Should Health Care be a Right?
There’s a deep philosophical debate underlying Congressional attempts to craft a health care reform bill, centered around whether access to health care is (or should be) a basic human right. Up front, we see compelling arguments on both sides, and the “Yes” camp might even have the weightier material arguments on its side. But the philosophical ones should not be brushed aside – especially given that the philosophical underpinnings of classical liberalism have served the U.S. and other western democracies pretty well (to critics, yes, realities have been far removed from ideals at times, but overall, these systems have proven remarkably stable and reasonably progressive).
The American Declaration of Independence asserted that three rights had been granted by God to each individual – life, liberty, and the pursuit of happiness (or as Woody from Cheers memorably put it, “the purfuit of hapineff”). This was based on John Locke’s philosophical writings, and contextually, it was a declaration that no individual should be deprived of their life, property, or vocation involuntarily. In other words, the experience of human beings under governments should exclude unjustified limitations, expropriations, torture, and death. Thus the conservative nature of classical liberalism – there’s not a whole lot at work here, other than setting limits on what people can do to one another, including those in positions of political power. Within those boundaries, there’s a vast range of possibilities for human conduct.
In the modern secular world, rights are no longer granted to individuals by God, but are now social contracts – through democratic institutions, a society determines and declares what rights an individual is entitled to. For example, social welfare systems have evolved since the late 19th century as an embodiment of the idea that people should have a right (if they choose to exercise it) to a minimum standard of income (transfer payments), housing, and health care (e.g., Medicaid). Educational systems embody a similar principle. This modern version clearly has a more solid logical foundation, as deeming rights is clearly an endogenous human activity (presumably, if God cares and we get any of them wrong, he or she will let us know at some point). So that transition away from divinely granted rights seems OK to us. But like the opening of Pandora’s box, the transition carries risks — primarily that the list of rights grows substantially over time, with many unintended consequences.
[On a side note, this observation should illuminate the remarkable arc of governments since the time of Locke and later Jefferson. Back then, rights were necessary to protect individuals from the depradations of the powerful. Since then, governments have been increasingly designed to benefit the weak at the expense of the powerful (or perhaps more accurately, the poor at the expense of the wealthy). Of course, they don't always work that way. But clearly, the idea of 'tyranny from below' is more feasible in modern social democracies.]
So today, instead of determining that individuals have rights that limit a government’s power over them, we articulate rights to things which, in many cases, governments must provide or at least enforce the provision of. That’s the critical distinction between rights today and rights in earlier centuries. Those earlier rights were intended to level the playing field between, e.g., landed aristocracy and free individuals, by transferring a certain amount of political and social power from the former group to the latter. Today they are more often intended to extract resources from the haves for the benefit of the have nots – however defined for that particular right.* To the extent that that the public reallocation of private resources provides a greater level of security and productivity overall, it may be a desirable activity. But that doesn’t address whether those reallocations need to be, or should be, enshrined as ‘rights’.
This is tangential to the choice between a political system guided by principles versus one guided by mandates. A principles-driven system has a core of ideals that can be applied flexibly to a wide range of real world situations. It allows for the rational acceptance of human imperfections, and the development of institutions for dealing with them as they occur. A system based on mandates is inevitably more complex, with rigid and sometimes contradictory rules and regulations that often become more complicated over time, and utopian standards of outcomes and conduct that, carried to an extreme, almost require that we legislate risk, bad outcomes, and human nature itself out of existence. An expanding list of human rights is almost certain to lead to the latter type of system. As just one example, consider ‘The Human Right to Health‘ declaration from The People’s Movement for Human Rights Education. It captures well the idea that we’ve gone beyond the right to not have government interfere with the voluntary conduct of individuals, to the right to have government provide (or ensure provision of) certain things for all individuals. These two kinds of ‘rights’ are conceptually so different that they probably ought to have different names.
If we’re going to take a rational approach to the question of whether access to health care is a right, we should look for a suitable existing analogue. To us, it looks like access is the key word, and that access to legal systems and political processes are close analogues. As law and political systems evolved, people have demanded (and received) greater access to them. More recently, as medical standards, technologies, and delivery have advanced, the demand for universal access to them has increased, and that’s not unreasonable. But whereas in Locke’s time, declarations of rights sought to reallocate power from ‘enemies’ of liberty who possessed too much of it (and too often wielded it unjustly), a declaration of a human right to health care requires a significant reallocation of resources from some of us to others of us. In other words, there is no ‘enemy’ in the situation at hand unless, to borrow from Pogo, one believes that enemy is us — that some have been depriving others of access to health care. And that presents a thorny set of issues for society to debate. Unfortunately, they’re not getting much attention.
As we noted at the outset, this is a deep philosophical question, and so this missive, like any colloquium in philosophy worthy of the name, utterly lacks a satisfying resolution. We would just ask people to be aware of the following: the distinct historical conceptions of rights; the unintended consequences that are bound to follow the adoption of any expanding compendium of human rights; and most importantly, in our view, the fact that past attempts at ensuring individuals’ access to health care have contributed directly to the large numbers of uninsured individuals and families and to the precipitous rise in medical expenditures. And we would point out that the current legislation only piles on to those previous errors.
* There are current debates that relate primarily to founding principles and rights. For example, same sex marriage clearly relates to liberty and (according to 20th century SCOTUS interpretations) the pursuit of happiness, and on its surface it would not appear to involve the reallocation of private resources. But ironically, it’s due to the existence of laws governing the allocation of resources, such as probate and spousal benefits, that same sex marriage becomes a thornier political issue than it might otherwise be.
URLs:
http://news.yahoo.com/s/ap/20090715/ap_on_go_co/us_health_care_overhaul
http://graphics8.nytimes.com/images/2007/11/25/arts/25carr2190.jpg
http://www.igopogo.com/we_have_met.htm
http://www.pdhre.org/rights/health.html
Tags: Agency Risk, Healthcare, History, Human Capital, Institutional Economics, Political Economy, Politics, Public Policy, Regulation, Technology
News and Views | art July 15, 2009
