(Originally published 4/2007 at solopassion.com, reprised in the wake of Leonard Peikoff's change of heart on the "fatwa.")
The OTHER Fatwa: Peikoff and The Medical Perspective AGAINST VOTING Dem
After some consideration combined with a first-hand experience, I'd like to formally denounce Peikoff's call to vote "Dem," (the "fatwa.") Ironically, Peikoff's own arguments elsewhere played a major part in my decision. Without throwing my unbridled support behind the Republicans or ignoring the religious implications of their power, I'd like to present my argument into the fray. It's long, but I promise there is a point.
I generally agree with Leonard Peikoff's assessment of the Republicans as fitting his (Mis-integrated) classification and the Dems fitting his (Dis-integrated) classification. But I take issue with his personal strategy, which, based on the above, is to vote Dem "across the board." I realize that he doesn't want to support the Dems, but believes that because the Dems are "disintegrated," they are "easier to defeat." I have to ask: Defeat by whom? Him and what army????? If the majority of the voting public were made of like-minded Objectivist thinkers, then maybe it would be feasible. But this strategy seems to overestimate the voting public, and would give the large category of disintegrated voters way to much power. As was argued on the old Solo site (I've lost the exact reference), it is much easier to overturn social politics of a religious nature than it is to overturn social politics of an economical nature. Whatever threat the Republicans pose via theocracy is nothing compared to the Brave New World scenario presented by the Left. It was this argument that swayed my vote for Bush (along with another, unrelated, argument that pulled me away from the American Libertarian party.) But it was one of Peikoff's own arguments against socialized medicine combined with first-hand experience that solidified my stance against his "vote Dem" strategy.
The particular experience to which I referred is a training class for employment for an insurance company, Independence Blue Cross. During my second class (yesterday as of this writing) a guest speaker began to touch on the nature of HMO's versus Primary Choice plans (he was in favor of the HMO as being "more practical.") Something about his argument seemed not-quite-right to me, and I went to read Rand's essay on "How NOT to Fight Socialized Medicine" in The Voice of Reason. This led me, naturally, to read Peikoff's following essay "Medicine: The Death of A Profession." The timing was perfect, as the following day's speaker touched on the same topics as Peikoff's essay, mainly, the history of Medicaid/Medicare and the HMO’s, going back to Kennedy and Johnson. The speaker, an "outspoken" baby-boomer reaching that Magical Age of 65, accurately presented the history, and depicted the everyday existence of the insurance companies as a "rope" in the "tug of war" between the government and the medical practitioners. Sadly, however, she sided with the altruistic side and forcefully presented her view, which was nothing but an unveiled threat to fight for socialized medicine. She was met with nothing but support from the entry-level trainees, mostly of African-American background, who probably have never heard a defense of capitalism. On this, Rand was slightly sympathetic in her essay: "Most people in this country are not moochers who seek the unearned, not even today. But if all their intellectual leaders and the doctors themselves tell them that doctors are only their 'selfless servants,' they will feel justified in expecting and demanding unearned services." Specifically, Rand blamed conservatives for giving in to the altruist claims, and the doctors who say compromise by saying they fight when the government tries to enslave them, but concede if it's the will of the people. When fellow classmates started to blurt that health-care is a RIGHT, one can only think, "Brother, you asked for it!"
(While the class was shouting "amen!," I summoned all my restraint. However, I suspect the speaker caught a glimpse of something in the crack of my stoic demeanor, based on a split-second cold shudder I saw shoot through her...)
Rand wrote that in 1963. In 1985 Peikoff followed up on Rand's premise, stating that "The Medicare patient is no longer a free man to be accorded dignity and respect, but a puppet on the dole, to be manipulated accordingly while the doctor is being transformed from a sovereign professional into a mere appendage and accessory, a helpless tool in a government-orchestrated campaign of shoddy quality and deception." Peikoff confirmed my suspicion of the previous speaker's defense of HMO's: while the speaker spoke of the practical options of an HMO (and I suspect he was simply "working the system" in the way that anyone would be forced to do), he failed to either realize or present that the reason why HMO's are more practical is because the "savings" for the HMO customers are paid for by the increase in the "personal choice" plans. But Peikoff takes this a step further, and suggests another prediction of an "imminent theocracy", albeit one of a socialist nature. He writes:
"The government's takeover of medical practice is not confined to public patients; it is starting to to extend into the private sector as well." After describing the workings of an HMO, Peikoff speculates that the "end of the Medicare road is complete socialized medicine." (Which, of course, it is.) Patients become hungry and doctors become "schmoos," with the government serving the meal.
Peikoff basically claims that the current HMO system, while private, is born as an answer to the result of government meddling. However, he claims that it is a system that is "set up to fail," in order to hasten the cause of socialized medicine. Peikoff offers a gradual withering away of the system, while asking the question "Is there still time for such a step?" In 1985, his answer was "In ten years, perhaps even in five, our medical system will have been dismantled. Most of the doctors will have retired or gone on strike, and the government will be so entrenched in the field that nothing will get rid of it." After this prediction of "imminent medical theocracy," he (again, rightfully) suggests that "[i] f you are looking for a crusade, there is none that is more idealistic or more practical." Just short of calling for a "fatwa" to vote Republican, he suggests, "Don't let it go without a fight."
Fast-forward to 2007. How do we assess Peikoff's 1985 prediction?
Despite the convictions of the "liberal boomer," I see a bit of truth in the depiction of the insurance companies as a rope in the tug of war between government and doctors. The fact that the company is not-for-profit is contrasted with the fact that they also run companies that are for-profit, if under other names. This silver lining, however, is lined with a dark storm cloud. His prediction may be off by some years, but in Pennsylvania, at least, the "brain drain" has begun, with doctors leaving over stifling malpractice insurance rates. And his prediction that the government will be so entrenched in the field? The answer speaks for itself. But who takes the blame for this? Peikoff revisits his '85 essay in his more recent "Why Health Care is Not a Right," and issues another prediction, that "[T] he Clinton plan will finish off quality medicine in this country -- because it will finish off the medical profession. It will deliver doctors bound hands and feet to the mercies of the bureaucracy."
Well, according to our guest speaker today at the company, during the Clinton years, health care costs maintained a steady low rate. Manna fell from the sky. The streets were paved with gold. Lennie, what happened? Health care didn't fall apart; it thrived! Everyone was happy! The system works! Praise socialized medicine!
Uh-oh.... here comes that mean, nasty, greedy Republican George Bush. What's this? Health care costs are rising.... rising...rising....AHHHHHH!!!!!! Grandma can't afford her medicine and now has to eat cat food! SARS is spreading! Global warming...we didn't listen! (You think I kid? The speaker brought up all these points. And of course she mentioned the war. Again, to the approving utterances of the class.)
Peikoff predicted that the government would "not go gently..." and Rand predicted that the failure of the Conservatives and the doctors themselves would pave the way for this to happen. So when the Democrats are given credit for the short-term golden age, it's the free market that will take the blame. Do you think the "huddled masses" are going to accept a "laissaz faire" approach at this point? No, because as Rand wrote, "People can always sense guilt, insincerity, hypocrisy. The lack of a morally righteous tone, the absence of moral certainty, have a disastrous effect on an audience-an effect which is not improved by the triviality of the arguments over political minutiae."
Forward to the Peikovian fatwa. Peikoff argued strongly and persuasively against the Democratic (re Kennedy and Johnson) plans for governmental control in health care, and, for the most part, his predictions were accurate. Rates are unaffordable, and the only way to get coverage is through a "compromise," as private options rapidly disappear. So why would anyone want to ignore this and give more power to a demonstrated foe? Again, to refute the idea that a disintegrated party will fall easily as an opponent is to ignore the misintegrated mindset of the voters created in the scenarios both Rand and Peikoff wrote about. The recent Imus scandal (a "shock jock" who recently made racially-tinged, misogynistic slurs against a women's basketball team leading to an appropriate uproar) shows that people in this country will not allow the rise of the past mores that allow the persecution of women, minorities, homosexuals, etc. But the opposite is the more "imminent threat": that multiculturalism, ecoterrorism and socialism are the biggest threats to our country because the proponents of capitalism are meek and have already surrendered. Without putting too much "blind faith" in the Republicans (the very conservatives who have capitulated), we must look past the voting process and start finding other ways to fight the Objectivist "Battle of Thermopylae."