Thoughts on Health Care, Part I: A Right to Health Care Access?

Over the next few months I wish to weigh in on the health care debate with a series of short essays. Here is the first:

One of the most relied upon arguments of proponents of socialized medicine is that health care access is an inherent right all human beings possess. I wish to challenge this assertion.

There are numerous practical arguments one can make against this claim. For instance, who will pay for the costs? How will perverse cost incentives be dealt with? How will the distribution of effective services be done efficiently? How will information be shared? The list goes on and on. But I wish to deal with one distinct issue: the fundamental contradictory nature of a so-called "right" to health care access.

Claiming health care is a right is to give credence to the notion of positive rights; rights which are based on action, or require one party to give and another party to receive. Examples are access to health care, as mentioned, or access to public education. Contrast this with negative rights, which are based on inaction, or the freedom "from" something. Popular examples are the rights of freedom of speech and assembly (freedom from coercive measures). Negative rights are a one party system; positive rights are a two-party system. To clarify, take crime as an example. A negative right application of crime in society would be "freedom from crime." If this right were to be violated, society would take ex post measures to compensate the victim for any damages suffered. A positive right application of crime would be the "right" to be served by a public police force, security cameras, etc... to prevent such violations from occuring in the first place.

The key difference between these two types of rights is that positive rights comes at a cost to some party to maintain the right of another party, whereas negative rights do not come at a cost to any second party. I am free to say what I wish, but no one is required to listen. I am free to assemble with others, but I cannot coerce others to assemble with me. On the other hand, if I have a right to health care access, I do not have to endure any cost to attain the benefits of the services of health care. But because health care is a limited resource, to receive it, it must come at some cost to another party. In this simple scenario, that party would be the provider. The cost would be endured in forms of lack of monetary compensation due to time spent, skill applied, effort applied, emotional capacity spent and others.

At its core, a right to health care access is a violation of property rights. The consequence of this would be the extreme perversion of The Law. Frederic Bastiat writes in The Law, "As long as it is admitted that the law may be diverted from its true purpose - that it may violate property instead of protecting it - then everyone will want to participate in making the law, either to protect himself against plunder or use it for plunder." A right to health care access legitimizes the idea that The Law exists not to protect, but to provide. The consequences of such thinking can only lead to totalitarian ends.

As Michael Cannon and Michael Tanner write in Healthy Competition, "Fundamentally, creating a legal "right" to health care is incompatible with the idea of individual rights. People cannot legitimately claim a right to something if that claim infringes on the rights of another." A right to health care is a seductive idea that thrives in the minds of reality-deluded utopian thinkers. All it will provide is a subtle avenue for government to seize individuals' liberties under the guise of paternal altruism.

Do not be fooled.

7 comments:

  1. Do American children have a right to education?

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  2. It depends on how you define education.

    Parents have a moral responsibility not only to maintain the life of a child at its youngest years, but also to provide it with the skills to survive on its own in society. Now normally the first task is handled directly by parents or is sometimes outsourced to a third party (babysitter, day care, etc...). The second task (providing societal skills) is on the other hand normally outsourced (public/private schools) and occasionally handled directly (home schooling).

    A number of complex questions arise from this:

    1. How much schooling can be deemed "enough"?

    2. Given the more complex nature of (most of) American society, does the American child have a right to "more" formal education than a child born in a third world country?

    3. Most importantly, I think: are third parties obligated to substitute for incompetent parents?

    I think the third question cuts to the heart of the matter. If you say "yes", then you believe the child has the right to education. If you say "no", you don't.

    I say no, for the same reasons I stated in my health care access argument (rights of one cannot infringe on freedoms of another), but I truly believe supply and demand and private volunteer efforts would provide a more than adequate mechanism to deal with what appears at face value to be a dreadful situation.

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  3. 1000 points of light...
    I have to admit I disagree with your answer to three. Saddling children with the inadequacies of their parents seems immoral to me. I guess that’s the root of our disagreement.

    Another question: If you could prove that universal education and health care, regardless of being a right or not, created a healthier, better educated society from a utilitarian standpoint, would you still choose not to universalize edu. and health care in light of your moral position?

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  4. Very interesting (and tough) question. I'm going to wrestle with it and then respond in a post.

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  5. For me anyways, and I imagine for many others, it's less about an inherent right to health-care (which I'll admit I agree with your post on) and more about a right to a level of health-care that is reasonably affordable for the average American. Certainly I think if you're willing to pay a lot of money for the best health-care you should get it but I also don't think people should be going bankrupt trying to pay their medical bills.

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  6. 100% agree with you AJAX. How we get to better affordability, quality, delivery, customization, etc... is a totally different story.

    What I wanted to do with this post is establish the premise that health care is not an inherent right, as you said, but instead a highly demanded commodity that can best be delivered to customers through free markets, not social engineering.

    But without first making the philosophical "rights" argument, I would have little to base my future arguments on.

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  7. I think you guys seem to agree, but are actually saying different things. It sounds like what Jackson is saying is that there is an inherent right to affordable healthcare, but Will is saying he agrees healthcare should be affordable (presumably because he believes the market can provide it as such) but makes no claim that anybody inherently deserves it.

    I believe a third option. First, we have to recognize that healthcare is not affordable through the market or provided wholesale through a government system. Public health is a matter of rationing because any society has limited resources to distribute on a problem that can consume infinite resource. Health insurance is a misnomer.

    Fire insurance works by everybody paying into a pool that will cover their homes in the event of a fire, a statistically predictable event. Some people will never have a fire and be happy to have the peace of mind and some people will have a fire and receive insurance compensation. Health “insurance” on the other hand is not insurance but a pay ahead system. Everybody will draw down on health care as they get older. We all die, and the astronomical costs (15% of medicare spent prolonging http://blog.reifman.org/2009/08/fifteen-percent-of-medicare-spent-to-prolong-last-60-days-of-life.html) the last 60 days of life is inefficient and will bankrupt either American individuals buying their own healthcare, American companies providing healthcare, or the American government providing healthcare. There is no easy solution, but there is a way to manage costs. It involves controls on when and what is considered the baseline standard of care that insurance, consumer, and the government can agree upon.

    I’m hoping we’ll see some controls on excessive spending, better engineered incentives, and a level of affordability that will provide access for all Americans to a minimum of care.

    http://www.nytimes.com/2009/08/18/health/18brod.html?_r=1&em

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