DEATH IS EASY by Russell Madden   Softcover, $14.95 Hardcover, $24.95    (Preview. Also available in a digital edition, $4.81.)	FREEDOM,  As If It Mattered by Russell Madden   Softcover, $24.95 Hardcover, $34.95   (Preview. Also available in a digital edition, $5.63.)	The Guardian Project by Russell Madden Softcover, $14.95 Digital Edition, $4.95 Preview available.	RaNdoM by Russell Madden Softcover, $14.95 Digital Edition, $4.95 Preview available.

You hear it every day: we're facing a health care crisis in this country. Burgeoning costs, people struggling to obtain health care coverage, services declining while demand increases, hospitals and doctors drowning in oceans of paperwork and red tape. Well, I agree that all of those problems -- and more -- exist. I also believe that they are destined to worsen considerably before the situation improves.

Yet I do not agree that these issues represent the real health care worries which we face. The difficulties dogging the medical field do not actually represent a "crisis" in any true sense of the word. They've been with us for the better part of this century. They worsened considerably after World War II when employers began providing health insurance as a fringe benefit for their employees. Even more problems arose in the early Sixties with the passage of Medicare and Medicaid. In the past thirty years, we have sunk deeper and deeper into the morass which today is characterized as the "health care crisis." But as I mentioned, these do not represent the most fundamental of our health care concerns. That misshapen form lurking in the shadows wears a face other than that which we've been led to expect.

The true problem with health care has arisen from one misconception which has taken widespread root and seems nearly impossible to dislodge: the mistaken idea that health care is a right.

Though politicians and commentators strive to sculpt medical issues as needing a "pragmatic" approach to solve, the issue is not one of pragmatics but one of morality. "Pragmatism" is the guiding philosophy of most people in government these days, of people who believe that "reality is negotiable." Unfortunately, as the old joke goes, pragmatism doesn't work. In contrast, it is the moral which is the truly pragmatic, that is, which offers us the best chance to succeed in obtaining our goals.

Pragmatism teaches us that nothing is absolute, that everything is malleable and subject to negotiation and change. But a moral person does not compromise on his moral principles. A "morality" whose guidelines shift mercurially from occasion to occasion, from person to person, from situation to situation is no morality, at all.

I am writing here about our medical care problems, yes, but health care is merely another symptom of a much more basic and encompassing malaise.

In a free and moral society, the basic principle of social interaction is the noninitiation of force, that is, that no one shall directly or indirectly use or threaten physical violence or harm to another individual. In such a society, only voluntary, mutually agreed upon actions are permitted, or, phrased conversely, any actions are permitted which are peaceful and voluntary. Only the retaliatory use of force is allowed, and then only against those who have initiated violence, that is, criminals and other nations which threaten us.

To aid us in maintaining the conditions necessary for a free and moral society, we form governments, that is, we delegate to the State our right to self-defense and invest our government with a legal monopoly on the use of force by our police, military, and courts. To protect us and our rights, then, is the only proper function of government. Because the State does have a legal monopoly on the use of force, it must be strictly limited in what actions it is permitted to do. Any time it steps beyond that boundary, it is operating immorally. (For more on this point, see Ayn Rand's essay, "The Nature of Government," in The Virture of Selfishness, New York: Signet Books, 1964.)

The defensive use of force granted to our government should not be called upon to make people do things they would not voluntarily choose to do within the moral limits discussed earlier. All of our laws, however, are designed to force people to act in certain ways. If they would voluntarily select such actions, then no law would be required. Governments -- whether moral or not -- are founded upon the principle of coercion. Unfortunately, the distinction between the initiation and retaliation of force has been blurred if not lost altogether in the world today.

Many people -- perhaps most in this day and age -- look to the government to do things for them. It has become a truism, however, that given the nature of the State, any time it does something for one group, it does something to another.

There are many things which people want and need: housing, clothes, food, health care, a job, a new car, loving relationships, a TV and VCR. But the ends -- no matter how worthy or laudatory or just plan nice such goals might be -- the ends never justify the means used to obtain them. In a free, moral society, only voluntary interactions are permitted. This applies to the obtaining of any and all values, whether those values are material or spiritual in nature. Each of us must be free to decide for ourselves what actions we will take. If we are correct in our choices, we alone have the right to determine how to utilize those values which we obtain by our efforts. If we choose incorrectly, then we alone are morally (and in a free society, legally) required to suffer the consequences of our mistakes.

To forcibly take values which another person has produced is at best theft and at worst an imposition of slavery. To force doctors to provide medical care on conditions which they have not voluntarily chosen is to make them slaves to those who demand such services and values. To force other individuals to pay for the values which someone else consumes is to make slaves of those people, as well.

To accede to such demands, to compromise -- "just a little bit" in order to appease the demander -- is already to have lost the war.

The morality which is based upon the idea of need (someone else's needs) and the idea of self-sacrifice, that is, surrendering to those who do not deserve them the values you possess -- the value of who you are -- is altruism. Only other-directed actions are deemed moral by altruism. Politically, it is only collectivism which is compatible with such a morality: collectivism -- whether in the guise of fascism, communism, socialism, or welfare-statism -- demands that the group (however it is defined) must take precedence over the individual. Collectivism holds that no individual person has rights; his life, his values, his wealth are there to be disposed of by "society." (See "How Not to Fight Against Socialized Medicine," by Ayn Rand, in The Objectivist Newsletter, March, 1963.)

But what is a "right."? A right concerns freedom of action in a social context. It is an extension of morality or ethics to the social realm in which we all exist. The basic foundation of our rights is the right each of us possesses to our own lives, that is, the freedom to use your life as you see fit, as long as you respect the like rights of others. This implies that a "right" must apply to all people equally. (See Ayn Rand's essay, "Man's Rights," in The Virture of Selfishness, New York: Signet Books, 1964.)

It is here that altruism and freedom clash. For example, if one person has a right to health care, he can demand -- can force -- someone else to provide it. After all, it is his by "right." He can force a doctor to treat him regardless of what the doctor wants to do. The patient's need has become a claim which others must fulfill; indeed, according to altruism, they are morally obligated to supply the values to satisfy such a need. The patient is implicitly saying that the doctor does not have a right to use his life as he sees fit, at least that portion of his life which the patient requires to treat his condition, to alleviate his need. The patient is proclaiming a right to his own life while denying that same right to the doctor.

There's the contradiction. A "right" is being asserted which does not apply equally to all human beings. It is clearly impossible to have rights based both on "others' needs" and "your own life." One person's freedom of action in the use of his values is preventing another from enjoying the same.

Again we return to the fundamental moral principle of social interaction: the noninitiation of force. There is, was, and never will be a "right to enslave" another person...even a little bit or only part time. The obtaining of values -- any values -- by the initiation of force is, was, and will always be wrong, destructive of both self and others.

The doctor creates his values -- his knowledge, his skills, his expertise -- through his own efforts. It is up to him to decide under what conditions he will offer them for voluntary exchange with other people, that is, his customers, his patients, in return for their values, that is, their money.

It would sound ludicrous if a doctor demanded and forced people to become his patients, if he forced them to pay for his services whether wanted or not, to make other people or the government provide him with his livelihood. It is just as wrong for a patient or the government to force a doctor to treat any person or group of persons regardless of his own wishes.

Voluntary interactions are the only moral way to provide for an exchange of values.

Unfortunately, doctors do frequently advocate for others what they abhor for themselves. When doctors demand that the government require -- by law -- that only people licensed by the state may practice medicine; when they require -- by law -- that certain practices be denied medical standing; when they demand -- by law -- that other doctors must provide free care to patients; when they demand -- by law -- that insurance companies must provide coverage for certain specified illnesses and conditions; whenever doctors look to the State to maintain their medical monopoly and ensure the security of their income, they are guilty of the same moral transgressions, the same abrogation of individual rights as patients clamoring for more government controls on physicians' lives.

When the government then creates new regulations limiting what doctors may or may not do medically, what they may or may not charge their patients, where they may or may not work, when more and heavier chains are forged to weigh them down, they will have no one to blame but themselves. The whip they'll hear cracking as they are forced to toe the government mandated line will be wielded by the very master they once considered their servant.

It is vitally important in this struggle that those most affected by the heavy hand of the State do not concede to their opponents the very moral principles they require to restore and then maintain the freedom they need to practice their profession.

Doctors, patients, anyone -- all of us -- must fight for freedom in the name of individual rights, the only rights which exist, the only rights which apply to all of us regardless of who we are. There are no such things as patient rights any more than there are doctor rights or women, gay, student, disabled or any other supposed kind of group rights. There are only the rights of the individual: the right to your own life, the right to use the values to sustain it which you obtain through voluntary, peaceful means. You have the right to be free, to live your life on your terms and not on those of someone else arrogant or condescending enough to believe they know better than you do what you require to live. You are the expert on your existence. You have the right to set the terms of that existence according to your own free will, to act as you deem best, not according to the whims of some faceless bureaucrat.

Truth, right and wrong, morality are not determined by majority vote. It is irrelevant how many people in this country want national health care or how many other countries have socialized medicine. The morality of need -- altruism -- demands the initiation of force to achieve its ends. The morality of freedom, of Objectivism, demands that there be no initiation of force. The morality of need is destructive to individual lives and human relationships, to the trust and goodwill which are hallmarks of positive relationships. The morality of freedom is consonant with the very definition of morality, that is, the ability to make free choices in the face of alternatives and to act without fear of violence according to those free will choices. These are the conditions necessary to foster social trust, benevolence, and a climate in which individuals can work and experiment to solve the very real problems we do face in the modern world.

For every person who demands that another sacrifice to satisfy his needs, there is someone else who must do the sacrificing. But I am not a sacrificial animal. I do not believe you are, either.

The principle of justice demands that you are entitled only to what you have earned. People may give you values as a gift -- and many physicians do provide care to poor patients -- but no one is entitled to what they have not earned through their own efforts. "Forced charity" is a contradiction in terms. "Forced charity" is equivalent to theft or involuntary servitude, and both are wrong. It makes no difference if such acts are committed by private individuals or the agents of the State. Morality is absolute and applies equally to us all.

Each of us is an end in our own right. You are not the means to someone else's ends. As Ayn Rand said in The Fountainhead (New York: Bobbs Merrill, 1943, p. 712), "Men have been taught that the highest virtue is not to achieve, but to give. Yet one cannot give that which has not been created. Creation comes before distribution -- or there will be nothing to distribute. The need of the creator comes before the need of any possible beneficiary."

What will happen if the government imposes national health care in this country? Consider the following written by Dr. Leonard Peikoff: "First, the government announces free medical care for everyone -- then there is a sudden, insatiable, endless stampede, as malingerers, neurotics and the authentically sick all clamor, in one howling mass, for medical attention -- then the doctors, crushed by impossible overloads, abandon, in despair, the attempt to treat each patient's problem thoroughly and conscientiously; increasingly, doctors turn into traffic directors, routing people out of their offices in three to five minute appointments per patient, making instantaneous diagnoses, dispensing routine prescriptions, and then calling for the next man; meanwhile the bureaucrats, dismayed by the endless flow of money pouring into the bottomless pit of patients, begin to clamp down more and more severely -- the doctors who use expensive new techniques, or exceed their quota of drugs, are fined for wasting the 'people's resources' -- the restrictions and the forms in triplicate multiply -- the doctors become part-time clerks -- the bureaucrats and their friends multiply -- the doctors begin to check a patient's political contacts before they prescribe -- and, in the end, the patients who have no contacts but really need medical attention start running to non-socialized countries, if they can find any."

This is already an accurate depiction of the general state of today's health care. Doctor's and hospitals are strangling in the mass of forms required by the government and fined or denied payment if they fail to follow the rules. Utilization review boards -- not doctors -- determine how long someone should remain in the hospital. A prominent politician receives organ transplants while those anonymous patients in more dire straits are forced to wait. Doctors overbook appointments, scheduling more patients than they can possibly see in any given hour, zooming in and out like someone in a frenetic Marx Brothers movie. A young, promising doctor abandons the demands and frustrations of medicine to become a semi-truck driver. Obstetricians give up their specialty rather than face endless lawsuits encouraged by arcane government directives which interfere with their professional judgments and by courts which have destroyed any rational basis for assessing personal responsibility. Costs skyrocket every year. The number of bureaucrats mounts even more rapidly. States begin to institute rationing of health care for Medicaid patients. Hospital facilities can be built and new technology purchased only with government permission. The list goes on...

As you can see, Dr. Peikoff has captured the essence of today's health care crisis. What would be funny if it were not so sad and ultimately so scary is that he wrote those words in 1962, over thirty years ago. ("Doctors and the Police State," The Objectivist Newsletter, June, 1962, p. 26.)

The future for health care reform does not look bright. To repeat what I said earlier, this "crisis" is not one of pragmatics, not one simply of eliminating waste and fraud and tightening regulations. This problem will not be solved until one fundamental fact is recognized and accepted as the only rational and moral principle to follow in guiding our choices and our actions: and this fact is that health care is not a right.