You Built That. You Just Didn't Do It Alone.

Dear Dr. Gaulte,

I ran across your posting here: 45 years after receiving Med school diploma, I realize I am an unethical physician and had some thoughts I wanted to share with you.

The statement that lead me to write this went as follows:

I cannot be ethical because I believe the concept of physicians as stewards of society's resources is sophistry and is bogus on multiple levels and is a dangerous notion. First of all, society does not have resources. there is no one named society . Society does not choose and society does not own. Individuals choose and individuals own.If one accepts the idea that individually owned assets are part of a societal pool, the next step is to correct whatever distributional inequality some observer feels is ripe to redistribute to mitigate some alleged or real inequality. As long as individuals are free to act in their own self interests within the limits of a democratic country there will be an endless array of inequalities that beg for correction in the eyes of the egalitarian.

How very Ayn Randy of you. I'll ignore your slam at "the egalitarian" ... though you thrived in a nation which began its painful birth under the ideal that "all men are created equal". It's the "society does not have resources" idea that irritated me the most.

I don't know you. I don't know your history. But I do know many doctors and other professionals. Here would be a typical story: A young person is schooled in public institutions (designed for the betterment of both him as an individual and society as a whole) and through that process learns a love for science and is inspired, perhaps by one of the many teachers on the public payroll, to take on one of the most rewarding and lucrative professions available to the middle class in America, a career in medicine.

That young person now heads to what is most likely a public university, perhaps one even attached to a public medical training hospital. Is educated, if one of the 98%, with a combination of personal work and public largess in the form of grants, scholarships, and publicly-financed loans. Does internship in that public hospital. Is licensed and joins the AMA which, through the help of public laws, sets a determination of who, in fact, is a doctor. This not only keeps out the riff-raff and charlatans but also legislates one of the more profitable monopolies in the U.S.

After that, several career tracks are possible. Possibly a private practice, either incorporated under public law or an LLP under the same legislative goals of helping individuals accrue wealth without having personal liability for their mistakes. The waiting room is flooded with patients, a large percentage of whom have government insurance and, on average, 20% of whom are public employees.

That doctor goes to work on public roads. Both home and office are built under public codes for construction quality. Feeds himself and children with publicly inspected foods purchased with publicly minted money on plates kept lead-free from public regulation. He prescribes medicines regulated by the government, uses medical devices patented with public regulations. He may well also give his children the gift of a public education though, if he's successful at all, will probably need less assistance to give them a university education or even to have them follow in his career. And that's a good thing. That's what the system is for.

Egalitarianism isn't to set an equality of outcome. It's to provide an equality of basic opportunity. What is done with that opportunity is where Randian objectivism operates. What provides those opportunities is where objectivism gets it all terribly wrong.

As I mentioned I do not know you. I am certain you worked your ass off both to become a doctor and throughout your practice. You may have been born poor or you may have had successful parents. The ideal of this country has always been that it should not matter if you wish to apply yourself.

So I'm not saying that you are one of those who "was born on third base and assume he hit a triple." I am saying that with all your effort you hit a triple and then turned around and flipped off the fans who bought the tickets that allowed you to be generously paid for what you do.

So save us all, please, from your sophistry and your ignorance of the meaning and spirit of living in an egalitarian society.

Had you been starting your career today, and I encourage you to stop and actually listen to those you are where you were 50 years ago, you would find them overwhelmed by debt, entering into professions where a growing number of patients are on the dole, not through some strange increase in American laziness but because an increasingly large piece of the American pie is being eaten, digested, and never shared in any way as it was when you started your path.

Their patients may have to work multiple jobs, without insurance, raising children who will never have the opportunities you were allowed when tax rates were as high as 91%. They are losing homes through financial manipulations and reinsurance schemes in which your practice or hospital may have participated.

When you climbed the ladder of your career you somehow managed to ignore the hands that were pulling or pushing with great optimism for what you would make of your life and education. Now, successful, you're determined to pull the ladder up behind you and scoff at those below for lacking your intelligence and ambition.

I'm trying to offer you a rational picture of where your thinking has gone wrong. But, frankly, there's no limit to the Anglo-Saxon epithets I'm inclined to send your way at this point.

Shame on you.