A Strategy for Desocializing Medicine

Don Watkins
23 min readNov 20, 2023

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Don Watkins

This is a lightly edited transcript of a talk delivered at the Salem Center’s Desocializing American Medicine event held on November 18, 2023.

Someday, far in the future, an historian is going to sit down at his desk to write the history of American healthcare, and he’s going to have to make a decision about where to start his story.

One possibility: he starts with Johnson signing Medicare and Medicaid into law — the first major step toward the full socialization of American medicine.

But here’s another possibility. He starts with this event, right here, today, as the turning point that explains why a future America embraced healthcare freedom. It’s not impossible. But it will depend on what you choose to do.

The purpose of this talk is to be a call to arms — and a battle plan. There is no movement for freedom in medicine today and if you don’t create one, then there will not be any freedom left in medicine tomorrow. I am urging you to take action, and what I want to do over the next 40 minutes is to sketch out what kind of action is necessary.

I come at this issue from a philosophic perspective. Specifically, I’m interested in morality and in moral movements. In my book RooseveltCare, for example, I show how the creation of the American welfare state was not a pragmatic response to practical problems inherent in capitalism. It was the product of an intellectual movement — the Progressive Movement — which promoted key philosophic ideas and used those ideas to argue for a radical change in the American system. The first major victory was Social Security — their second major victory was Medicare and Medicaid.

If we look at these and similar movements, what we see is that successful moral movements have three qualities: they are principled, persuasive, and practical.

So that’s going to be our agenda for this afternoon.

I’m going to argue that a pro-freedom healthcare movement must be principled: it must be animated by an uncompromising philosophic framework with a positive moral goal.

I’m going to argue that a pro-freedom healthcare movement must be persuasive: it must know how to win the minds of people who are persuadable — but who share many of the ideas leading to the socialization of medicine.

And I’m going to argue that a pro-freedom healthcare movement must be practical: it must strategically work to spread the right ideas and the right solutions to the right people in the right way.

So let’s get started.

Principled

The lesson here is that socialized medicine’s growth is driven by philosophic ideas and can only be opposed with philosophic ideas.

Philosophical frameworks shape thought and action — they determine the goals people embrace and how they interpret and respond to the challenges they face.

I mentioned the creation of the American welfare state. It’s often said that the welfare state was a response to the conditions of industrialization or the Great Depression. But that’s wrong. It was the product of how industrialization and the Great Depression were explained and evaluated given philosophic ideas that were alive in the culture. There was a dominant philosophic framework that interpreted these challenges as failures of capitalism and proposed solutions based on government coercion. Had the culture’s philosophic framework been different, our response would have been different.

One of the lessons that should have come through from today’s talks and panels is that the same thing can be said about the rise of socialized medicine in America.

So what is the philosophic framework driving socialized medicine? I would name one moral goal and four core assumptions.

Start with the goal. Every healthcare decision is made in light of a moral goal or standard of value. The moral goal that explains the rise of socialized medicine is: healthcare equality. This goal says that everyone is entitled to the best healthcare, regardless of their choices or ability to pay.

For example, we hear a story that some new drug is so expensive that only the rich can afford it. Well, that’s immoral because it denies most of us “access” to the best medicine available.

Or, you oppose forcing insurance companies to cover people with pre-existing conditions? That’s immoral because it means that someone with diabetes won’t receive the same coverage as a healthy 22 year old.

Now, every moral goal rests on certain assumptions that make the goal plausible, that make opposing the goal seem immoral and destructive, and that push us toward the policies advocated by the goal’s champions.

What are the assumptions that underlie healthcare equality? Here are four important ones.

Assumption 1: Patients are helpless to make good healthcare decisions.

They can be helpless for any number of reasons.

Maybe they lack sufficient knowledge. We can’t do without the FDA, for example, because I as a patient am not in a position to judge whether a drug is safe or effective.

Or, maybe they lack time. A free market only works if I am able to choose among competitors, but how can I choose among competitors when I’m having a heart attack?

Or maybe they lack money. Little good my freedom to choose does me if I’m too poor to choose anything.

Assumption 2: A good doctor is a selfless doctor.

The idea here is that a doctor’s own interests, financial and otherwise, conflict with the interests of the patient. During the push for ObamaCare, for instance, Obama told us that doctors were performing unnecessary surgeries on patients in order to line their own pockets.

Good doctors, by contrast, are selfless servants, who place the welfare of their patients above their own. A doctor who complains that a policy will hurt his financial well-being is by that very fact a bad doctor. Similarly, a profitable drug company is morally suspect because it is profiting off of sick people.

The more we remove the profit motive from healthcare, the better healthcare we’ll have.

Assumption 3: Medical progress is inevitable.

This assumption is rarely explicit, but you see it in the fact that we seldom discuss the conditions that medical progress requires, or discuss how particular policies will impact medical progress.

Medical progress can be taken for granted, and our focus need only be on how that progress is distributed.

Assumption 4: The American system is or recently was a free market.

Here, in pattern, is how every new expansion of government coercion is argued for. America is a free market economy, it has problems, therefore government intervention is the solution.

In the debate over ObamaCare, for example, we heard that the free market had made health insurance unaffordable, or completely unavailable for those with preexisting conditions, and so we could either settle for the disastrous status quo or support Obama’s policies. The failed free market — or real solutions.

This, of course, was said at a time when we had Medicare, Medicaid, EMTALA, S-CHIP, the FDA, Certificate of Need laws, and so many tax incentives, licensing laws, and insurance regulations that I couldn’t even begin to catalog them.

So what did a free market mean in this context? It meant: not 100% socialized.

It’s important to realize that opponents of socialized medicine are nearly as guilty for entrenching this assumption as supporters. They’ll point to waiting lines in Britain or Canada and say: thanks to America’s free market system, we get the care we need when we need it. They’ll point to medical innovation and say: it’s all thanks to America’s free market system. This is a major concession to socialized medicine advocates.

If people assume that the American system is a free market, rather than a mostly socialized mixture of freedom and controls, they won’t feel the need to investigate whether problems in healthcare are the result of too much freedom or too much control. They will see opponents of socialized medicine as defenders of the status quo. They will see advocates of socialized medicine as offering solutions, and opponents of socialized medicine as reactionaries thwarting progress.

What policy implication follows from the goal of healthcare equality and these four assumptions? Socialized medicine is a moral ideal. Anything that moves us in a more socialized direction is good, anything that moves us away from that ideal is evil.

What’s the conventional response to this framework? Typically, opponents of socialized medicine do not challenge the healthcare equality framework. Instead, they argue that socialized medicine is an impractical ideal.

Yes, it would be fantastic if the government could ensure healthcare equality, but it can’t. It’s too expensive, too bureaucratic, it has all sorts of practical problems that can’t be helped.

So what’s the solution? There are no solutions, only trade offs. We need to settle for managed markets that allow for a reasonable amount of choice, competition, and innovation while doing what we can to inch in the direction of healthcare equality.

For sure, the problems opponents of socialized medicine point to are real. Socialized medicine is expensive. It does lead to shortages. It does force patients and doctors into a bureaucratic system where their choices are restricted.

But conceding that socialized medicine is an impractical ideal is suicidal. It grants advocates of socialized medicine the moral high ground, and he who owns the moral high ground wins the war, even if they lose a particular battle.

Here, in pattern, is how this plays out. Since socialized medicine advocates are fighting for an ideal, they will relentlessly point to the failures of the current system to achieve the ideal, and constantly introduce proposals to move us in the direction of the ideal. You’ll object that each proposal is too radical, too expensive, too bureaucratic. Maybe you’ll defeat one of their plans, maybe you won’t. But on the whole you will be reactive, defensive, overwhelmed.

Occasionally, you’ll work up the courage to propose your own plan, intended to roll back the most unpopular of their policies. But they’ll scream that your plan will move us away from healthcare equality, since some people will not receive the best care. You’ll have no answer and the reform will die.

Often what you’ll do is propose some compromise half-measure intended to appease socialized medicine advocates. They want free healthcare? That’s crazy. How about subsidized prescription drugs?

You call yourself an opponent of socialized medicine, but the truth is you’re at best an opponent only of the next step toward socialized medicine — or maybe, if you’re bold, the last step. But you don’t dare advocate real freedom. Real freedom, you know, is incompatible with healthcare equality. And that is a goal you will not challenge.

Am I exaggerating? A few weeks ago I visited the website of the largest conservative think tank, the Heritage Foundation, and clicked on the first thing on the healthcare section of their website: “The National Debate over Government-Controlled Health Care.”

Now, I want to stress, this is not the worst thing opponents of socialized medicine have produced. In certain ways, it’s one of the best. What do we find?

Well, we’re told, there are two visions for healthcare in America. Here is the vision of socialized medicine advocates:

The proponents of Medicare for All or a single-payer health care program . . . claim that they want to provide all Americans, without distinction, with health care as a legal right. They promise that their program of national health insurance will provide superior care to all Americans economically and efficiently and that care will be more affordable.

[Advocates promise] [f]ree care for all at the point of medical service; high-quality care for everyone; universal coverage; comprehensive benefits covering everything from tonsillectomies to toupees; no deductibles; no copays; no premiums; no messy managed care networks; no high administrative costs; and, finally, really serious, no-nonsense cost control.

But this, we’re told, is unrealistic. It will be too expensive and bureaucratic. So what is Heritage’s inspiring, principled alternative vision of healthcare? It’s:

that of a health care system powered by choice and competition. My colleagues at The Heritage Foundation, along with 90 representatives and analysts of different policy organizations, have developed the Health Care Choices Proposal as a down payment on such a system. It is a major transfer of regulatory authority over the health insurance market from the federal government back to the states. It would enable state officials to tailor their statutory and regulatory initiatives and reforms to address their particular problems within the particular conditions that exist within their borders. The proposal would repurpose existing funding to better assure access to private coverage for people who have preexisting conditions and who need financial assistance because of their relatively low level of income.

That’s it. That’s the vision.

If this is the response to the vision offered by socialized medicine advocates, then we will lose — and we deserve to lose.

To desocialized medicine, we need to seize the moral high ground, which requires replacing the healthcare equality framework with a new framework.

I’m not going to argue for this framework. Greg and our other speakers did that. But I will summarize the arguments this way:

Vital Truth 1: Patients are capable. The overwhelming majority of people are able to make intelligent medical decisions and afford the healthcare they need.

Vital Truth 2: Good doctors are profit-seeking creators: they prosper by delivering quality medicine that improves and saves lives.

Vital Truth 3: Medical progress depends on freedom, including the freedom to charge high prices.

Vital Truth 4: Doctors and patients have never been fully free to create and consume medical care — and the US system has been largely socialized since the 1960s.

These four vital truths underlie a radically different healthcare goal: not healthcare equality but healthcare quality. Patients, doctors, and medical innovators should be free to pursue medicine that is affordable, effective, and advancing.

What policy does the healthcare quality framework imply? It implies that the moral ideal is not socialized medicine but medical freedom — a totally free market in medicine completely liberated from government coercion: no restrictions, no intrusions, no handouts, no controls. Medical freedom means you get to pursue the best medicine has to offer — and medical providers are free to keep raising the bar, so the best keeps getting better.

So that’s the framework we need to fight for. But how do we convince people to accept it? For that we need a movement that is persuasive.

Persuasive

What I’ve described is the principled framework desocializing medicine requires — but we also need to translate that framework into persuasive messaging.

Many of you are fans of Alex Epstein’s work in energy. Alex, for those who don’t know, is the author of The Moral Case for Fossil Fuels and Fossil Future. He’s been enormously effective at influencing how fossil fuel companies defend their industry, how policy makers advocate for energy freedom, and how hundreds of thousands of people think about energy issues.

For many years I worked with Alex to promote energy freedom. And the key to our approach was developing a new framework for thinking about energy issues, and then translating that framework into persuasive messaging.

We called this Master Messaging, and you can see what it looks like if you go to energytalkingpoints.com. Master messaging is the fuel that powers a movement. It’s what allows journalists, politicians, business leaders, grassroots activists, and the man on the street to understand why your position is right — and to argue for it effectively.

Nothing like this exists for healthcare. It’s not simply that no one has assembled and distributed persuasive messaging for healthcare freedom — it’s that the material hasn’t been created. Creating it will require intellectual innovation.

What we need is not repackaging the good work that’s been done by conservatives and libertarians. We need to radically reconceive how healthcare is thought about and discussed.

I want to stress this point because I know a lot of smart, ambitious young people tend to go into fields like technology in the belief that what intellectual work consists of is repeating things Ayn Rand said. No. What Rand gave us was a new fundamental technology: her philosophy, Objectivism, the Rearden Metal of ideas. But just as Rearden Metal made possible new innovations in every field, so Rand’s philosophy makes possible new innovations in intellectual fields like energy and medicine. But those innovations require innovators.

Why is innovation necessary here? Because existing messaging by socialized medicine opponents has been woefully insufficient, often doing more harm than good.

Most messaging, as we’ve seen, concedes that socialized medicine is an impractical ideal.

The best messaging that currently exists tries to replace healthcare equality with choice and competition as the framework for thinking about healthcare. But if you champion choice and competition without uprooting the deeper premises behind socialized medicine, you’ll achieve nothing.

Why not? Take choice. So long as people buy into the healthcare equality framework, they’ll believe that those who lack knowledge and money aren’t capable of making wise choices.

Or take competition. So long as people buy into the healthcare equality framework, they’ll believe that economically powerful companies don’t face genuine competition.

More generally, it’s simply a fact that choice and competition manifestly don’t lead to healthcare equality. They don’t ensure that everyone gets the best healthcare.

So we need to develop healthcare messaging that reflects a completely new framework. I can’t give you that messaging today. Part of what I mean when I say that it requires innovation is that it takes a long time and deep expertise in the field of medicine, which I don’t have.

What I do want to give you are three principles of effective messaging, over and above the requirement that it reflects the right healthcare framework.

First, your ideas have to be superior. You must make it overwhelmingly obvious that healthcare freedom is superior to socialized medicine in whatever form and to whatever degree.

Good messaging is guiding people in making a decision, and it does so by identifying the options and evaluating them in light of a moral goal. What effective messaging shows is that your solution is wildly superior to the alternatives.

One mistake is to speak only about the positives of our own solution for fear of being negative. For example, one thing Alex and I noticed was that some fossil fuel companies would be inspired by Alex’s positivity about fossil fuels, and so they’d started running commercials where they said, “Natural gas powers hospitals, schools, computers.” So what? Your critics say that wind and solar can do it more cheaply and without the pollution or CO2 emissions. The point is not that you have to be negative — the point is that you have to be superior: if you aren’t superior, you aren’t good.

One way this shows up in healthcare is when we struggle to explain why freedom will achieve the same outcomes allegedly guaranteed by coercion. “A woman shows up at a hospital bleeding but can’t pay for treatment. Are we supposed to let her die?”

It is not enough to argue, “No, she’ll get charity” or something like that. Freedom isn’t good because it will probably achieve what coercion supposedly guarantees. Freedom is good because it allows human beings to achieve the best possible outcomes for human life, while coercion callously sentences human beings to poverty, illness, stagnation, needless suffering, and an early death.

The other mistake is to speak only about the negatives of the opposition. You can point to all of the flaws in the British or Canadian healthcare systems, but unless you have something better to offer in their place, you will have accomplished nothing.

To make your conclusion overwhelmingly obvious, you have to do both: argue for an aspirational solution, while tearing down the alternatives to that solution as immoral and destructive.

Second principle: your ideas have to be clear. Specifically, the causality has to be clear.

Opponents of socialized medicine often make one of two errors.

Error 1: They argue at way too high a level of abstraction. For example, they’ll say, “Health insurance is expensive because of government regulation.”

But this is experienced like an empty assertion: how does government regulation make health insurance expensive?

Error 2: Opponents of socialized medicine will argue at way too low a level of abstraction. What you get here is pages of technical explanation that no one can understand or retain. See any white paper ever.

The challenge is to make the causality clear but simple. “Of course your health insurance costs more than it should: the government has made it illegal for you to buy health insurance that covers only what you want it to cover.”

Finally, principle 3: Your ideas have to be memorable. Messaging needs to be clear, concise, unforgettable.

My favorite example of unforgettable messaging is Steve Jobs announcing the iPod: “A thousand songs in your pocket.” That speech was more than 20 years ago, but I will never forget that line.

Every crucial point in the healthcare debate needs to be formulated in a way that will stick in the mind of your audience. For example, that Heritage report tells us that Bernie Sanders’ healthcare plan will be really expensive:

In his analysis of the Sanders’ proposal, Professor Kenneth Thorpe from Emory University, a former adviser to President Bill Clinton, estimates that the Senator’s plan, if fully funded, would consume about 20 percent of payroll. . . .

I promise that the actual cost of the single-payer system will be much larger than advertised. When Senator Sanders initially introduced his proposal, he billed the cost at $13.8 trillion over 10 years.

That’s all well and good. But setting aside the fact that those numbers are meaningless on their own — knowing how to make numbers meaningful is another aspect of good messaging — this is utterly forgettable.

Contrast that with something like: “Nothing is more expensive than free medicine.” That’s the kind of thing that Medical Master Messaging would provide for every essential point in the healthcare debate.

Practical

S o far we’ve seen that desocializing medicine will require a movement that is principled and persuasive. Now I want to turn to the final point: the movement needs to be practical. Desocializing medicine will require aspirational goals, practical policies, and courageous leadership by doctors.

Aspirational goals. There is an important asymmetry between moral movements and immoral movements. Immoral movements often thrive by disguising their goals and moving piecemeal toward their ideal. How many ObamaCare advocates assured us that they did not support socialized medicine — and how many of them are now urging us toward precisely such a system?

But moral movements cannot do that: a movement for freedom in healthcare has to openly, unapologetically, proudly demand full freedom: no government controls, no welfare schemes, full freedom to produce and trade.

There can often be a fear that you will alienate your audience by openly advocating a radical goal. But radical views are only alienating when the audience does not understand why you support it, or when they think you support it because you place ideas above people. That’s precisely what a proper framework and persuasive messaging will solve.

By contrast, if you shy away from naming your conclusions, your opponents will sense that and exploit it. “By your logic, we should eliminate Medicare and Medicaid.” What are you going to say to that?

Instead, you should proudly embrace a free market as an aspirational goal. As the movement becomes successful, what you’ll see is that people will concede, “Sure, medical freedom is moral, but it’s not practical.” Your opponents will be the one arguing that healthcare freedom is an impractical ideal. Once that happens, it’s game over. Success is a matter of time.

Desocializing medicine will require practical policies. If you look at the creation of the welfare state, one notable fact is that American progressives did not just preach the creation of the welfare state, but had actual policies ready to put in place.

By contrast, observe that the Republicans railed against ObamaCare for 10 years, and when they finally had an opportunity to pass an alternative, they had nothing to offer.

An effective movement to desocialize medicine therefore needs to develop practical policies. Some of these policies will be politically realistic — they are policies that could conceivably be passed in the next 5–10 years. Others will be politically ambitious, but they will show that we can get to genuine freedom from where we are today. All of the policies we propose, however, must represent genuine steps in the direction of freedom.

I can’t give you a full slate of pro-freedom healthcare policies. You’ve heard some ideas today, but this is an area that will require new thinking and innovation. I can’t even give you all of the principles that would go into thinking about which policies to champion. But here are a few general guidelines.

First, pro-freedom policies do not have to establish full freedom, but they cannot introduce new controls or “managed markets.” For example, RomneyCare was proposed as a “market-based solution” to the problems in healthcare. But of course it was in reality just the template for ObamaCare.

Second, pro-freedom policies can start with low-hanging fruit, but too much focus on these often reflects cowardice: a fear of championing unpopular policies that challenge the healthcare equality framework.

For example, conservatives love criticizing certificate of need laws. And, yes, these laws are awful and senseless and need to be repealed. But they are hardly the most destructive laws. The main reason to focus on them is that it lets you sound like you are offering solutions without having to challenge the healthcare equality framework.

So, by all means, go after the low-hanging fruit. But don’t evade the responsibility of challenging sacred cows.

Third, pro-freedom policies shouldn’t be aimed at achieving any specific economic or social objective.

This is a point I got from Greg. The point here is that freedom is not a means we deploy to achieve specific social outcomes, like a desired amount of health coverage. Freedom is the condition that allows human beings to figure out the best way to pursue their own happiness. How they use that freedom is up to them.

And so we can talk at a broad level about how healthcare freedom will promote healthcare quality. But we are not social engineers trying to pull the levers needed to get the right healthcare prices or the right amount of innovation. We are trying to remove the coercive obstacles society has put in the way of people achieving their values.

Fourth, pro-freedom policies cannot be assessed in isolation but must be assessed in their full context.

In banking, for example, we stripped away certain regulations during the late 20th century that limited risk-taking by banks, while leaving in place deposit insurance and too-big-to-fail. This meant that financial players could benefit from taking on risk while being able to impose the losses on other people. This helped contribute to the 2008 financial crisis.

The lesson is that rolling back a single control is not necessarily pro-freedom — it often amounts to creating a new and potentially disastrous regulatory regime.

In healthcare, there may be similar risks, especially in insurance. For example, was repealing ObamaCare’s individual mandate while leaving in place controls forcing insurance companies to cover people with preexisting conditions a pro-freedom step? That is not obvious. Genuine decontrol can involve certain package deals.

Finally, pro-freedom policies must take seriously that government has usurped certain necessary functions that are not easily replaced.

The FDA, for example, has usurped the role private companies would have played in a free market of advising doctors and patients on which drugs are safe and effective. You cannot simply eliminate it overnight.

Greg has suggested an approach to privatization where we first eliminate controls so that government agencies function as government provided services (with which others can try to compete) rather than as regulators, and then we privatize the agencies by first isolating them from government revenue and then spinning them off entirely.

That’s plausible to me. But what’s certain is that the process of decontrol must be a process. It should happen as fast as possible — but no faster.

I’ve been speaking this afternoon about what a movement to desocialize medicine should stand for, but now I’d like to say a word about who will make up that movement and how it should function. My own belief is that desocializing medicine will require courageous leadership by doctors.

You could imagine a healthcare freedom movement being led by intellectuals and grassroots activists. But I don’t think that’s likely. Doctors, along with nurses and pharmacists, are the most trusted professionals in society. This means that they are powerful advocates for their own freedom — and it means that they are powerful opponents, if they do not champion their own freedom.

One of the points we’ve seen today is that doctors played a pivotal role in the socialization of medicine, both through sins of omission and sins of commission. In particular, they conceded that they were selfless servants of society, which was the precondition for government policies that treat them as selfless servants of society.

To reverse that we need doctors with self-esteem: doctors willing to stand up and say, “I work by my own judgment for my own profit, and I am unwilling to pretend to function in a system that deprives me of the freedom to function.”

Every successful moral movement has been a movement fighting for justice. And it’s vital that the victims of injustice speak out in their own defense. In medicine, that includes patients — but it especially includes the professionals exploited day in and day out by the system.

We do not need a majority of doctors on our side, but we do need a vocal minority. A vocal minority means: doctors willing and able to speak out in moral terms — to their peers and to the public.

One of the key jobs of intellectuals here is to arm doctors with pro-freedom arguments and pro-freedom policies. And the doctors, in turn, can help pro-freedom intellectuals understand the healthcare system and the myriad and often hidden ways coercion cripples the medical field.

Patients have an important role in supporting doctors as well. Specifically, they can provide doctors with moral cover by affirming and insisting on their right to pursue profits and practice medicine under freedom.

The central activities of this movement will be education, reform, and innovation. Education means formulating and distributing the messaging needed to win supporters. Reform means formulating better policies and working to implement them at the state and federal levels. Innovation means looking for Uber-like opportunities to inject freedom into medicine without waiting for permission.

All of this will require money — a lot of money. But it must be money spent wisely. What does wisely mean? To answer that question would require a far longer discussion about what an effective movement will look like. Should it be one organization or many? For-profit or non-profit? What are the best messages and the best policies? Who are the best messengers and the best audiences? Who can we most easily persuade and which are the most valuable audiences to persuade?

These and many more questions need to be debated. But one thing that we absolutely need is a few people to step up and make this their life’s mission. There is a lot of talent in this room, and outside of this room, willing and able to do their part. But their efforts will not add up to impact without tireless, strategic, well-funded, full-time organizers ready to provide the movement with leadership. Are you going to step up and provide it?

Conclusion

I want to end with two warnings and one reassurance.

First, beware of defeatism. Radical movements depend on a conviction that ideas matter and that good ideas can win, no matter how unpopular they are at the start.

But all too often I hear deep cynicism from pro-freedom people. “Yes,” they say, “you and I both know that freedom is good. But most people aren’t intelligent or moral enough to accept it.”

This cynicism, which poses as realistic and wise, is in reality deluded and pathetic. Radical movements — good and bad — have triumphed in the past, and there is no reason this one can’t. If you are capable of recognizing the truth, then so is any other human being with an intact brain. If you can convince one mind, you can convince a nation.

Second, beware of moral cowardice. Radical movements demand courage, including the willingness to be unpopular and even the willingness to bear personal costs. Moral cowardice is the refusal to bear these costs, usually with the aid of some rationalization to explain why it isn’t really cowardice.

Moral cowardice can show up as the desire of an intellectual to appear sophisticated to other intellectuals, who will view any principled stand as simplistic. It can show up as the insistence of a doctor that advocating freedom will hurt his relationship with his colleagues and patients.

I have zero sympathy with these attitudes. People throughout history have risked their lives — given their lives — for their ideals, from Revolutionary War soldiers to Civil Rights activists. No, there is no obligation to sacrifice yourself for a cause, but if you regard taking any personal risk in the name of your ideals as a sacrifice then you have no ideals, no self-esteem, no values to sacrifice.

What I’m calling for is not martyrdom, but the recognition that great values often come at a great cost. Thankfully, a movement to liberate healthcare will require nothing like the cost borne by most pro-freedom movements. Women in Iran face death for taking off their veils — why exactly are you afraid to criticize Medicare?

Here, then, is my reassurance. This is a battle that can be won and fighting this battle will enrich your life. You’ll find allies you didn’t know existed and achieve a pride you didn’t know was possible. And, for those intellectuals among you, you may just find that it’s more profitable to be a radical innovator than a second-rate policy wonk.

So what I ask of you is this. Today, before you leave, think of one action you can take to launch a movement to desocialize healthcare — big or small.

Start an organization. Cut a check to sponsor the work of someone like Ray. Print up pins that say, “Ask me about abolishing Medicare.” I don’t care. Just think of an action and take it. Now, or as soon as you can.

There will be no movement to desocialize medicine unless you create it. So create it.

The health of this country depends on you.

Follow me on Twitter at donswriting.

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