Noble Vision by Gen LaGreca is a contemporary novel in the Randian tradition, whose substance and style are perhaps the greatest reflection of the ideal of the founder of Objectivism since the latter’s death in 1982. The characters are designed to carefully reflect their chosen value premises, while the plot is at the same time comprehensible and complex, logical and multifaceted, as LaGreca impeccably weaves numerous threads of the storyline throughout the book. Furthermore, this novel examines, using perceptively rational analysis, a critical contemporary issue which had only begun to emerge during Ayn Rand’s time, the usurpation of medicine by encroaching government. By demonstrating the harms of such centralized control, LaGreca establishes herself as a fitting heiress to Rand’s literary legacy, and one willing to extrapolate it to new issues and dilemmas.
In the novel, the state of New York has already fallen prey to the worst form of government control over medicine, a complete public monopoly on funding. The pet program of Governor Malcolm Burrow, CareFree, guarantees “free health care” for all and forbids private funding to be used in the provision of health services. As with all public health initiatives, shortages result, inefficiency abounds, and the state rewards doctors for cutting services and costs as opposed to providing them. After two years of existence, the program is on the verge of bankruptcy, immediately prior to the gubernatorial election, wherein Governor Burrow’s success depends on the vitality of his favored project. Thus, the Burrow administration decides to impose further severe restrictions on services rendered through CareFree, and, as its means of enforcement, seeks to crack down on those remaining honest doctors who continue to practice as if the free market had still existed and the doctor gained when the patient gained. Those doctors, by seeking to cut no corners and act in accordance with the requirements of objective reality and patient health, as opposed to the arbitrary whims of bureaucrats who have never seen the patients whose treatment they restrict, risk being fined, imprisoned, or having their licenses pulled, instead of getting paid. The enforcement of this morass of bureaucracy is spearheaded by Secretary of Health Warren Lang, a former neurosurgeon who has sold out to collectivist ideals in order to fulfill his ambition to someday become governor. His motto is, “To serve the public interest above all concerns-this is the noble work of medicine.” In serving the “public interest,” Warren Lang becomes the enemy of tragically injured patients, his own former beloved profession, and his own sons, David Lang and Randall Lang.
Dr. David Lang is a world-renowned neurosurgeon who had flourished in the days of free-market medicine, when his financial success correlated with the well-being he restored in his patients. He had once performed an operation to separate two conjoined twins, which brought him medical renown and immense pleasure at solving an intricate problem and saving lives. The bureaucrats, however, do not care. In the days of CareFree, a fitting name for the government program’s attitude toward the interests of patients and doctors, David Lang receives fines for operating longer than the “average” time the bureaucrats determine a given operation requires, even if the time extension saves a patient’s life. He is fined for not following a faulty diagnosis by a general practitioner of an impending hemorrhage as “migraines” and operating on a patient, thereby saving her life. Most grievous of all, a government committee forbids him from continuing his research of seven years, already on the verge of successful nerve regeneration, because of the alleged involvement of “cruelty to animals.” Rather than having animals be operated on experimentally, the government prefers the extremely “humane” and “benevolent” practice of euthanizing them outright. David’s wife, Marie, is a general practitioner who flourishes under the new government paradigm by cutting corners and saving money instead of treating patients; her ingrained fear of disapproval from her peers and the law leads her to oppose David’s desire to maintain integrity in his practices. Furthermore, David’s brother, Randy, though highly sympathetic to his efforts, must maintain the veneer of adherence to government regulation in order to keep his job as a hospital administrator and support his three highly talented kids. Randy’s dilemma is a subplot of its own in the story, as the government essentially holds the futures of his children hostage and, by the nature of its intervention in medicine, sets Randy’s professional integrity against his concern for his family’s prosperity.
Facing opposition from the government and his own family, David Lang nevertheless, in the tradition of the Randian hero, possesses an iron will to persist in his conviction of the moral and efficacious way to practice medicine. For him, medicine is a passion, not a chore, and he delights in the scientific approach to real, pressing problems. He is willing to break government law when it conflicts with his precise and uncompromising understanding of absolute moral law. As spiritual fuel for his struggle, he draws his inspiration from the ballerina Nicole Hudson, who had risen out of destitution to perform in the ballet, Triumph, an alternate version of the Greek myths of Prometheus and Pandora, where man ultimately prevails over the gods. However, his inspiration is nearly shattered when a terrible accident leaves Nicole blind, with her optic nerves severed. In order to save her, David must perform his experimental, but illegal, nerve regeneration procedure. If he pursues this aim, he risks losing his job, family, and livelihood. If he does not, he will certainly lose his moral integrity. This is the treacherous double bind into which government regulation places the most rational, benevolent, and productive of men. His choice, and his struggle, are the focus of Ms. LaGreca’s novel.
Along with a devastatingly efficient critique of government involvement in medicine, Ms. LaGreca analyzes numerous broader questions. What do politicians seek when they impose regulatory programs? Why do some people cave in to the desire to conform at the cost of their selves and their values, while others persist in their loyalty to principles? Why does the government favor those currently in poverty, while imposing its greatest burdens on those who have risen out of it due to their own effort? Most importantly, what is the difference between the objective, the demands of reality, and the subjective, the whims of other people, and what happens to a person who favors the latter over the former? In the process of analyzing these questions, Ms. LaGreca offers extensive rebuttals to the mentalities of collectivism, altruism, conformity, and utilitarianism.
Furthermore, Ms. LaGreca demonstrates that it is only on the grounds of the unmitigated right of the individual to pursue his self-interest that true freedom in medicine can be justified. The following conversation between Governor Burrow and Secretary Lang illustrates the impossibility of justifying medical innovation solely in the name of the “public interest.”
“‘The public interest lies in new treatments and cures.’
‘The public interest lies in limiting treatment, so we can meet CareFree’s payroll.’
‘The public interest lies in nerve repair, Mack.’
‘The public interest lies in vaccinations for kids.’
‘The public interest lies in crossing new frontiers.’
‘The public interest lies in keeping up with our old frontiers.’
‘The public interest lies in David’s work!’…
‘I stand for the public! An act against Mack Burrow is an act against the people!’ Burrow roared angrily. Then his voice lowered to a whisper, as if sharing a secret: ‘The public interest is me, Warren. Haven’t you figured that out yet? The public interest is me!'” (248).
This is an excellent illustration of the fact there, in truth, exists no such thing as “the public interest,” any more than there exists such a thing as “society.” There are only individuals and individual interests, and he who claims that the “public interest” ought to supersede individual interests, only means that some people’s interests should be sacrificed to his own. Mack Burrow and regulatory politicians like him are no different from Louis XIV when he claimed, “”L’état c’est moi!” [I am the State].
Noble Vision is a novel of heroes and villains, good and evil in the most fundamental existential sense. In it, men of integrity confront men of cowardice over the issue of state-controlled medicine. In the real United States, the government is still greedily eying the medical field, seeking to shackle and regulate it in preparation for a complete usurpation. Will there be enough real-world heroes to resist this infringement upon individual sovereignty, prosperity, and progress? For those who wish to partake in the struggle for free markets, Noble Vision is an excellent companion and source of intellectual ammunition.