Dr. Charles W. Johnson is a general practitioner in San Antonio, Texas. Serious students of liberty for a number of years, he and his wife, and their son, Paul, completed the Comprehensive Course at Rampart College in 1965, and participated in the 1966 Workshop and the Graduate Forum. In 1965, Dr. Johnson announced that he would not be a participating physician under the government program of Medicare, and urged patients to retain private hospital insurance.

The following is a speech by Dr. Johnson before the Association of American Physicians and Surgeons at their annual convention in Anaheim, California, on October 14, 1966.

If it is true that only those who rely upon themselves are competent to teach self-reliance; and if it is true that to become free, one must first come to rely upon one’s own self; then I am speaking to a most important audience. Many people advocate self-reliance. Not so many choose it. You have. I salute you. (¶ 1)

Considering all the obstacles to non-participation that were thrown in our path by government and much of the health insurance industry, I think our movement is doing very well down in my part of the country. It appears that the Individual Responsibility Plan has gained widespread acceptance. Indirect billing is unpopular. Utilization committees are reluctant to function. It appears that Title 19 patients will be handled under I.R.P. or direct billing procedures. There is an increased resistance among physicians to third-party involvement, and the medical leadership has assumed a more determined posture. Physicians have not capitulated, and our opponents are proceeding against us with more caution for fear they cannot implement what they legislate. (¶ 2)

On the other hand, there continue to be many problems in persuading our colleagues to fully adopt non-participation. Hospitals, with some notable exceptions, are participating. Most doctors are signing certification forms. (¶ 3)

But, I would like to discuss four other problems in the realm of communicating the philosophy of non-participation to our colleagues. I believe that these are areas in which our efforts need to be strengthened. (¶ 4)

1. Opposition to Non-Participation

What has been the biggest hindrance to the spread of the idea of non-participation among our colleagues? I have yet to hear anyone put forward a rational argument for participation. I presume it can’t be done. (¶ 5)

It’s not that they do not understand us. It is difficult to misunderstand the words non-participation. The phrase says it all—very clearly. Opposition stems from the challenge we have made to a collectivist doctrine; a doctrine which is held by many who consider themselves to be conservatives. This doctrine is that we who possess valuable knowledge have no rights, because of that valuable knowledge; that we are the property of the people, and that they may rightly dispose of us as they see fit. It is our assertion that we do have rights which elicits our opponents’ anxiety and their antagonism, for it is chiefly upon our belief in their doctrine that they depend for our cooperation. Our opponents hold two contradictory beliefs, one collectivist, one individualist. They cannot resolve them, so they repress them. They need frequent reminders that they do have contradictions so that they may resolve them. (¶ 6)

2. Compassion Re-examined

It is easy to see the patient and have compassion for him. It is not so easy to see the victim. When, out of compassion for the patient, the physician assists in rendering injustice to others, say by signing a Medicare certification form, the victims are the ones who are thereby compelled to pay. By signing, the physician is helping to confiscate someone else’s property. If he did not sign, hte property might still be confiscated, but not because the physician helped the process. When one acts on pity instead of justice, it is the good who suffer, and the evil who prosper. The only way a person can act on the basis of pity, in such a circumstance, without trampling justice, is to take from himself to give to another. Compassion with other people’s money is not compassion. It is moral fakery, and should be pointed out as such to its practitioners. (¶ 7)

3. A Powerful Weapon

Though our colleagues have had a small demonstration of the effectiveness of non-participation as a weapon against Medicare, they do not have a full appreciation of its power, nor do they realize how essential it is to the overall battle against collectivism. (¶ 8)

Non-participation’s ability to diminish government can best be appreciated by examining the role that participation plays in the structure of government. Our rulers sitting on top of their pyramid of power can see it very well. They studied it in their political science courses in college, or in the school of practical politics. They do not govern real estate or inanimate structures. They govern people. Their pyramid of power is built of people. (¶ 9)

It is possible that one man may rule over another man by brute force. this is not a very suitable arrangement for either of them, but it is possible. One man may establish mastery over ten men, but not by force alone—any two of them could dethrone him. He must command by means of his mind, with the cooperation of his subjects. (¶ 10)

The primary reason for the use of force is not to compel the obedience of the particular person who is coerced: it is to discourage others from similar disobedience. In the face of determined non-cooperation, sanctioned by a widely held notion of fairness, the limited coercive power of the rulers is insufficient to compel cooperation, and large-scale reprisals only further alienate both the recalcitrants and the public at large. The problem becomes even greater when the non-participants possess skills which are essential and not quickly replaceable. (¶ 11)

In a complex spcecialized society such as ours, brute force as an effective mechanism of rule is out of the question. Planners may use some force and more threat of force, but both must be limited and very carefully used. (¶ 12)

They must also have some mechanism, some peaceful method, to bind their subjects into this structure, to get them to volunteer to be the building blocks of the pyramid of power. There must be some kind of authority to rule over others, that has been derived not from their own qualities but from some mystical, ethereal, incomprehensible higher authority before whom the people kneel in awe. (¶ 13)

Ancient rulers claimed to be gods. Later, they claimed to be half god, half mortal. More recently they claimed authority by the divine right of kings. The current mystical authority is the divine right of majorities. (¶ 14)

Most of us know better; the writers of the Declaration of Independence knew better. We can demolish the concept of the divine right of majorities to anyone who will listen; yet I fear that subconsciously we still pay homage to this concept in many more ways than we now realize. (¶ 15)

For example, a majority cannot support the pyramid of power. A much greater amount of participation is required. The rulers must have a consensus, as they call it, which recognizes their claim to authority. It is of minor importance whether their subjects cheer or grumble; it is of major importance that they maintain their position in the power structure; that they participate. Once even a relatively small number withdraw and recognize someone else as their sovereign or recognize each individual as a sovereign-self, the ruler is disarmed, no matter what he decrees. He cannot rule by force. He cannot rule by majorities. He can only rule by consensus; by participation of all except the insignificant minorities. (¶ 16)

In a modern highly specialized society, the refusal to participate by a significant portion of even a small, but irreplaceable group, can seriously disrupt or prevent the implementation of a policy. (¶ 17)

Non-participation is not a new weapon. It is one which has been employed for many centuries. History records the power structures that arose. It does not record those that did not occur. Lao-Tze, the founder of Taoism in the fifth century B.C., was probably the first articulate spokesman for non-participation. He said that in an ideal government, a corpse could be an emperor. He taught that without participation there could be no power, and it would not matter who ruled because he would rule in name only. Taoism’s philosophy of government was an important influence on China for over 2,000 years, and the fact that China as a civilized nation survived for over 2,000 years is a pretty good indication of the practicality of the philosophy that guided it. (¶ 18)

The early Christians refused to participate in Roman laws which required them to worship Caesar as a god. They were willing to render unto Caesar that which was Caesar’s but not that which was God’s. Rome fell, but Christianity was just getting started. (¶ 19)

Mahatma Gandhi has been this century’s most prominent spokesman for non-participation. He taught much of what we are teaching. He succeeded in shrinking the power of government until it was almost non-existant. Gandhi professed to believe in no government. But he also believed that when people became free from government, they would by their nature live in a kind of voluntary socialism. when this did not occur, he and his followers converted the movement into one of the national independence, and, unfortunately, compulsory socialism. (¶ 20)

I view non-participation as the method that is essential to reduce the power and scope of government; and all other methods, such as politics, education, and what have you, are adjuncts—useful in promoting non-participation. Non-participation is not just a tactical maneuver to frustrate Medicare, it is the basic strategy of freedom. (¶ 21)

4. A Qualification for Freedom

Non-participation is more than a legitimate and powerful weapon. It requires its practitioners to make individual decisions as to their own behavior. It requires its practitioners to examine their intellectual contradictions, and perhaps thereby to check their basic premises. It qualifies people for freedom. There are many people who profess a belief in freedom and individual responsibility and they admire it in others, but emotionally and psychologically most people fear freedom; or at least they fear the self-reliance that freedom entails. Their internal apprehensions serve as more effective chains on their freedom than do external forces. (¶ 22)

They want to seek their goals collectively, everyone at the same time. They seek collectively that which if it is secured cannot be had collectively. There is no such thing as collective freedom or collective self-reliance—those are contradictions in terms. There is only individual freedom for individuals, and self-reliance is the opposite from reliance on others. We may profitably deal with another in many ways, trading ideas and combining forces to repel those who would destroy our freedom. But there is no such thing as organized freedom. Free men live in harmonious disorganization. (¶ 23)

Men become free one at a time. Each must strike out on his own, seizing the freedom that is available. For one who chooses this course, it is of little consequence whether others join him in his moral achievements. He is properly concerned with the merits of his own existence and his own code of behavior. (¶ 24)

Freedom is not acquired by begging for it. We cannot expect our oppressors to give us freedom. Why would they? They believe in what they are doing. We know howconfused their morals are. We should expect them to ignore us when we are licking their boots and honing their axes. (¶ 25)

They do not want to use force. They want our voluntary cooperation, and our voluntary cooperation is all that makes them possible. (¶ 26)

A prudent man obeys their laws; he pays their taxes, but he does not help them to fake reality. He does not help them to disguise the nature of their actions against him. He does not pretend that the gun in his back is a helping hand. (¶ 27)

We should not fear them. They are only people with two eyes, two hands, and two feet. They are not so wise as we. They are agitated, inconsistent, and busily occupied with their insurmountable problems. Most of them don’t even know what they are doing, and if they should learn, many of them would stop doing it. (¶ 28)

Our oppressors are impotent; they have nothing to offer us. We do not need them. It is they who need us. Let us not assist them, so they will discover that fact. (¶ 29)

Non-Participation, n. 1: The Association of American Physicians and Surgeons is a libertarian organization which for many years has advocated non-participation as one of its cardinal principles. The failure of organized medicine to defeat Medicare by the legislative process has resulted in an intensified interest and appreciation of non-participation. This audience is composed primarily of physicians who limit their medical activities to the free market.

Non-Participation, n. 2: Much of the health insurance industry has been converted into a quasi-governmental agency as administrators of Medicare. Many aged policy holders had their private policies cancelled when Medicare went into effect. Many others who held non-cancellable contracts were persuaded by their insurance companies to withdraw and accept Medicare plus a supplemental policy. All of the state 65 plans (non-governmental) were non-cancellable contracts. They were all cancelled as all of these enterprises dissolved on the day Medicare took over.

Non-Participation, n. 3: The Individual Responsibility Plan involves the use of a simple form, accompanied by a printed explanation that the physician is responsible only to the patient, and that the patient alone is the other party in the contract. No payment is accepted from third parties whether it is an insuror or the government. The form is an itemized statement with blanks provided for the patient to complete with his insuror’s name and policy identification. The patient may use this form as he sees fit to seek reimbursement.

Non-Participation, n. 4: Indirect billing is the process whereby the physician treats the patient and then applies to the government agent for payment for his services. Direct billing is the process whereby the patient pays the physician and uses his receipt to apply to the government for reimbursement.

Non-Participation, n. 5: Title 19 is the section of the Medicare Act known as Medicaid, providing subsidies and controls to states for Medicare care of the needy of all ages.

Non-Participation, n. 6: Many hospitals and Medicare administrative agencies interpret the Medicare law to require physicians to sign a certification form on Medicare patients at regular intervals during their hospital stay, stating that hospitalization is a medical necessity. Aside from the fact that hospitalization is never necessary, the certification form is the only visible interposition of the government between the over-65 patient and the non-participating physician (who bills his patient directly under the Individual Responsibility Plan).