You are raising good points and I have (I think) good answers.

I guess fundamentally, my over-arching answer is that abstractions like "there can be no conflict of interest between honest men" and "do not initiate force" are not useful to anyone who has not personally induced them from reality. Only when you have done that can you see precisely why it's a valid abstraction and understand what the delimited context is.

Of course, by that point, the abstraction isn't really "useful," except as a mental shortcut or as a summary to tell someone else (which is likely to confuse them, unless they know to merely treat it as a goalpost that they can personally try to induce).

Most of the Objectivist literature is exactly that: a summary without the full induction provided. Fortunately, not all of the Objectivist literature is that way. After all, I am describing issues in Objectivist epistemology right now, I didn't come up with this stuff.

Regarding the first example: The principle doesn't apply in a mixed economy (i.e. one where you can get regulatory monopolies), except to say that it is in everyone's interest to have a freer, more rights-respecting system. That doesn't mean the principle is invalid, it reflects the fact that every principle is delimited to a certain context.

Regarding the second example: That is correct, non-initiation of force does not apply in an emergency situation. And that is not the only thing delimiting the context. For example, it does not apply in a state of anarchy, which is why you can morally yet forcefully establish a minarchy out of an anarchy. Rand-influenced anarcho-capitalists do not understand this point.

I don't think we should require hospitals to admit non-paying patients for emergencies, I think we should immediately create a totally free market for medical care. I think that the cost of medical care for humans would eventually approach that for animals (i.e. veterinary medicine, which is insanely cheap), at which point poor patients could all be admitted via charity, along with a large number of other benefits to everyone.

If we are not going to take that step, I guess we should keep forcing hospitals to treat these people, but I think you could argue either way. iF you are going to slowly phase in a free market in medicine, maybe you slowly phase out the free medical treatment. I say "maybe" because Ayn Rand does not deal with this mixed case, and I don't think there is a "philosophically right" answer. She would just observe that it's in everyone's self-interest to live in a society where the government does not put up barriers to pursuing personal values; a free market in medicine is an implication of that. So she (and I) would argue for instituting a free market as quickly as possible.

> And at that point, your philosophy is basically consequentialist - so why not just cut out the middleman of an overarching philosophy and directly support those policies that have desirable consequences?

It is basically consequentialist already. It's just that you need to talk about things like the nature of reality, valid epistemology, the nature of man, etc. to properly understand cause and effect at a broad level and, therefore, to make sound consequentialist arguments and to be able to refute all the people who say, "the best consequence is when we all serve God" or "the best consequence is when we all serve Society," or "the best consequence is to have an economy that mixes regulation with freedom because without regulation, selfishness [1] takes over and the system gets corrupted" and on and on.

[1] As you probably know, AR claimed that "selfishness" as used in the culture is falsely combining two unlike things, (1) rational self-interest and (2) victimizing others for short-term benefit, which she argued is not a rational strategy in the long run.