Ayn Rand anti-social
Ayn Rand. 1957. The prophetess of "ethical egoism"

The “roaring 20’s” gave us a stock market soaring to unimaginable heights, robber barons looting the banks and other enterprises they controlled,  opulent palaces serving as temples to the god of Mammon where the 0.1% worshipped. This was the world of “The Great Gatsby” and of “Atlas Shrugged”. It was also the world of “The Jungle,” with its abject poverty, unconscionable exploitation and corruption at all levels of business and government.

Ayn Rand. 1957. The prophetess of "ethical egoism"
Ayn Rand. 1957. The prophetess of “ethical egoism”

The intellectual foundation for this Hobbesian world was provided by The Chicago School of Economics. Their economic theories were based on the mythical Economic Man (women didn’t count; they were too emotional). Briefly, they theorized that humans are perfectly rational beings, always acting in their best interests. There is really no need for the State to protect its citizens from poor judgement and folly -they know what’s good for them and will act accordingly, and if they misjudge or make a foolish choice-it’s only fair that they bear the consequences. And what about the poor for no fault of their own? We hear no more than some mumbling of volunteerism by church groups. The literary expression of that world, “Atlas Shrugged” by Ayn Rand, sings the praises of the “job creators”, and portrays the rest as moochers and the Government as their tool. She elevated her incoherent musings to the pseudo-philosophy of “ethical egoism.” Am I detecting an oxymoron here? Are you hearing echoes of that period in our century?

All this should have ended with the cataclysmic implosion of the economy in 1929 and the great Depression of the 30’s.  But it didn’t. Surely the financial collapse of 2008 and the Great Recession that followed should have slain this ideological dragon once and for all. It didn’t. Despite all the damning evidence of the bankruptcy of the theory of Economic Man as a perfectly rational agency, provided by the science of Behavioral Economics, it persists to this very day. Only it morphed into an ideology, with the Chicago School as its main proponent, and another Rand, Senator Rand Paul, its political hero.

Rand Pau, 2011. Healthcare? Take personal responsibility and don't get sick!
Rand Paul, 2011. Healthcare? Take personal responsibility and don’t get sick!

What does all this have to do with healthcare, you might wonder?

The rabid opposition to the ACA is not based on a better alternative; none was seriously offered. It was a purely ideological opposition to any intervention by the Government in anything at all, with the exception of Defense. This is not new. Similar vehemence was displayed in opposition to Social Security, Medicare and Medicaid. Even water fluoridation was deemed a socialist plot.

And then there is gun control, another important healthcare issue, but also one of the biggest anathemas of all to the anti-government folks.  Not only are we unable to pass even the most modest of gun safety laws – ones that the polls show are supported by most of the public – but politicians in many parts of the country are loathe to even talk about the issue for fear that the NRA will target them and cause them to lose their next election.  This despite evidence that links easy access to firearms to high rates of deaths, particularly suicide as shown in a recent policy paper from the American College of Physicians.

The policy paper on reducing gun-related injuries and deaths was presented at a press briefing at the society’s Internal Medicine 2014 annual meeting. The paper was simultaneously published online in the Annals of Internal MedicineThe salient findings:

  • Firearms are involved in more than 32,000 deaths per year (roughly 11,000 homicides and 19,000 suicides), which works out to about 88 deaths per day. The rate of non-fatal firearm-related injuries is more than double that of deaths.
  • Evidence pointed to some impact from a waiting period on the reduction of suicide, but not the reduction of violence towards others.
  • Geriatric people were more likely to suffer self-inflicted accidental or intentional gunshot wounds; firearms were the most common suicide method in the geriatric population.
  • Wyoming has among the highest gun ownership rates in the country and has a relatively low homicide rate, but the highest rate of suicide by firearms.

The irony of it all is that the conservative rural population, which often blindly supports the twin ideologies of Economic Man and Libertarianism, is its main victim. Alas, the rest of us are as well.

Dov Michaeli, MD, PhD
Dov Michaeli, MD, PhD loves to write about the brain and human behavior as well as translate complicated basic science concepts into entertainment for the rest of us. He was a professor at the University of California San Francisco before leaving to enter the world of biotech. He served as the Chief Medical Officer of biotech companies, including Aphton Corporation. He also founded and served as the CEO of Madah Medica, an early stage biotech company developing products to improve post-surgical pain control. He is now retired and enjoys working out, following the stock market, travelling the world, and, of course, writing for TDWI.


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