San Diego Objectivist Study Group

A Houston Chronicle news clip announces: “Texas Doctors Opting Out of Medicare at Alarming Rate.” Though the total number of doctors who are opting out of the Medicare system is small in magnitude, the rate as measured from previous years is alarming. Rearranged as a table, here are the data for the state of Texas:

The numbers, however, only show one side of the issue. They show only those doctors who have made the decision to opt out. They do not show how many are contemplating it. According to a recent poll conducted by the Texas Medical Association, four in 10 doctors are considering the option.

Only four in 10! The only logical reason these four and the other six–all the doctors–have not left the Medicare system is that they are still motivated by altruism. Over and above their usual benevolence, it is altruism that is keeping doctors from exiting the government-run health care system.

Altruism, the moral doctrine that one’s action is judged moral only to the extent that it benefits others, is their controlling motive. Doctors, like anyone else, want to act morally. However, their morality has pitted them with a dichotomy: Stay with Medicare to help others and be moral, or opt-out to survive and be immoral. For these doctors, at least for now, the inertia of altruism is tugging them to stay with Medicare.

One can see how painful emotionally this moral tug is. Here is Dr. Guy Culpepper, a Dallas-area family practice doctor who opted out in March of this year: “I’ve been in practice 24 years, and a lot of my patients got old right along with me. It’s stressful to tell them you’re leaving Medicare and they’re responsible for payments if they want to stay with you. You feel like you’re abandoning them.”

Bob Bidinotto has written a timely report on a new scare campaign that is spun off from an older one. Based on the tactics of the campaign from the late 1980s against alar, a chemical growth agent sprayed on apples, the new scare campaign is against atrazine, a safe, widely used, fifty-year-old weed herbicide.

Proponents for banning atrazine include environmentalist group Natural Resources Defense Council (NRDC), The New York Times, and trial lawyers, led by the Texas law firm Baron & Budd. What do the proponents of the campaign count on? They count on the lack of memory of the original scare by the current generation of individuals comprising society. They count on the moral outlook that individuals cannot take care of themselves but must told by “society” how to live their lives. They count on the inertia from the political premise that the government—in this case, the Environmental Protection Agency—has the duty of protecting its citizens from nature. In other words, they are counting on the postmodern culture of the day.

A fruitful dialog began from a potential mistake of identity:

> Well, it’s a good thing I did not get up to make a fool
> of myself on that evening …

Imagine you did approach the person in question and assume him to be me, only to learn moments later that it was not me. Why do people feel so uncomfortable and/or embarrassed when they mistake someone’s identity? Have we been trained by society to be embarrassed in these situations, or is it a natural response? Are other primates or mammals capable of feeling embarrassment in general? What emotions require reason? Certainly fear does not require reason, but I think embarrassment does. Also betrayal, guilt, and the joy of accomplishing something difficult all require reason; hence animals cannot feel those higher emotions. Or can they? I don’t know.

Emotions are humanistic. What brutes experience may be said to be similar to a primitive form of emotion, but it is not emotion. Emotions are products of ideas; without them, we don’t emote. Like sensations, emotions are states of consciousness, but while the former are experienced causally by the direct stimulation of the object, the latter are experienced causally by both the object and its intellectual estimate. Watch enough America’s Funniest Videos, and you will see that toddlers begin with no fear of anything: they will put crickets in their mouths; they will swing snakes like ropes; they will crawl into the path of black cats.

Let’s suppose embarrassment is the emotion from seeing ineptitude in oneself in a public setting. I would feel embarrassed if, thinking myself to be refined in sartorial elegance, I showed up on a date with mismatched socks. In the same circumstance, I would not feel at all embarrassed if I thought elegance comes from refined control of one’s movements, but would instead if I picked up a glass and spilled its content.