting
individual rights. Just a few examples of such reforms include
allowing patients to purchase health insurance across all 50 states,
eliminating onerous mandated insurance benefits which merely raise
costs to benefit a few special interests, allowing in-store health
clinics to serve patients, and allowing individuals to purchase Health
Savings Accounts to cover small routine expenses, while using
high-deductible, catastrophic-only insurance policies to cover their
major medical expenses. Such reforms could lower costs by 50% or
more, making quality health care available to many who cannot
currently afford it.

The standard pattern of the free market is for prices to fall and
quality to rise over time, as anyone who has recently purchased a
computer can easily attest to. America does not currently have a free
market in medicine - instead, it is a semi-free mixture of some market
elements combined with heavy government regulations. But those
sectors of medicine such as LASIK and cosmetic surgery which are the
closest to a free market (i.e., least regulated by the government)
have shown the same pattern of falling prices and rising quality that
we take for granted in the rest of the American economy. Instead of
adopting failed models of socialized medicine from other countries, we
should unleash the proven benefits of the free market to all sectors
of medicine.

As a physician, my patients trust me with their health and their
lives. I cannot betray that trust by turning them over to the tender
mercies of a government-run "single-payer" or "universal" health care
system administered by the same people who run the Department of Motor
Vehicles. Americans deserve the best, which only a free market can
provide. If we value our lives and our health, we must not settle for
anything less.

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