Health Care Reform: " What Can One Do? "

In 1972, philosopher-novelist Ayn Rand wrote an incredibly insightlful and inspiring essay dealing with the issue of what can be done to combat and try to help reverse what she perceived as a distressing American cultural decline on many levels, in innumerable ways over many generations. 

I slightly modified the text of her essay below < in brackets> to turn the issue to the US health care/ health insurance system which had been strangled by decades of government regulations even prior to going off the cliff under the suffocating irrational decrees of ObamaCare- which the incoming administration and Congress have the power to undo. Whether they have the wisdom and will to do so - and the knowledge and political courage to implement much needed economically sound policies remains to be seen.....

"What Can One Do?"
- by Ayn Rand

"This question is frequently asked by people who are concerned about the state of < today's health care system > and want to correct it. More often than not, it is asked in a form that indicates the cause  of their helplessness: "What can one person do?"

I was in the process of preparing this article when I received a letter from a reader who presents the problem (and the error) still more eloquently: "How can an individual propagate < the correct ideas > on a scale large enough to effect the immense changes which must be made in order to create the kind of ideal social system < or health care system > which you picture?"

If this is the way the question is posed, the answer is: he can't.

No one can change a country single-handed. So the first question to ask is: why do people approach the problem this way?

Suppose you were a doctor in the midst of an epidemic. You would not ask: "How can one doctor treat millions of patients and restore the whole country to perfect health?"

You would know, whether you were alone or part of an organized medical campaign, that you have to treat as many people as you can reach, according to the best of your ability, and that nothing else is possible.

People approach intellectual issues in a manner they would not use to deal with physical problems.

They would not seek to stop an epidemic overnight, or to build a skyscraper single-handed. Nor would they refrain from renovating their own crumbling house, on the grounds that they are unable to rebuild the entire city.

But in the realm of ideas, they still tend to regard knowledge as irrelevant, and they expect to perform instantaneous miracles, somehow or they paralyze themselves into inaction by projecting an impossible goal.

If you are seriously interested in fighting for a better < health care system >, begin by identifying the nature of the problems.

The battle is primarily intellectual (philosophical), not political. Politics is the *last consequence*, the practical implementation, of the fundamental philosophical ideas that dominate a given nation's culture.

You cannot fight or change the consequences without fighting and changing the cause; nor can you attempt any practical implementation without knowing what you want to implement.

In an intellectual battle, you do not need to convert everyone.History is made by minorities or, more precisely, history is made by intellectual movements, which are created by minorities.

Who belongs to these minorities? Anyone who is able and willing actively to concern himself with intellectual issues. Here, it is not quantity, but quality that counts (the quality and consistency of the ideas one is advocating).

An intellectual movement does not start with organized action. Whom would one organize?

A philosophical battle is a battle for men's minds, not an attempt to enlist blind followers. Ideas can be propagated only by the men and women who understand them.

An organized movement has to be preceded by an educational campaign, which requires trained- self-trained - teachers (self-trained in the sense that a philosopher can offer you the material of knowledge, but it is your own mind that has to absorb it).

Such training is the first requirement for being a doctor during an ideological epidemic and the precondition of any attempt to "change the world."

"The immense changes which must be made to < rationally reform the American health care system > cannot be made singly, piecemeal or "retail," so to speak; an army of crusaders would not be enough to do it.

But the factor that underlies and determines every aspect of human life is philosophy; teach men the right ideas and their own minds will do the rest. Philosophy is the wholesaler in human affairs.

Man cannot exist without some form of philosophy, i.e., some comprehensive view of life. Most men are not intellectual innovators, but they are receptive to ideas, are able to judge them critically and to choose the right course, when and if it is offered.

There are also a great many men who are indifferent to ideas and to anything beyond the concrete-bound range of the immediate moment; such men accept subconsciously whatever is offered by the culture of their time, and swing blindly with any chance current.

They are merely social ballast, be they day laborers or company presidents, and by their own choice, irrelevant to the fate of the world.

Today, most people are acutely aware of our cultural-ideological vacuum <and the legal and economic chaos of our health care system>; they are anxious, confused, and groping for answers. Are you able to enlighten them?

Can you answer their questions? Can you offer them a consistent case? Do you know how to correct their errors? Are you immune from the fallout of the constant barrage aimed at the destruction of reason <and freedom in our health care system>? Can you provide others with antimissile missiles?

* A political battle is merely a skirmish fought with muskets; a philosophical battle is a nuclear war.*

If you want to influence a country's intellectual trend <or bring rational reform to the health care system>, the first step is to 
bring order to your own ideas and integrate them into a consistent case, to the best of your knowledge and ability.

This does not mean memorizing and reciting slogans and principles; knowledge necessarily includes the ability to apply abstract principles to concrete problems, to recognize the principles in specific issues, to demonstrate them, and to advocate a consistent course of action.

This does not require omniscience or omnipotence; it is the subconscious expectation of automatic omniscience in oneself and in others that defeats many would-be crusaders (and serves as an excuse for doing nothing).

What is required is honesty- intellectual honesty- which consists in knowing what one does know, constantly expanding one's knowledge, and never evading or failing to correct a contradiction. This means: the development of an active mind as a permanent attribute.

When or if your convictions are in your conscious, orderly control, you will be able to communicate them to others.

If you like condensations (provided you bear in mind their full meaning), I will say: when you ask "What can one do?" the answer is "SPEAK" (provided you know what you are saying).

A few suggestions: do not wait for a national audience. Speak on any scale open to you, large or small, to your friends, your associates, <your patients>, your professional organizations, or any legitimate public forum.

You can never tell when your words will reach the right mind at the right time. You will see no immediate results, but it is of such activities that public opinion is made.

Do not pass up a chance to express your views on important issues. Write letters to the editors of newspapers and magazines, to TV and radio commentators and, above all, to your Congressmen (who depend on their constituents).

If your letters are brief and rational (rather than incoherently emotional) they will have more influence than you suspect.

The opportunities to speak are all around you. I suggest that you make the following experiment: take an ideological "inventory" of one week, i.e., note how many times people utter the wrong political, social and moral notions as if these were self-evident truths, with your silent sanction.

Then make it a habit to object to such remarks. No, not to make lengthy speeches, which are seldom appropriate, but merely to say: "I don't agree." (And be prepared to explain why, if the speaker wants to know.) This is one of the best ways to stop the spread of vicious bromides.

(If the speaker is innocent, it will help him; if he is not, it will undercut his confidence the next time.) Most particularly, do not keep silent when your own ideas and values are being attacked.

Above all, do not join the wrong ideological groups or movements, in order to "do something". To join such groups means to reverse the philosophical hierarchy and to sell out fundamental principles for the sake of some superficial political action which is bound to fail. It means that you help the defeat of your ideas and the victory of your enemies.

The only groups one may properly join today are ad hoc committees, i.e., groups organized to achieve a single, specific, clearly defined goal, on which men of differing views can agree.

In such cases, no one may attempt to ascribe his views to the entiremembership, or to use the group to serve some hidden ideological purpose (and this has to be watched very, very vigilantly).

I am omitting the most important contribution to an intellectual movement: writing. Books, essays, articles are a movement's permanent fuel, but it is worse than futile to attempt to become a writer solely for the sake of a "cause." Writing, like any other work, is a profession and must be approached as such.

It is a mistake to think that an intellectual movement requires some special duty or self-sacrificial effort on your part. It requires something much more difficult: a profound conviction that ideas are important to you and to your own life. If you integrate that conviction to every aspect of your life, you will find many opportunities to enlighten others.

It is too late for a movement of people who hold the conventional mixture of contradictory philosophical notions. It is too early for a movement of people dedicated to a philosophy of reason.

But it is never too late or too early to propagate the right ideas- except under a dictatorship.

If a dictatorship <or government run socialized medicine> ever comes to this country, it will be by the default of those who keep silent. We are still free enough to speak. Do we have time? No one can tell. But time is on our side because we have an indestructible weapon and an invincible ally (if we learn how to use them): reason and reality.

"What Can One Do?" by Ayn Rand
< with personal editorial modifications in
bracket >

This appeared in original form in the Ayn Rand Letter, January 1972
Published in " Philosophy: Who Needs It? "

<NB: We also have other powerful tools at our disposal the awesome 
power of social media in disseminating ideas. If and when they speak out, 
doctors and other health care providers also have an the most important 
and most powerful tool of all: the trust of patients for whom they personally 
provide life- giving and life-preserving medical care- and who trust 
their own doctor to make decisions that are in their best interest, 
while rightfully distrusting politicians, lawyers and today' s 
politically biased media.>