Anyone going Galt?

Medscape asks if US physicians are considering going Galt over the plans for Obamacare. The poll shows many are.

Poll Results

Dr. Hendricks’ quotes from Atlas Shrugged paint
A valid representation of the course our society is on, which the government and the populace should digest and learn from. 

56% (37)

A remarkable representation of my life as a physician/surgeon in today’s world, having been written 50+ years ago by a non-physician. 

27% (18)

A picture completely unlike my experiences/perspectives as a physician today. 

9% (6)

A delusional picture, which is the polar opposite of where our society is headed on its present course. 

8% (5)

Dr. John Galt

Greg Hood, MD, Internal Medicine, 01:14PM Aug 5, 2012

“I quit when medicine was placed under State control, some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything – except the desires of the doctors. Men considered only the welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only to serve.’ That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind – yet what is it that they expect to depend on, when they lie on an operating table under my hands?”

“Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it-and still less safe, if he is the sort who doesn’t.”

Ayd Rand introduced the name John Galt to the world in 1957, with the weighty tome, Atlas Shrugged. Published in 1957, when Dwight Eisenhower was president, when the country was very different. For better, and for worse, the country and the opinions and comportment of its citizens have changed dramatically since the time of Sputnik, the ’57 Chevy, and the rise of the military-industrial complex.
The book is both popular and influential, having sold many millions of copies, and rated in some surveys of the influence upon readers as second to the Bible. It transports us to a world in which liberals and statists have had all their dreams of power and control come true. Today, that doesn’t seem like a very long journey. It outlines the struggles of a few libertarians as protagonists in this world. One common misconception when discussing these matters is to superimpose the opinions of the characters, and the readers (or non-readers) with whom one discusses the book into a single axis political framework. As noted in this graph, political spectrums can be envisioned in a dual axis manner, with the tendency to embrace individualism (libertarianism) opposed to preferring government control (statism).


In the novel John Galt is a character who was an engineer-inventor. He invented a miraculous new type of motor while working for the Twentieth Century Motor company. It was powerful and efficient enough to power an automobile off ambient static electricity. Such an invention could revolutionize the world to an even greater extent than the development of the internet has, since cars, trains, planes, home power, and appliances could all be powered by variations of this motor. Essentially free and unlimited energy would be available to anyone, anywhere on the planet, and no one would have to develop business strategy or political strategy around the acquiring of fossil fuels.

In the novel his employer, in the name of “social good”, adopts a policy that all production of the company must be divided amongst all employees. In particular, the worker’s union votes that the profits of the company must be distributed from each, according to their abilities, to each according to their needs. Rather than have the results of his talents and long labor taken from him in this manner he destroys his motor and his research records and sets out to “stop the motor of the world”. He then convinces, one by one, the top minds in industry, law, music, banking, and medicine to withdraw their genius, creativity and productivity from society, denying society the ability to plunder those assets. It should be noted that in spite of the obvious personal moral failings of some of the characters, Rand presents each character as having lofty and inscrutable professional morals, arguably a significant luxury that a writer of fiction is able to afford herself.

As the central government and the statists start to lose control they act to pass more and more progressive laws. They take over companies, regulate who has the power to fire employees and proceed through a plethora of other mandates. Nevertheless, as they tighten the government’s grip ever tighter and employ their liberal theories to the operation of industry more and more technology and infrastructure break down, until civilization collapses entirely.

There are many criticisms out there of this work. Some have merit, as they point out differences in how the real world functions in distinction to that of a fictional world. Some do not have as much merit, because the either fail to take Rand’s concerns seriously, or misunderstand/misinterpret her meaning, such as over the issue of being “selfish”, which had a different meaning in the mind of this mid-century Soviet refugee than that which Americans employ in daily common use.

None of the critics thus far have appeared willing to open their minds to conjecture of what would happen in our world if the producers, the businessmen, the innovators, and the inventors truly did destroy or abandon their efforts. To be clear, this is not merely an argument about the “One-percenter” group. In Atlas Shrugged mid-level managers and railroad brakemen, among other “common man” workers also responded to the moral call of John Galt, and “shrugged” off the world’s imbalanced demands upon them.

There are powerful reasons to doubt that such a unified and sustained “strike” would ever happen here. “Producers” produce. Those who are driven to contribute productively to society have a very hard time not behaving according to their nature. Unfortunately, the “destroyers”, whose contribution to society is to work to dismember and destroy the targets of their attention, also are driven, and have found ways to earn a living destroying, often in positions as bureaucrats, paid for by the taxation on the efforts of the producers. What they do not understand is that their livelihoods and lifestyles as destroyers and consumers of the efforts of the producers depends on a steady supply of production. If the output of the producers stops, then the world of the destroyers collapses as well.

The producers in Rand’s world were able to set up a parallel system in which their labors were recognized and validated by other producers. Think of it as concierge medicine, off-grid, with no GPS coordinates. They were able to produce what they needed or wanted for themselves and to remunerate each other in a mutually agreed upon manner. Inventors still were able to invent. Their transactions were overseen by a morally erect banker. When ill, they had a physician to care for them. That is a lofty, unlikely goal to accomplish in itself.

Think of what would happen in America if the government controlled all aspects of life. If they controlled where companies could build factories, what physicians had to document in patient charts, and what products citizens are required to buy, as examples.
What happens if physicians to as John Galt asks, and they shrug? A survey published this summer quotes 83% of physicians as considering quitting. The physician medical community is one of the last, best bastions of promoting the importance of ethics in workplace decisions. 61% of respondents find the current healthcare system as a challenge to their ethics. 65% place the blame for problems in healthcare today on government involvement in healthcare. 70% say that reducing government would be the single best fix. 52% say that they would rather see some Medicaid/Medicare patients for free. Said one doctor from Alaska,”I feel sorry for those who are valiantly trying to practice good medicine in such a dysfunctional system.”

Furthermore, in an industry move mirroring Atlas Shrugged, due to mounting regulations and taxes some medical device makers are “going Galt” by either cutting back on planned expansion  or by moving overseas . There are other examples outside the healthcare environment as well.
In the novel, John Galt worked intentionally to accelerate the destruction of society. In today’s environment our world appears to be speeding towards a similar fate quickly enough without a Galt figure working behind the scenes. Say that a figure with similar professional moral ideals but a different strategy were to arise in healthcare today, a Dr. John Galt, who could gain the endorsement of the producers of the world and warn the entire world of the consequences of the course being steered.

Would the world change course? Could the tide be turned before we go over the waterfalls without a barrel? Are we already past the point of no return? Are the lessons of Atlas Shrugged unlearn-able, until experienced in first person? Was Ayn Rand right? Is (the theoretical) Dr. John Galt’s only choice to shrug?

But maybe the US doesn’t have to worry about Obamacare.  The NHS might hobble over there if Gordon Brown’s plans to globalise it take off under his acolyte, David Cameron.

Post image for Statement by LSE Students in Anti-Gaddafi Occupation

Just as British universities chase wealthy foreign “students” at the expense of the debt-ridden locals, the Government plans that the NHS should seek profit from wealthy foreign patients.  Don’t worry, the plans won’t work – sometimes NHS management is an asset.

More sensibly, UK teachers are preparing to reject harmful inspections of their teaching:

The National Union of Teachers backed plans that may lead to a campaign of “non-cooperation” with the regulator amid claims inspections have a major impact on staff workload, damage morale and promote a culture of exam cramming…”

As usual, read the comments not just the journalism.  For example:

“Difar 04/09/2012 03:26 PM 

“There is absolutely no evidence to show that ofsted inspections have improved achievement.

“The old method of H.M.Inspectorate dropping in was much more productive for all concerned.  They were there to help, not hinder.

“Heads are paid to manage their staff and to ensure that they are performing as they should do.  Ofsted inspectors are paid to check up on the heads and to ratify that their judgement can be relied upon.  Seems like the government is paying twice for the same outcome.

“Imagine what could be done with the money saved.”

Maybe clinical staff will catch on and do likewise.

Break the groupthink – inspectability is not quality!

This entry was posted in Bureaucracy, Economics, Education, Laboratory medicine, Management, Medicine, NHS, Philosophy, Politics and tagged , , , , , , , . Bookmark the permalink.

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