>>I worry about how and whether they earn it, especially when I have comparatively nothing to say about it. I can negotiate a fee with an attorney. When I'm in the ER with a heart attack, I can't talk about fees so I'm at the mercy of the MD's integrity or lack of it.

Dude, this is all very loaded. I keep telling you that the physician bill is not the totality of the bill or even the largest part of it- and the physician you meet in the ER may well be on a salary these days. The idea that it's appropriate to just keep slapping away at the physicians, is not sustainable if you want to fix the problem rather than the blame.

It is true that often self-payers are hit with a lot bigger fees than those tendered to insurance companies. I'm reminded of those signs on the back of US hotel doors with a huge rack rate for the room, sometimes triple what I actually paid. I wonder who, if anybody, actually pays those prices except somebody who has no choice. Same with healthcare: turn up at the ER as a self-payer and you're the mug who turns up at the Hilton without a reservation when it's snowing out.

>>I noted that Paul Ryan (your namesake in Wisconsin) has recently distanced himself from AR.
>>He said that she had influenced his economic ideas at one time but since he's a devout Catholic, he totally rejects Objectivism.

I spend a bit of time in Wisconsin. They're decent people. But Objectivism is rejected by a lot of people and one of the tenets of all Christianity is to turn the other cheek and give alms to the poor rather than denying them healthcare, so good luck making sense of all that. ;-)