Atlas Shrugged: Only a Flesh Wound

Atlas Shrugged: Only a Flesh Wound April 24, 2015

Stethoscope

Atlas Shrugged, part III, chapter I

Since Dagny was injured in her crash landing and can’t walk, John Galt romantically carries her from the scene. (Helpful tip: The best way for one person to carry another is a fireman’s carry, but somehow I don’t think Rand pictured her slung over Galt’s shoulders like a sack of potatoes.)

He was carrying her down a narrow trail that went winding to the bottom of the valley. On the slopes around them, the tall, dark pyramids of firs stood immovably straight, in masculine simplicity, like sculpture reduced to an essential form, and they clashed with the complex, feminine, overdetailed lace-work of the birch leaves trembling in the sun.

…And then she gasped, because the trail had turned and from the height of an open ledge she saw the town on the floor of the valley.

It was not a town, only a cluster of houses scattered at random from the bottom to the rising steps of the mountains that went on rising above their roofs, enclosing them within an abrupt, impassable circle. They were homes, small and new, with naked, angular shapes and the glitter of broad windows. Far in the distance, some structures seemed taller, and the faint coils of smoke above them suggested an industrial district.

Two things to notice here. First, despite her professed hatred for “unimproved” nature, Rand took pains to make Galt’s Gulch a place of great natural beauty. It’s an idyllic wooded valley with a mild climate, surrounded by a dramatic backdrop of mountains.

In a society of rapacious, profit-seeking capitalists unbound by environmental laws, how long is that going to last? How long will it be before those pristine fir and birch groves are all chopped down and fed to the sawmill, or before the clear air of the valley is filled up with the “sacred” smog and pollution of heavy industry? How long before those scenic mountains are dynamited into rubble and carted away for the valuable ore they contain? It’s convenient that Dagny just happens to arrive in the brief time before the valley is fully developed.

Second: another thing that can’t possibly exist here is zoning. After all, zoning laws only come about though the imposition of an evil government that tells people what they can and can’t do on their own property, etc., etc. And Rand confirms that with an offhand remark of buildings “scattered at random” throughout the valley. This is only going to work for so long. What happens when somebody decides to build a coal-burning power plant or a sewage treatment facility in someone else’s backyard?

Dagny asks John Galt if he’s the owner of this place:

“I? No.” He glanced down at the foot of the ledge and added, pointing, “There’s the owner of this place, coming now.”

A car stopped at the end of a dirt road below, and two men were hurrying up the trail. She could not distinguish their faces; one of them was slender and tall, the other shorter, more muscular…

“Well, I’ll be goddamned!” said the muscular man, whom she did not know, staring at her.

She was staring at the tall, distinguished figure of his companion: it was Hugh Akston.

It was Hugh Akston who spoke first, bowing to her with a courteous smile of welcome. “Miss Taggart, this is the first time anyone has ever proved me wrong. I didn’t know — when I told you you’d never find him — that the next time I saw you, you would be in his arms.”

“In whose arms?”

“Why, the inventor of the motor.”

… “It would have served you right if you’d broken your neck!” the muscular man snapped at her, with the anger of concern, almost of affection. “What a stunt to pull — for a person who’d have been admitted here so eagerly, if she’d chosen to come through the front door!”

“Miss Taggart, may I present Midas Mulligan?” said Galt.

Not to belabor the point, but Dagny couldn’t have “chosen” to come here if she’d wanted to, because neither Galt nor Francisco nor anyone else ever told her about this place. Francisco has a bad habit of timing his visits so they’re interrupted by disasters, and Galt almost did but then changed his mind.

Midas Mulligan asks what they’re going to do with Dagny now that she’s here, calling her “the first scab” and saying this was the one eventuality they hadn’t planned for. John Galt says he’ll deal with it, and they all pile into the car to take them to his house.

Galt carries Dagny across the threshold into his house, which “had the primitive simplicity of a frontiersman’s cabin… but reduced with a super-modern skill” – handmade wooden furniture and an electric stove with a chrome finish. He sets her down, and Mulligan goes to get the doctor:

The doctor who arrived was a gray-haired man with a mild, thoughtful face and a firmly, unobtrusively confident manner.

“Miss Taggart, may I present Dr. Hendricks?” said Galt.

“Not Dr. Thomas Hendricks?” she gasped, with the involuntary rudeness of a child; the name belonged to a great surgeon, who had retired and vanished six years ago.

“Yes, of course,” said Galt.

…She watched the rapid efficiency of Dr. Hendricks’ work, as he examined her injuries. He had brought an object she had never seen before: a portable X-ray machine. She learned that she had torn the cartilage of two ribs, that she had sprained an ankle, ripped patches of skin off one knee and one elbow, and acquired a few bruises spread in purple blotches over her body. By the time Dr. Hendricks’ swift, competent hands had wound the bandages and the tight lacings of tape, she felt as if her body were an engine checked by an expert mechanic, and no further care was necessary.

… “Thanks,” said Galt. “Send the bill to me.”

“Certainly not!” she said indignantly. “I will pay it myself.”

The two men glanced at each other, in amusement, as at the boast of a beggar.

“We’ll discuss that later,” said Galt.

So, Dagny’s sole injury from a dramatic plane crash was a sprained ankle and some cuts and bruises. Fortunate, that. Or rather, convenient.

Richard Leakey, the famed paleontologist and conservationist, was in a similar small-plane crash in the 1990s. But unlike Dagny, who’s protected by plot armor, both his legs were crushed and had to be amputated. What would have happened if Dagny had suffered some comparably devastating injury in her crash landing – a broken leg or a skull fracture? What if she’d needed surgery followed by extensive rehabilitation? What if she’d wound up in a wheelchair?

Serious injury or disability is another of those things that don’t exist in Randworld. It would pose difficult dilemmas for a libertarian worldview, so Rand simply writes the narrative so that it never happens. Despite the fact that all her protagonists work around heavy machinery (mining, smelting, railroads), no one ever gets killed or maimed in an accident. No one gets repetitive stress injuries. No one gets sickened by pollution or food poisoning. No one is ever a victim of violent crime. No one ever gets pregnant.

In a laissez-faire utopia, if someone suffers a critical injury and can’t prove on the spot that they can afford medical help, what happens? Would they be left to bleed to death on the ground? What if the injury is one that permanently impairs their ability to work? If there’s no reasonable prospect of them ever being able to pay for their treatment, would they be left to die as surplus to requirements?

As we’ll see shortly, Rand’s solution is for Dagny to work as John Galt’s housekeeper to pay off her debt. This is charmingly naive. Only in an imaginary world would a month of low-skilled work be sufficient to cover major medical bills.

The reality is that, until Obamacare’s reforms, medical care was so expensive in America that a serious health crisis could plunge even a middle-class family into poverty. A study conducted in 2007 found that more than 60% of personal bankruptcies in America were due to medical bills – and of those people, almost four-fifths had health insurance.

The problem with leaving health care up to the market is that treating complex and chronic conditions is extremely expensive, and getting more so all the time as medical technology becomes more sophisticated. So, of course, health insurance companies did what any good capitalist would do. They protected their profit margins by charging unrealistically high premiums, finding arcane excuses to deny as much care as possible, imposing onerous limits on what they would pay for, or just plain dropping people when they got sick. The result was a system where millions of people were shut out of even the most essential and urgent care, and millions more thought they had coverage until they needed it, whereupon they were suddenly faced with massive bills. (Note that Dagny didn’t ask in advance what Dr. Hendricks proposed to charge for treating her.)

Health care is the classic example of a market failure. Profit incentives alone can never create a society where access is universal and affordable – every insurance company has an incentive to cherry-pick only the healthiest customers. It’s no coincidence that America, the “freest” health-care market in the developed world, both pays the most for it and gets the least out of it.

Reforms like Obamacare address those problems by requiring people to purchase a minimum amount of insurance and mandating that insurance companies offer a minimum level of coverage in return (together with subsidies for the poor, this is the so-called “three-legged stool“). There are already encouraging signs of progress, though it’s doubtful if it will ever work as well as the countries that simply instituted a single-payer system fully run by the government.

Galt’s Gulch, the ideal Objectivist society, has no laws or regulations and therefore no limits on what doctors can charge or what insurance companies can do. Since Rand’s characters are blessed with apparent immunity to sickness and major injury, it’s a problem that never has to be confronted within the pages of Atlas Shrugged. Flesh-and-blood human beings, however much they love capitalism, are unlikely to be so fortunate.

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