Financed Medical Care: Only Fair

U.S. hospitals are justified in selling patients’ unpaid bills to banks, credit-card companies, and other financial concerns, which collect the money from the patients and charge interest. Pro or con?

Pro: Services Require Payment

Doctors and nurses get paid salaries. Drugs cost money. Surgical instruments cost money. Bedding, sterilization equipment, and towels cost money. So do property insurance, heating, and water. Hospitals and other medical facilities need an inflow of revenue every month to pay for such things. To afford these expenses, they need to collect money from patients.

It’s that simple.

Yes, finding a way to get coverage for uninsured Americans — and more-comprehensive plans for the underinsured — sounds more humane than handing over outstanding hospital bills to interest-charging third parties. But until a grand solution is realized, hospitals have no choice but to make deals with outside health-care financing entities.

Consumers who defer payments for hospital bills are in essence forcing the hospital to give them a loan, according to Yaron Brook, president of the Ayn Rand Institute in Irvine, Calif.

“There’s no reason a hospital should be funding its patients for anything other than what the hospital’s policy calls for,” says Brook. “If people default, the hospitals shouldn’t have to worry about collecting it. That’s not a hospital’s area of expertise, and is that really something it should expend its resources on? As long as nobody’s breaking patients’ legs for not paying, third-party collectors are fine.”

Con: It’s Just Too Much

Most people default on hospital bills not because they’re dishonest, but because they lack the resources to pay for a service they need. In the U.S., 63 million people have either no insurance at all or some coverage that leaves them responsible for a significant part of the medical costs.

So the solution is to sic over-glorified collections agencies on them? Charge them double-digit interest rates that rise in accordance with how long they take to pay their bills? Wrong.

“Hospitals often know when somebody has poor insurance and that it won’t cover everything, so they know they’ll have to wait for the full payment,” says Katherine Swartz, a professor at Harvard’s School of Public Health. “Third-party collectors don’t know that, so they hound people. It’s better for the hospital to work out payment agreements with patients.”

Furthermore, patients and any accompanying family members generally arrive at emergency rooms harried and consumed with worry. They have little time to consider a hastily completed document that obligates them to comply with payment terms they’d need a lawyer to understand.

Indeed, some consumers have complained they thought they were signing up for an insurance plan that would require them to pay only a modest co-payment. Instead, they get a credit plan with interest rates that in some cases rise as high as 27% if payments are late. Not that such payment plans are totally without effect: They’ll certainly do a great job of perpetuating the circle of poverty.

Reader Comments

European

Outrageous that 47 million Americans are uninsured. Shame on the government.

jim

This is the most egregious method for screwing the poor I've ever seen.

random

Services of health-care providers cost money and even the most charitable of non-profit hospitals and clinics need to recoup their costs by collecting payments. But it's also true that tens of millions of Americans can't pay for emergency or complicated procedures and tests without going broke and since they don't want to die of their problems or complications, they tend to seek treatment first and worry about what it will cost later. A visit to the ER for a relatively mild problem costs around $10,000 for an uninsured patient. I'd like to know how an uninsured household, very likely to have $5,000 in debt and a savings rate of 1% per paycheck can summon this much cash. When people gripe about the "immoral over-spenders who default on loans," they often miss how devastating medical bills can be to even a relatively healthy budget.

I've taken care of someone who's health insurance from a private entity would've been $1,500 a month (no joke, he was gravely ill with multiple ailments) and who's ER visits would've amounted to $16,000 per. If he didn't receive government help in the form of Medicare, I could not imagine how he could ever pay the hundreds of thousands of dollars in medical bills. Those souless enough to declare people like him a moocher on their taxes should be lucky they don't face his ailments and think about the fact that without government help, his life would've been agonizing (and it already wasn't easy) and a decade shorter.

That said, hospitals need to be able to recover their cash, but the contractors to whom they outsource the collection job must be made to understand that these are people who need help and who want to repay their debts, but they need flexibility and compassion rather then angry phone calls telling them to pay up or else. Banks and credit card companies could provide debt consolidation or other services that will help patients pay their bills and for once in the last decade help consumers when giving them credit. Hospitals may not be in the loan business, but banks and credit card issuers sure are.

If we can't find it in ourselves to help people with astronomical medical bills and simply gouge them for money in any way possible to collect on an unpaid bill the size of some people's annual income, the uninsured may have no choice but to self-medicate or simply wither away and die since they're unable to pay for the treatment and they'll be hounded by collection agencies all the way to the grave.

Also, I'm not sure that referring to the president of an Ayn Rand club is wise in such a debate. Rand and her followers were so scared of any form of communal sharing and caring that they probably despite non-profit hospitals because they don't seek wealth from their skills and exist to help people first and foremost. According to an Objectivist, the very notion of caring for someone is an absurd fantasy of the ignorant masses to use Rand's words.

Ameri-CAN!

I have a dog in this fight.

Who here does not like to put food on the table? Who wouldn't like put his kids through school?

Who would like to run a business and lose 15% to theft? Do you think Best Buy, Sears, Circuit City, JC Penney, etc. would be able to survive if that is what happened?

As for the socialized medicine crowd--get a clue. How long do you have to wait for a surgery in Canada or England or France? I can schedule a surgery with less than one week notice if there is a need. Also,how many of our surgical procedures are considered outpatient (same day surgery)as opposed to theirs?

If any of you have ever been to a free clinic and waited for hours on end to see a nurse, that's how socialized medicine is.

And for those not-for-profit hospitals that only offer 10%-15 % discount off the charges, shame on them. I won't get into how charges and costs are totally irrelevant here.

We, as a for-profit hospital, offer the uninsured a 60% discount. And people still won't pay.

John W. Bales

Americans who can afford to pay for their own health care subsidize Americans who can't, by paying higher prices. If a hospital, to remain solvent, must bring in $50,000 for every 10 patients, but only half can pay, then the hospital must charge $10,000 per patient. It's simple arithmetic. Every dollar collection agencies collect from insufficiently insured patients reduces the rates a hospital must charge sufficiently insured patients.

The same principle operates when Americans pay higher prices for prescription drugs than the rest of the world. Since most other nations cap the price of drugs, drug companies must charge Americans more in order to remain sufficiently solvent to develop new drugs. Every time a Canadian or Englishman gets free or cheap prescription drugs, Americans are making up the difference out of their own pockets.

Neil

The root problem with health care in U.S. is the quality of health care being too high. Everybody wants to have 100% success ratios--hence doctors and hospitals have to shell out malpractice insurances to safeguard against the lawyers. That increases the cost of health care. Lawyers demand paperwork, hence insurance companies have to increase administrative expense, thereby affecting monthly health care plans. Bottom line--to achieve 100% results, the average cost of health-care insurance has gone up over 200% in last 10 years--leaving more people uninsured/underinsured.

Do we really need this high success rate? I'd rather see 99% people get cheap affordable health care if it means 10% people get misdiagnosed or bad treatments.

I'm a doctor- if there was an epidemic and I had to chose between saving the lives of 99 people who need to be administered preventive care vs one patient who needs brain surgery- I will chose to save 99 people and let the one guy die!!!
I might be sued for neglect but morally I am ok with that! Shouldn't we be all?

Neil

Steve Henderson

No according to an Objectivist you shouldn't sacrifice your interests to others and the government shouldn't force people to pay for other people's needs. You should definitely care about your values and interests and other people can be incorporated into one's self-interest. Take some time and read Ayn Rand's moral arguments and understand egoism and selfishness before you attempt to attack straw men.

Lars

Hospitals are closing all over the country because they are forced by law to take the indigent into emergency rooms with no expectation of payment on the one hand, and pay outrageous wages coerced by the greedy nurses unions on the other.

The only money that government has to offset the costs of treating these parasites is the money it takes in taxes from self-sufficient wage-earners.

Why must the responsible pay the bills of the irresponsible? There is no logical answer. If you bleeding hearts want to pay the tab for these failures, do it on your own. Give to whatever charity you like. Just keep your hands off of my rightful earnings.

Rakesh Chugh

Are the uninsured deserving of a "break," or a fair plan? Until this country's voters realize that their elected officials are tightly gripped by drug companies and health insurance companies, no rational solution is possible. The entry of "finance" in the equation of health care will only further impair the system's ability to maintain access to patients who depend on it most. I fear that banks and credit card companies do not have an interest in serving patients in the same way as hospitals and doctors. Instead, they intend to develop new "service lines" to gain profits and make up their losses from other failed businesses (ie subprime mortgages).

Paul Hsieh, MD

Dr. Yaron Brook is completely correct. Numerous laws such as EMTALA (the Federal Emergency Medical Treatment and Active Labor Act) force hospitals and doctors to provide medical services at a loss. No restaurant could survive long if it was required by law to provide free meals for anyone who showed up at the front door and said he was hungry. Why should hospitals and doctors have to do so?

The chief cause of the skyrocketing prices in medical care is government interference and regulations, which raise the costs of both medical care and health insurance for everyone. Laws such as FDA regulations, HIPAA requirements, insurance mandates, all contribute to the spiraling costs of health care. These laws violate the rights of doctors, patients, and insurers by preventing them from contracting freely for goods and services according to mutual self interest. As a practicing physician, I know from direct experience that the market in health care is not a free market.

In every other sector of the economy, the free market consistently brings higher quality goods and services for lower prices over time. The same free market principles need to be applied to medical care and health insurance. This is the only sustainable way to bring down the high costs.

Finally, the myth that large numbers of patients are being forced into bankruptcy due to medical expenses is simply not true. Recently (July 2007), Todd Zywicki, Professor of Law at George Mason University School of Law, testified to the U.S. Congress that this was simply not the case. His three central points were:

1) "There is No Evidence That There Has Been An Increase in the Frequency or Severity of Job Loss or Income Interruption as a Result of Health Problems"

2) "There is Little Evidence That Medical Debt Is a Major Causal Factor in Bankruptcy Filings"

3) "[T]here is no evidence that lack of medical insurance is a major causal factor in bankruptcy filings."

His testimony is available online at:
http://mason.gmu.edu/~tzywick2/Medical%20Bankruptcies%20Testimony%20July%2017%202007.doc. "Working Families in Financial Crisis: Medical Debt and Bankruptcy."

Each point is substantiated with the appropriate evidence and citations.

Nimesh Patel

Well why not bring back debtor's prison like we used to have? If people cannot pay their debts, then they have to do hard labor at a prison. Once they serve their sentence, then they can go back into society.

Richard Watts

Random said:"According to an Objectivist, the very notion of caring for someone is an absurd fantasy of the ignorant masses to use Rand's words." This is false. Rand definitely never said anything of this kind, and it is not a part of Objectivism.

I challenge Random to tell us all exactly where in Ayn Rand's works these alleged words of hers are to be found. Tell us the title of the book or article, with chapter and page number, please.

b

"...According to an Objectivist, the very notion of caring for someone is an absurd fantasy of the ignorant masses, to use Rand's words..."

You have no idea what you're talking about.

What you people really want is to use the government to force people to give up their earnings without indulging in any of the 'charity' you praise.

Carl M. Zapffe

Interesting article, scary even, but I have a question. Under U.S. law, hospitals are required to treat all patients, even illegal aliens. Do the hospitals go after illegal aliens to pay their medical bills, or is it just us U.S. citizens?

random

"As for the socialized medicine crowd--get a clue. How long do you have to wait for a surgery in Canada or England or France? I can schedule a surgery with less than one week's notice if there is a need. Also,how many of our surgical procedures are considered outpatient (same day surgery) as opposed to theirs?"

The average wait time for surgeries in the U.S. is measured in months according to AP and BusinessWeek. If there's an emergency need to do a surgery in a week, other patients whose surgeries can wait get bumped down the list to fit it in, and likewise in European countries. If you're sick and need to have an operation, waiting a few more weeks or even a month more than you could is better than dying.

Also what procedure is considered an outpatient or inpatient in what country has no bearing on quality and affordability of care. If all you care about is speed, you're probably not going to get good care by rushing through your treatments. It's a red herring.

"What you people really want is to use the government to force people to give up their earnings without indulging in any of the 'charity' you praise."

So what happens if you need treatment but don't have the money to pay for it? Just roll up and die not to burden anyone else? Is it better to let people die rather then treat them? Imagine you need to have back surgery because the pain won't let you function, but you have no money for it. Are you really going to be so moral as to live with back pain for decades without making a peep about how someone should help you?

News flash: The government takes your earnings every paycheck so it can pay for roads, police, fire fighters, schools, military, sewers, and street cleaning. Should we abandon those, too, because someone is taking your money to provide service for others? Sure, you benefit, but it's your money being used to benefit someone else as well.

Just in case you're sitting around looking at your bank balance and chanting "they're not getting my money," well, yeah--they already did.

random

"I challenge Random to tell us all exactly where in Ayn Rand's works these alleged words of hers are to be found. Tell us the title of the book or article, with chapter and page number, please."

Hmm... I'm being challenged. No, not asked, not invited to, not requested to substantiate my claim but challenged. I might not be able to give exact chapter and page, but I can certainly provide the name of the book and where exactly in the plot these statements are made. Editions and books are different and going through a 700 and a 1,400 page book to find the exact pages of a speech for a debate on health care of all things is simply unreasonable.

Regardless, here are the requested examples.

1. The Fountainhead's protagonist, Howard Roark is on trial for blowing up a housing project for the poor, because the building didn't meet his designs with 100% exactness. Before he designed the project for Peter Keating (who got the nod to develop it from Toohey), he was made aware that there will be a big collaboration of architects on the project and that designs may be changed in their final form. He decides to blow it up because of an unsightly bulge in its side made to accommodate a community gym, and in his long speech to the court, declares that it was his design and no matter how many others worked on it and what changes were made, all that matters is what he thinks about it. He totally ignores that fact that hundreds of people will have nowhere to live now that he destroyed their homes on a whim, but that's interpreted as a good thing because those poor are presented as lazy and ungrateful leeches on society.

2. In The Fountainhead, Ellsworth Toohey's articles and social clubs promoting community and togetherness are revealed by Toohey himself to be part of a nefarious plot to undermine individualism, self-awareness, and self-accomplishment so he and his friends could rule over the clueless masses. He goes into great detail on this with Keating right before Roark's big trial in the climax of the book, and states that being encouraged to care for one another dulls the masses into a sheep-like state in which they strive for nothing but to please others and invent nothing of their own, simply take from those "dangerous minds" who still have a sense of personal self.

3. In Atlas Shrugged, John Gait decides to hide his invention from the world because he's told that it will be used for humanitarian purposes and to help the masses. He deems the masses unworthy of receiving the benefit of his grand invention, because they won't appreciate it's sophistication and he is against any act of charity. Yet he is the person we're supposed to root for.

4. In the scientific utopia of Atlas Shrugged to which Gait and like-minded scientists escape as not to give up their inventions by government decree, they must take an oath not to help anyone and to work only for their own accomplishment. To give up their inventions, they state, is to be at the mercy of the masses and to give up personal accomplishment. If we were to use Atlas Shrugged as a yardstick for what's good in the scientific world, we would have to shun colleges and nonprofit labs working for the government as immoral despite the pioneering work they made in weapons, medicine, and space exploration.

Ayn Rand escaped from a Russia that was becoming more and more totalitarian under the guise of "moral and communal good" and hence she was so scared of anything that had to do with community coming from societal luminaries and government leaders that she started to write parables denouncing communal or social goals as nefarious plots to rule over brilliant minds and force them to work for unappreciative masses. Remember how derisively people are described in The Fountainhead and Atlas Shrugged. They're presented as uncivil, easy to manipulate, sheep-like and too selfish to give anything of themselves other then for the most base and profane reasons.

In Gail Wynand's social experiment in The Fountainhead with a scientist who had a world-changing invention and a pregnant prostitute, both asking for money. The masses choose the prostitute and hence Wynand vowed to write only the raunchiest of tabloids to entertain the small-minded people he so loathed. In Atlas Shrugged, they try to appropriate anything useful for themselves the instant it's made. If this what people were really like, all of North America, Western, Central and the vast majority of Eastern Europe as well as Israel, India, Japan, South Korea, and Taiwan would collapse, their free market economies unable to bear the brunt of the base, greedy populace.

Rand may have been using characters, but the words of protagonists are her personal opinions, and she certainly does say some bizarre things.

sue

It's one thing to require people to pay their hospital bills and another thing to snooker them into agreeing to pay high-interest rates on the debt.

drew

Boy, oh boy. I have a friend from the UK. One time I asked him how much an X-ray would cost there, and he was laughing his head off. The hospital gave him money for his meds after his visit--now that is health care. I doubt we'll ever get that here in the U.S. with the "financed medical care."

KiKi

I worked for a large not-for-profit hospital in the Los Angeles area, so I know a thing or two about what "self pay" patients' visits do to a hospital's bottom line. Our nurses--unionized here in California--are expecting to receive a raise this year, which will add $30 million to our salary expenses. However, we don't have $30 million in extra money sitting around (how many non-profit organizations do you know that do?). That money has to come from somewhere, since the raise is mandated. If we could get the "self pay" patients to pay even a quarter of what they owe, then we could afford the raise. Since they don't pay, however, we are forced to lay off employees instead, to try to bring down our salary expense.

Hospitals, especially the not-for-profit ones, are in a bind. We can't afford for these patients not to pay. Our expenses are too great, and reimbursements from Medicaid, Medicare, and insurance companies are too low to cover the full cost of running a hospital (including the expenses incurred in treating the "self pay" patients).

Juergen

This whole discussion is going the wrong way. Everybody is concerned about patients' not paying their bills. However, it should focus on the point that nearly 50 million Americans are uninsured. In my eyes it is a shame that in one of the richest countries in the world people go broke from being ill. It just makes me sick.

Sebastian Bassi

I live in Argentina, and I believe this is Fourth World (not even a Third World country). But at least if you have a job, you are insured. The only workers not insured are the ones in the black market, but there is no such a thing as having a job not having a medical plan of some kind. Even the unions have medical plans (and all people are part of a union; you can't choose about it).

Squeezebox

If we spread the cost of caring for the sick across the whole populace, the burden should be relatively light. That's what health insurance was supposed to do, but now it's gone from a mutual benefit society to a for-profit corporation. They squeeze doctors, they squeeze employers, they squeeze the insured, and they cherry-pick who will be in the risk pool in order to maximize profits. The best way to ensure all are covered is to force the insurance companies to insure all comers, just as hospitals must treat all comers.

Physician

Most of these comments are missing a significant point: Hospitals charge non-insured patients outrageously inflated prices that the hospitals (and their paid agents) then try to collect aggressively. A hospital will agree to a payment of $15 for an EKG for an insured patient but will charge an uninsured patient $89 for the same test. A hospital might charge an uninsured patient $120 for a blood test, but will accept $10 or so from Medicare or an insurance company for the same test on an insured patient. There are many other examples. In addition, there are issues of blatant overutilization of tests, rampant duplication of charges, and "creative" junk fees that would put mortgage brokers and payday lenders to shame.

These tactics are outrageous and should not be condoned.

FDMOM

Neil, glad you're not our doctor. Our daughter has a rare genetic disorder. There are 450 in the world. Guess you'd be okay with our 12-year-old living with pain and watching her die. Sorry, we can't. I hope that you never are faced with a similar situation that no one planned. All the "healthy living" in the world can't stop every ailment.

We are upper-middle class living paycheck to paycheck as our out-of-pocket keeps going up (I think we'll hit $30,000 this year).

FDMOM

The argument seems to be going after the wrong people. Uninsured and underinsured people pay and are charged significantly higher fees than those with insurance. Even those with insurance are likely becoming underinsured with each passing day.

Insurance conglomerates negotiate fees to the point that no hospital or doctor can cover their costs, let alone make a profit. That's where the crime is. Fight back against the insurance companies.

Fundamentally, we should all have the ability to pay for our own basic medical care. Insurance should cover the catastrophic (which we have in our family--$50,000 in costs in a good year).

Insurance is simply a commodity and payment system now. We want them to pay for everything. They'll pay for stupid stuff, but I have to fight tooth and nail to get appropriate therapy for my daughter or wait a year to be reimbursed for the in-flight oxygen required when seeing her physician (the only one in the U.S.). I wish I could earn my regular salary for the time I spend dealing with claims "specialists" who do everything in their power to not pay. I say, go after the insurance companies for increased payments from their patients. Don't let them become the rulers of the earth.

I'd be happy to pay for a doctor visit if it didn't cost $100 to $200 for 15 minutes of the physician's distracted attention. Distracted because the doctor spent so much of his time bowing to the demands of insurance companies.

The system is completely broken. Only Wall Street and corporate greed prevent it from being fixed.

lifeisbeautiful

I recommend you watch the presidential candidate interviews on their health-care policies, available through the Kaiser Family Foundation at kff.org. There is a one-hour program for each candidate who has agreed to participate, focusing solely on their health-care platforms. This is the No. 1 domestic issue, and you should really know where the different candidates stand. If you have limited time, I would recommend you watch Biden, Clinton, or Edwards (essentially the same) and McCain. (the only Republican to participate so far I believe.). Ask yourself what is fair, what is possible, and who will benefit. Will we be the country we can be, or have our self-interests win the day once and for all?

Corey

Statement 2: Some 47 million Americans do not have health insurance.

This number from the Census Bureau is often cited as evidence that the health system is failing for many American families. Yet by masking tremendous heterogeneity in personal circumstances, the figure exaggerates the magnitude of the problem.

To start with, the 47 million includes about 10 million residents who are not American citizens. Many are illegal immigrants. Even if we had national health insurance, they would probably not be covered.

The number also fails to take full account of Medicaid, the government’s health program for the poor. For instance, it counts millions of the poor who are eligible for Medicaid but have not yet applied. These individuals, who are healthier, on average, than those who are enrolled, could always apply if they ever needed significant medical care. They are uninsured in name only.

The 47 million also includes many who could buy insurance but haven’t. The Census Bureau reports that 18 million of the uninsured have annual household income of more than $50,000, which puts them in the top half of the income distribution. About a quarter of the uninsured have been offered employer-provided insurance but declined coverage.

Of course, millions of Americans have trouble getting health insurance. But they number far fewer than 47 million, and they make up only a few percent of the population of 300 million.

Any reform should carefully focus on this group to avoid disrupting the vast majority for whom the system is working. We do not nationalize an industry simply because a small percentage of the workforce is unemployed. Similarly, we should be wary of sweeping reforms of our health system if they are motivated by the fact that a small percentage of the population is uninsured.

Roderick Fitts

This goes out to "Random."

According to an Objectivist, the very notion of caring for someone is an absurd fantasy of the ignorant masses to use Rand's words.

From the way this sentence is structured, you appear to be quoting someone, evidently an Objectivist. If so, could you name this "Objectivist" so I could ask him where he got his mistaken idea?

The Objectivist virtue of justice states that you should treat others as they deserve, according to their character and actions. Ultimately, this is for one reason: Other people stand to benefit your life or act to destroy it. If you do judge someone as good, as someone who is a value to you, then in action you should care for them, befriend them, and even love them.

Hmm... I'm being challenged. No, not asked, not invited to, not requested to substantiate my claim but challenged.

Why are you acting as if you should be treated with kinder words, such as "requested"? In a debate on health care, you throw in a silly smear against Rand and anyone who accepts her ideas, and further: You accuse her of ideas she didn't actually advocate.

In any type of debate, so long as the participants are peaceable, their ideas come secondary to the arguments and evidence they present in the debate (at least, this is how I think it should be). The mere fact that someone holds an unusual idea cannot be grounds for excluding him from a debate when he has something to say on the subject, especially in this case where Objectivists are one of the few groups who object to forcing hospitals to collect their patients' unpaid bills.

On to your examples:

1. Roark's destruction of Cortlandt: How does this show that Objectivism is against caring for people? Does "caring for people" involve allowing fraud to be committed, as is the case with the Cortlandt design? Roark designed the project on the agreement that it would be built according to his designs--this agreement was not met. By what right did those with political power decide that they could benefit from Roark's time and energy without the proper respect (abiding by the contract)? If anything, it was these people (Gus Webb, Gordon Prescott, etc.)who could be said to "not care for people." It was their useless changes that increased the price of the housing, when the entire purpose was to design easily affordable housing, which is what Roark's original design would have provided. The example you cite, the gymnasium, was useless because there were "two schools and a Y.M.C.A. within walking distance," (Part IV, Ch. 12) and only added to the cost, precisely the element that was supposed to be minimized.

2. Ellsworth's secret motive: Ellsworth certainly would not qualify as an Objectivist; he is explicitly anti-individualist and his motives can allow one to interpret him as a psychotic. He had lost touch with reality long ago, sometime after he was 15 and thought that he should "collect souls" (Part II, Ch. 9), which led to his interest in socialism. This shows that Ellsworth is a horrible person, and that he doesn't care for people, but it doesn't show that Objectivism advocates such a policy, and nothing you cite ever will.

3. It discredits your position when you can't even spell names correctly--it's "John Galt"--not "John Gait." Galt is not told that his motor will be used for "humanitarian" purposes. Stop making things up. The company he's employed by, "Twentieth Century Motor Works," decides to implement Communist policies, particularly "from each according to his abilities, to each according to his need." This is an explicit sacrifice of everyone with even a shred of ability, to anyone who has less ability or does not possess any.

It's not that he "deems the masses unworthy," as you put it; the problem is that people (the ones at his company) seek to control his mind, to decide for him what he is supposed to do with his mind and ability. By what right? And once they put their sadistic thoughts into action, how is he going to combat them? His answer was to not cooperate with them, and instead go on strike. Galt never states that he is "against any act of charity." Again, stop making things up.

4. They took an oath to not rule others or be ruled, to reject masochism and sadism, to reject masters and being slaves. The issue is not they refuse to "give up their inventions." The government was using force to take things it had no right to--benefiting others is not a justification for violating the rights of individuals. That is the issue here: people using force on the minds of others. The Strikers refused to deal with such people--and why should they?

As for colleges and NPOs: Since taxation is a violation of property rights, the "public" organizations that are funded by them should not exist, but only to that extent. Nonprofits that are funded by charity have a right to exist (as would schools funded that way, if they even exist), and I know of no passage in Atlas Shrugged that says otherwise. Again, with the making up of facts...

On your paragraphs on Ayn Rand: Quit trying to psychologize.

And I noticed that you, in fact, did not make the point you attempted to make.

Mark

Mr. Fitts--very well put sir.

I imagine a nationalized health care would end up just like our nationalized social security--inefficient and out of money. When has anyone known any government that manages anything well? Anyone stopped by the DMV or the Secretary of State lately? Do you want your hospital run by these people?

Why not use our energy to work on reforming health care to a system where everyone benefits--not a system with winners and losers. This is a problem that does not require sacrifice--merely rational thought.

Newt Gingrich founded the Center for Health Transformation (CHT). Rather than wasting more time and energy on this nationalization/regulation debate, why don't we spend time working together on a plan that wins for everyone.

random

Mr. Fitts,
I do wonder how Objectivists who are supposed to be so stoic and brush off criticism of those they consider ignorant as completely inconsequential manage to start a rabid fight the moment their idol's name is mentioned in a less then pleasant light and demand that every last criticism be labeled, annotated, debated to death, and then command that any discussion of Ayn Rand's well-known and well documented history in the Soviet Union and the impact it had on her writing be halted and never brought up again. Yes, God forbid anyone try to point out Rand's motivation for creating Objectivism. After all, she's beyond all questioning, right?

Now, for your refutation to my examples, I have to contest your accusation that I'm making up the facts. The Cortlandt project was never intended to be just his design. I don't know how you read The Fountainhead to miss that it was a brainchild of Toohey to promote his personal stable of architects. I would suggest rereading the book to note that Peter Keating had Roark do his work for him and promised to do what he could to preserve his designs, but could not guarantee it. So your entire point of how it was a fraud is just nonexistent. When it comes to the efficiency of the gymnasium, Roark didn't care about the cost of the housing, just his design. Was it a poor decision to add a gym to the Cortlandt building? Yes. But does this give Roark some sort of moral right to destroy housing for hundreds of people just because his precious design was violated as Keating warned it could very well be? Rand seems to think so.

Now can you imagine behaving like this at work? Somebody asks you to help with a complicated spreadsheet. You spend the time and effort to help out and then, when your design, formulas, and overall presentation are changed by others on your team as the spreadsheet goes through its iterations or they get new directives from the boss, you decide that the spreadsheet is ugly and go into all the network drives where it's backed up to delete it. Then, you hack into each of your team member's computers to delete whatever iteration they're working on at the time. When the furious boss and teammates ask you why you did it, you tell them that they're a bunch of moochers who can't appreciate the sophistication of your fine work and only seek to debase and destroy true art and creativity in spreadsheet design. I don't think your career at that company will be long and productive. But then again, if you're anything like Roark and Galt, you won't care. Unless of course the same thing is done to you.

When it comes to Ellsworth, I never claimed that he was on Objectivist. That's a straw man. Your claim that he was insane since 15 doesn't match the book's description of him as just an unabashed collectivist and control freak who seeks to elevate mediocrity for his personal goals. I used him to point out that his character was Rand's vehicle for presenting any sort of collective thought or concern as a malevolent scheme, that's all. You have used another straw man fallacy.

As for the petty slap on my spelling of John Galt's name, that's to be expected. After noting that I misspelled it, I knew somebody was going to thunder that despite knowing the plot, characters, and issues in Atlas Shrugged, an "i" instead of an "l" means that I supposedly have no idea what I'm talking about. Because after all, it's that "i" and the "l" that matter and your personal interpretation of the events, not the work itself, right?

Twentieth Century Motor Works makes the determination that those in need should receive at least some of the benefits of his work. In reply to their decision, Galt destroys it. What Twentieth Century Motor Works decided could've been seen as an act of charity, but in Rand's writing there is no charity, only some sort of dictatorial-style collectivism that justifies Galt's destruction of his prototype so nobody could get it free of charge. So yes, Galt destroys the machine because he feels that the masses are unworthy of any charitable act. He never says he's against charity in those exact words, but his actions speak volumes as he refuses to give out his machine to anyone who's not willing to accept it on his obstinate terms. His employers never made any kind of "Communist decision," because they paid Galt for his work and they owned it and thus could decide what to do with it. You simply gave it a sinister interpretation. Wow, for someone who constantly accuses me of making things up, you sure do like to use a lot of straw men.

You can claim that his bosses were trying to control their mind because they wanted to convince him that they had a point. By that measure, when I worked at a company with a lot of military families, ex-military workers, and on-call reservists and the company told me that it would be nice if I could donate something for a care package for troops stationed in Iraq, they were trying to control my mind and asking to give of myself to another person. How dare they? Oh and all those times they asked me to change my designs to better suit their customers? Again, how dare they tell me what to do? I am my own individual, I should do as I please, and if the rest can't see my brilliance and adapt, it's their problem. Or I could just be wrong about what I think clients want and need to adjust my designs accordingly, and there's no nefarious plot to control my head going on there.

Finally, the scientists made a vow of never living their lives for anyone else when they entered Glat's Gulch. That's very far from rejecting sadism and masochism. Doesn't "I promise not to live my life for any other man or ask any other man to live his life for me" sound a little different from "we reject sadism, robbery, masochism, and dictatorial control"? Just a little bit? Oh and oddly enough, Galt ends up living for others as his invention keeps his Gulch and its residents living and working. So ironically enough, he ends up breaking the very oath he institutes by allowing other scientists and atlases to use his invention for their needs and asks from them by their ability. The only rights the Strikers had violated was their right to act like a bouncer at a nightclub and administer ideological litmus tests of who should and should not be able to use their inventions. If you work for an employer, you have this right violated on an hourly basis and by your logical back flip, the very act of being an employer is a form of sadism and masochism.

Now for colleges and NPOs, your problem with taxation to fund them is understandable, but guess what? Many of the discoveries they make end up being a benefit to you. Sure, there is a lot of waste when taxes are used to fund government activities in the form of pork, earmarks, and sweetheart deals by corrupt lawmakers. But most taxes end up right back in your pocket or as a benefit. Police, military, firefighters, and cutting-edge technology to protect you, education to help you and your children earn more in the future and live a better life, roads to help you get around the country at a moment's notice, and money in your old age to supplement your income.

I've made my point. You simply chose to use straw men and logical back flips and commanded me not to talk about the past Ayn Rand says influenced her in letters and many interviews in which she makes it clear that this a an anti-USSR parable. Censorship and a highly questionable interpretation of vast books do not a refutation make.

flash

Random, your reading of Rand is very suspect, and your pot shot at Dr. Brook and Objectivism was uninformed and tacky.

"Also, I'm not sure that referring to the president of an Ayn Rand club is wise in such a debate. Rand and her followers were so scared of any form of communal sharing and caring that they probably despite [sic] non-profit hospitals because they don't seek wealth from their skills and exist to help people first and foremost. According to an Objectivist, the very notion of caring for someone is an absurd fantasy of the ignorant masses to use Rand's words."

First of all, Dr. Brook is President of the Ayn Rand Institute; it is not a "club." Second, he absolutely has the credentials and qualifications to comment on this topic. You can view his qualifications at http://www.aynrand.org/site/News2?page=NewsArticle&id=5151&news_iv_ctrl=1181#Curriculum_Vitae.


Ms Rand explicitly stated, not only in her fiction but in her nonfiction as well, that true benevolence is, in fact, a virtue (as opposed to altruism). So, you are simply wrong.

For example, Ms Rand wrote: "Benevolence is incompatible with fear. It is only when a man knows that his neighbors have no power forcibly to interfere with his life, that he can feel benevolence toward them, and they toward him--as the history of the American people has demonstrated."

Then, in her journals she wrote: "In private and voluntary instances of help to another person (and this is only kindness, not altruism) it works well only when the recipient of help is a worthwhile person (essentially an 'action' person) who is temporarily in need, purely through accident, not through his own nature. Such a person eventually gets back on his own feet and feels benevolence (or gratitude) toward the one who helped him. But when the recipient is essentially a 'passive' person, chronically in need through his own nature, the help of another gets him deeper into parasitism and has vicious results: he hates the benefactor. Therefore, here's the paradox about 'helping another': one can help only those who don't actually need it. With the others, help leads only to disaster. Help is proper only in a catastrophe or emergency--such as rescuing a drowning man. It seems right by the very nature of things: a catastrophe is the opposite of the normal; therefore, that which is proper in a catastrophe is the opposite of that proper to a normal, healthy human existence."

So, you must be careful here. I point this out because Ms Rand was utterly brilliant in many ways, and some of it is oddly subtle. Do I agree with everything she penned? Of course not. However, the self-evidence that she pointed out with seeming ease is rather stunning. Perhaps not so much in 50 years' hindsight, but given its proper perspective, she was (and to a great extent still is) an intellectual earth-mover.

She also wrote: "The proper method of judging when or whether one should help another person is by reference to one's own rational self-interest and one's own hierarchy of values: the time, money or effort one gives or the risk one takes should be proportionate to the value of the person in relation to one's own happiness."

If you take the time to honestly appraise and study her work you can see that she clearly believes in true benevolence, but the idea is that it must comport with one's rational self-interest and not be coerced (which eliminates the whole idea of true benevolence).

This is the fundamental problem with socialized medicine in general and, apparently, your gripe with Dr. Brook and Objectivists--you want coercion because you don't believe men are good enough to practice the morality you think they ought to feel.

Ms Rand's views on helping her fellow man are far more complex than you have flippantly outlined here. If I may be so presumptuous, may I suggest one of her more obscure writings? I think this would be a good starter for you to get a better (basic) grasp of her and Objectivism.

The Objectivist Newsletter: Vol. 2 No. 2 February, 1963 "Check Your Premises: The Ethics of Emergencies By Ayn Rand

random

Oh, Flash. Or is it Mr. Gordon?

Honestly, at this point I am not sure why I'm replying to the constant objections of Objectivists regarding Rand instead of the topic of the debate itself. The adage of how riled up an Objectivist can get if someone holds a less then flattering view of Rand's philosophies seems to be proven here.

So like a fool, here I go one last time...

If one calls a social club an institute, it doesn't change the nature of the club itself. I could call my department at work a ministry, but it would still only be a department. The Ayn Rand Institute was created by her loyal follower and legal benefactor, and sponsors various neo-conservative writers to promote its world view and keeps reminding the world of Rand's books, energizing new and loyal fans. Before the institute was created a few years after Rand died, she gave speeches to wowed college students who formed Ayn Rand fan clubs and thus achieved prominence with the legions of fans who would later associate with the institute. So the institute is still very much an Ayn Rand fan club, founded and run by her devotees. Tacky or not, this is the truth, and my tackiness is in the eye of the beholder.

"Ms Rand explicitly stated, not only in her fiction but in her nonfiction as well, that true benevolence is, in fact, a virtue (as opposed to altruism). So, you are simply wrong."

But then all the ideal heroes in her novel do the opposite. So she says that helping people as good, but then goes on to create her human ideals in Fountainhead and Atlas Shrugged to care only about how the only ones worthy of help are those who agree with them. Roark is willing to help Wynand, Galt is willing to help his fellow atlases, but the only reason they help is that the recipients of their help are in total ideological agreement with them. Oh, and they don't really need any help since Wynand is a billionaire and the atlases get along just fine without coming to Galt's Gulch. So they're being helped to what end again? Oh, right, to keep the plot moving along.

"But when the recipient is essentially a 'passive' person, chronically in need through his own nature, the help of another gets him deeper into parasitism and has vicious results: he hates the benefactor. Therefore, here's the paradox about 'helping another': one can help only those who don't actually need it."

First and foremost, if someone is in a chronic state of need, there's a reason for it and a very good one. Very few people are always in need because they just happen to be needy. Most people are in need because they're poor but just can't get a job or afford education to qualify for one, have an illness, or are just plain unlucky in just about everything they do. (We all know such people, the ones who can't seem to add two and two together without ushering in some sort of calamity on themselves.)

So forgive me if I note that the statement above makes no sense. It has no evidence behind it, no scientific theory and makes one think only of anecdotal, circumstantial cases in which rage at condescending helpers who rush to the rescue without being asked to do so, lead to the helper being loathed. Some barely relevant anecdotal case here and there do not a theory make, and the statement is a bombastic, categorical proclamation with zero substance behind it. When there is a study on emotional equity (the psychology of giving, doing, and accomplishing things), which confirms this statement and done by a reputable institution of higher learning, then this proclamation may even make some semblance of a logical statement.

"... It seems right by the very nature of things: a catastrophe is the opposite of the normal; therefore, that which is proper in a catastrophe is the opposite of that proper to a normal, healthy human existence."

And oddly enough, you're quoting Rand saying that helping someone is the opposite of proper, normal human behavior. So, helping is good but none of her famous "ideal men" such as Roark and Galt do it without being paid or administering an ideological litmus test first, and help is the opposite of a normal human behavior according to her very own statement. I'm not sure what she's going for and I frankly can't see her infamous utter brilliance. I seen on obtuse attempt at a Socratic dialog and wait for Socrates to disprove it with his reply.

"If you take the time to honestly appraise and study her work, you can see that she clearly believes in true benevolence, but the idea is that it must comport with one's rational self-interest and not be coerced (which eliminates the whole idea of true benevolence)."

This is another one of those statements that contradicts itself. So she believes in true benevolence, but yet promotes the elimination of true benevolence? How is that possible? If true benevolence is giving without any concern for oneself and she promotes giving only when it's in the interests of the giver (the opposite of true benevolence), how does she support true benevolence? Is there a Benevolence Lite? Because this is what she seems to be advocating.

Implying that I'm being intellectually dishonest in my appraisal of Rand's work is a fallacy known as poisoning the well, wherein you taint someone's statements with an accusation of dishonesty, ill will, or character assassination to dismiss anything they have to say without having to put in too much effort. The only "dishonest" thing I did was to hold a different view then you.

As for coercing giving, I suppose that all charitable foundations that tell you about how your money will help the poor and how the poor need your help must be misguided according to the arguments you have laid out. The poor most of them are trying to help are poor in their nature, born into places where their lives are doomed to suffering so they will only resent their helpers. Then, they coerce you with ads and emotional appeals to give selflessly of yourself, something Objectivism is for and against at the same time by some strange logical back flip. Finally, giving an act that is opposite of human nature and permissible in the case of some sort of catastrophe. Well, I guess the Red Cross, United Way, Livestrong, and all those other around the clock donation funded nonprofits just don't fit into the Objectivist view. Except when they do, I suppose.

"This is the fundamental problem with socialized medicine in general and, apparently, your gripe with Dr. Brook and Objectivists--you want coercion because you don't believe men are good enough to practice the morality you think they ought to feel."

Have I ever advocated socialized medicine? No. Have I ever said that I wanted some sort of coercion to do something loosely defined as moral for the indebted? No. Have I ever spoke about what I expect people to feel or not? No. In fact, I get the feeling that none of those going after me with big serrated knives for daring to note Ayn Rand's questionable views of charity and selflessness, have even read anything other then my comment on her philosophy.

I stated, and I quote from my first comment (still there for you to see) that "... hospitals need to be able to recover their cash, but the contractors to whom they outsource the collection job must be made to understand that these are people who need help and who want to repay their debts, but they need flexibility and compassion rather then angry phone calls telling them to pay up or else. Banks and credit card companies could provide debt consolidation or other services that will help patients pay their bills and for once in the last decade help consumers when giving them credit. Hospitals may not be in the loan business, but banks and credit card issuers sure are." Helping in this case refers to debt reduction through consolidation and investment loans. Compassion being not stalking and harassing them to pay up when they know the debtors need loans and concrete repayment plans.

Nowhere did I say that the help must come free of charge or be altruistic. I never even said that loans should be reduced or forgiven. I merely suggested that banks and credit card companies offer financial services to help those indebted to pay off their bills without having to pull teeth or call in Vinny with a brass pipe and noted how prices of medical care are reaching insane levels. Does that sound like I want or have advocated socialized medicine and charity driven health care?

I would greatly appreciate if Objectivists and universal/socialized health care opponents stop lying about what I said and what I advocated. Yes, the word is lying, not "misconstruing" or "misinterpreting" or even "using straw men." If you said that someone wants X when they clearly argued for Y, you are lying.

Roderick Fitts

Another response to Random (most likely my final one):

"I do wonder how Objectivists who are supposed to be so stoic and brush off criticism of those they consider ignorant as completely inconsequential manage to start..."

Objectivism does not advocate the repression of feelings, if that is what you meant by "stoic." The only reason I bother with this topic is because I think I can get some value out of it, despite my growing impression that you understand very little of the philosophy (like your "stoic" comment demonstrates, if I understand it correctly).

I don't recall starting a fight, let alone acting "rabidly." I made points, and tried to show that your points didn't hold up. If you'd like to call that "ruthless," then by all means.

"Yes, God forbid anyone try to point out Rand's motivation for creating Objectivism. After all, she's beyond all questioning, right?"

That's what I mean by psychologizing. Perhaps if you were you some kind of Rand historian, your points would have more bearing, but entertaining pet theories without proof gets discussion nowhere.

On to the examples (again):

"The Cortlandt project was never intended to be just his design..."

It may have been Toohey's purpose in Cortlandt to show off his architects, but the purpose of the Cortlandt was to provide cheap housing for poor tenants:

"They [Cortlandt owners] wanted a scheme devised to build a structure as cheaply as possible (Part 4, ch. 18, Roark's speech)."

"So your entire point of how it was a fraud is just nonexistent."

Legally speaking, I agree that there was no fraud; Roark's contract with Keating was not legally binding. So Roark had no legal promise; all he had was Keating's word (which he shouldn't have trusted).

Roark, however, was still deceived by those who changed his plans, since Roark's stipulation for designing Cortlandt was that it be built to his specifications.

"When it comes to the efficiency of the gymnasium, Roark didn't care about the cost of the housing, just his design."

Why the cost/design dichotomy? Roark had spent years investigating ways to provide affordable housing to poor tenants, which necessarily included using only certain kinds of designs, because it represented an interesting problem to him, which he wanted to solve. In short, Roark did care about the cost; it was his consideration of the cost that led to his specific type of design. The form (the design) followed the function (making affordable housing for low-income individuals). The principle of "form follows function" is what Roark used in all his professional designs, if you recall.

"But does this give Roark some sort of moral right to destroy housing for hundreds of people..."

Well, he had at least two other options:
- He could have let the project stand, knowing full well the time, energy, and resources that were wasted on it since they changed his designs.
- He could've sued the government, a case he would have almost certainly lost, or more realistically, he would've ran out of money paying for the court dates, etc., in comparison to the seemingly all-powerful, all-resourceful government.

The point was that Roark was wronged, and the situation was such that there was no way for him to be compensated, and so he took away what the other architects had no right to alter: his design.

Ellsworth example:

"I used him to point out that his character was Rand's vehicle for presenting any sort of collective thought or concern as a malevolent scheme; that's all."

My point in stating that Toohey wasn't an Objectivist was to point out that Rand would not agree with Toohey's ideas, not to put up a straw man. Personally, I'm not aware of the existence of "collective thoughts"; to my understanding, our minds do not "link up."

Here's a statement by Rand on compassion: "I regard compassion as proper only toward those who are innocent victims, but not toward those who are morally guilty. If one feels compassion for the victims of a concentration camp, one cannot feel it for the torturers. If one does feel compassion

So I disagree with your statement that Rand thinks that "collective concern" for some group is necessarily a scheme.

"Your claim that he was insane since 15 doesn't match the book's description of him as just an unabashed collectivist and control freak who seeks to elevate mediocrity for his personal goals."

I'm sorry; my understanding of "insane" includes men who think they should rule other people, like Toohey. And Gail Wynand as well. In their own ways, they both did away with reason, proof, logic, and decided to act on their hedonistic whims.

"but in Rand's writing there is no charity..."

During one train ride, Dagny allowed to ride on the train a vagrant named Jeff Allen who divulged the full story of the fall of the Twentieth Century Motor Works. I can hear the rebuttal now "But that's only one act..."

"So yes, Galt destroys the machine because he feels that the masses are unworthy of any charitable act."

The theme of the novel is "the role of the mind in man's existence." It was the events of the Twentieth Century Motor Works that led to Galt's discovery of the relationship between physical force and mind, and thereafter the removal of his mind from those who wanted to engage in force; it was not because he didn't want to engage in charity.

If he wanted to halt charity, wouldn't he had formed some kind of principle prohibiting the activity? Instead, regarding my point about force and mind, he forms a principle banning sacrifice by anyone to anyone: "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."

"Galt ends up living for others as his invention keeps his Gulch and its residents living and working."

"Living for others" means being a slave, and "having others live for you" is being a master; both masters and slaves are rejected in that oath. The oath does not mean that I must now be an isolationist and never deal with people ever again. It simply means that whenever I deal with people, I will never rule over them or allow them to rule over me. In Galt's case, this meant that he dealt with the people in "Galt's Gulch" on a voluntary only basis; and voluntary associations are not prohibited in the oath.

And since you accused me of posting "straw men," I'll do likewise, and we'll let the readers decide:

#1 Your faulty view of Objectivism as endorsing some form of stoicism.

#2 Your presentation of Roark as only caring about his design, in contrast to "form follows function."

#3 Your alignment of Toohey's ideas/statements with Rand's--which do not coincide at all.

#4 Your statement that Rand has no charity in her works, which I think I've demonstrated to be false.

#5 Your straw men regarding Galt's reason for destroying his motor. (For some reason, you just can't get off the issue of charity.)

#6 Your portrayal of the oath the strikers took as somehow disapproving of helping support others whom you care about, is a straw man.

Good bye, Random. Good times.

Dr Anil Yadav

Everybody must be covered for basic health-care insurance for life-threatening diseases. If the person can't afford it, then government must step in. This is the minimal Social Security a citizen must have.

JW (European)

Socialized health care would be disastrous for America. Read this article: http://www.theobjectivestandard.com/issues/2007-winter/moral-vs-universal-health-care.asp.

frank templin

It's quite similar to the subprime business where homes were sold to people who couldn't afford them. In this case, medical care is given to people who can't afford it. And it's another story of middlemen getting into the picture and taking huge cuts. And it's why somebody says that the only good health policy for this country is "don't get sick."

Nickalis Tower

Thank you, Mr. Roderick Fitts. Nicely done. Regarding the article, the payments for medical care wouldn't be so outrageous if the free market were permitted in medicine again. Time for people to understand capitalism, and who better to start with than Ayn Rand? "Capitalism: The Unknown Ideal," and Andrew Bernstein? "The Capitalist Manifesto." Prices have gone down in the technology industry, because it's the most free of government regulations and interference. Let's free our health care system. Time to educate yourselves, Americans.

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