Health Care and Rights of Action

As the current health care reform debate takes increasingly religious and moral overtones, it’s likely we will hear asserted more and more that health care is a basic human right, which the government has an obligation to provide to its people.  However, whatever the utility of the kind of health care reform considered in Washington and discussed across town hall meetings across the country –and I think reasonable minds could differ on that– I hope we can dispose of what strikes me as a silly notion that health care is a right.

Certain difficulties of such a right present themselves pretty quickly.  Health care is an evolving, improving thing– is my right to health care more substantial than my parents’ right in 1970?  How could a basic human right change like this?  I suppose we could define this right as entitling us to the best health care available currently.  However, it’s clear that in nations with socialized medicine– many who prefer to refer to their care as a basic right of their citizens– the level of care is good, but certainly not the best available (see Canada, Cuba, the U.K., Ireland, etc.).   Would this level of health care be practically impossible to achieve?  (And if so, how could that then be a right?)  Maybe a right to health care bespeaks an “average” or medium level?  The practical difficulties of defining such a tranche are obvious.  A “basic” level?  Keep in mind, hospitals are already required by law to not refuse anyone of emergency care, regardless of lack of insurance.  Perhaps we’ve already met this basic level.

When it comes down to it, a right to health care would be a right to someone else’s labor and property– those of doctors and hospitals, and ultimately, other private citizens.  Suppose no one decided to go through medical school to become a physician.  Would the right to health care allow us to compel a certain number of citizens to become doctors to service the rest of society?  After all, health care could not exist without such labor.  If enough people did choose to become doctors voluntarily, now the fruits of your labor may help pay for these doctors to treat me, who pays less taxes than you.  (Remember, the top 1% pays more taxes than the bottom 95%, which constitutes a moral outrage for another day.)  And what about the people who can afford to purchase insurance, but choose not to?  Does it make any sense for you to have to pay for the insurance I could already afford, even though you made the “wiser” decision of also purchasing insurance for yourself as well?  Is any of this morally right?  Do I have a right to your labor and property, even if I don’t need them?

Interestingly, Thomas Jefferson defines inalienable rights (upon which a true democratic society is based) to those of life, liberty and property, which on their face may seem to create tension in our context.  (I have a right to life, and thus a right to be kept alive?)  Not really, though.  As Leonard Peikoff argues in a powerful essay worth reading in its entirety, Jefferson is articulating rights to action:

“Observe that all legitimate rights have one thing in common: they are rights to action, not to rewards from other people. The American rights impose no obligations on other people, merely the negative obligation to leave you alone. The system guarantees you the chance to work for what you want — not to be given it without effort by somebody else.

The right to life, e.g., does not mean that your neighbors have to feed and clothe you; it means you have the right to earn your food and clothes yourself, if necessary by a hard struggle, and that no one can forcibly stop your struggle for these things or steal them from you if and when you have achieved them. In other words: you have the right to act, and to keep the results of your actions, the products you make, to keep them or to trade them with others, if you wish. But you have no right to the actions or products of others, except on terms to which they voluntarily agree…”

The right to the pursuit of happiness advances the argument.  You’re not entitled to happiness, whether provided by God or society, but you are free to pursue it for yourself.

Rights to action have a simple elegance to them in that they are not evolving, unlike what a right to health care may be (ex. 1970s vs. now).  (Sure, rights to action were gradually recognized throughout history, but that doesn’t mean they didn’t always exist in absolute form.)  Rights to action are not imperfect, inchoate or qualified– they are complete and achievable.  More importantly, rights to action also have the advantage of not coming into conflict with each other.  To simplify, we are free to do what we want, as long as that doesn’t impinge on others’ ability to do what they want.  My rights start where your rights stop.  Etc. etc.  On the other hand, my right to health care would conflict with your right to your own property, the fruits of your labor.  How could that be so unless we were to do away with the foundation of democratic society as conceptualized by our founders?

Now, I’m all for charity– I’m not implying that we shouldn’t be looking out for one another on a private, moral level.  I understand the very admirable intentions of some who’d like to locate a right to health care in some transcendent metaphysical reality that would compel the government to act– I really do.  (After all, I think you can find an obligation to be your brother’s keeper in a transcendent spiritual reality.)  But to impose a right to health care on society through public means is inappropriate and undemocratic because it runs against the logic of inalienable rights.

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9 Comments

Filed under Brandon

9 responses to “Health Care and Rights of Action

  1. whb

    It won’t perhaps surprise you to know that I disagree. First, you start with the idea that a Right is a right to pursuit of those things, not a guarantee. For the most part, I guess I would agree and say that in the US, we don’t have equal access to basic health services. Sick people are dropped by their insurers all the time, the poor (myself included) cannot afford more than basic insurance. This means that sure, if we get cancer we won’t be totally (just mostly) screwed. However, the preventative care that discovers cancer before it is too late.
    The parsing of just what the right to health care means skirts over basic facts: a large portion of Americans are dying in the US because health care (something that is absolutely basic and not a luxury) is set up to make profit rather than take care of citizens. How is your health care plan? Comes through your employer? Must be nice.

  2. Christopher

    Brandon, I really appreciate your sharing this stance on the issue because I used to be right there with you. Suffice it to say, life experience has changed my position dramatically. While I agree with you that there is no inalienable ‘right’ (per se) to health care, I diverge in my acknowledgment that advanced societies see fit to provide services which befit the common good of its citizens, collectively paid for by its citizens. We don’t have a right to well-maintained highways and interstates, though we agree as a society that it is worth paying for because of the ease and freedom it affords us as Americans. The same can be said for health care.

    Everyone of us gets sick, and everyone of us will eventually die. Illness, along with death, may be the ultimate equalizer, as it is blind to race, wealth, and creed. What is the role of government? Is it to pull me over and give me a ticket for not wearing my seatbelt? Or is it to work for the ease and freedom of it citizens?

    If you really believe in liberty and freedom within the context of our society, we can’t asses it through self-protectionist, 18th century, agrarian values. America is an evolving and heterogeneous cultural milieu. There are many hardworking, tax paying, law-abiding citizens who have contributed greatly to the prosperity of our country and are unable to meet the financial obligation of their health care needs. And maybe it’s not the role of our employers (those of us fortunate enough to have jobs with benefits) to offer us medical, dental, or vision. Our own personal freedom, safety, and prosperity are better ensured as Americans when we take symbiotic action to ensure the health of all our citizens.

    I realized some time ago that the problem with the “Rights of Action” philosophy. Though it is indeed an elegant answer, and appears agreeable, it fails to offer solutions to society’s complexities. What of those in society who are unable to act for themselves: the physically and mentally disabled? What of the paradigm citizens who will die because they cannot afford health? I’m not just talking about poor, Brandon. I’m talking about my self-employed father who suffered a nearly fatal heart attack 2 years ago. He’s now wrought with $100,000 medical bills because no one would give him health insurance 10 years ago. He had to sell his house and move in with his sister to make ends meet. I’m talking about the middle class. In that vein, our society is failing us. Since we are a government of the people, our people’s government should act accordingly.

    I happen to believe we can form a society in which our freedoms are preserved (and extended) while limiting our government in ways that allow it to work for us (as in universal health care). It’s not “the citizens vs. the feds”….we ARE the feds. What are we going to do about it?

  3. GCC

    I think this post boils down to two separate issues, but it seems that only one was really intended to be addressed.

    The first, rather objective, issue is whether or not healthcare is a right. I think the answer is clearly, No. When it comes to healthcare and things like it, we can call it a right as much as we won’t, but that won’t turn it into one. Rights cannot be imposed. (Indeed, just thinking of those “imposing” and “rights” together is a bit unsettling.)

    The second issue is more subjective: Public Healthcare, Yes or No? I don’t think Brandon addressed it much in this post, though his last sentence does seem to leave open the idea that a public healthcare program may be wrong. It seems to me that the importance of freeing ourselves from the errant notion that healthcare is a right, lies in what the resulting approach to the healthcare debate would likely be.

    More on that later…

  4. czfinke

    Brandon. Thanks for the post, here’s my (quite direct) approach.

    This is quite a jumbled, strange argument against Health Care as right. I don’t understand how someone having a basic right and that depriving others of their property/labor is a problem. All of our rights do that. Because we are dependent on others to take care of the things that we cannot do for ourselves. Which is a lot.
    Our rights are provided for us by others, they don’t materialize out of some magical source. We make sure they are available, and it takes the property and skills of others to keep this going. As much as the bootstraps mentality of “rights to action” might be our preferred notion of American freedom and Rights, it is simply not our country. Students have a right to be bussed to school to enable attendance. Someone has to drive that bus and someone owns that bus, but the child still has a right to get a ride to school. A basic right, our country, despite much fighting, has decided this.

    But the real problem in your essay, for me, are these two phrases: 1) “A true democratic society” and 2) “Now, I’m all for charity.”
    I don’t think much positive can follow those two phrases. That implies (to my liberal sensibilities, of course) that the next thing to come will somehow be denying someone something they probably need.

  5. GCC

    I think CZF has just demonstrated why it is sometimes so hard for individuals on multiple sides of an issue to understand each other. There are dramatically different Weltanschauungen, and the different sides are operating with dramatically different understandings of the most basic things.

    Take the concept of rights for instance. Some suggest that rights are inalienable or inherent, while others suggest that rights are acquired or granted. For the former position, very few things are and can be rights. For the latter position, many things are and anything could be a right. While the latter position seems to view rights as things (or services, etc.) to be acquired or granted, the former seems to view rights more conceptually. When things and services are viewed as rights, the existence of the right is dependent on the existence of the thing or service. On the other hand, no thing or service must be present at all for the more conceptual rights to exist; they are independent. Conceptual rights (as Brandon calls them, rights to action) are present even when a person is in complete isolation, apparently having no source. Where as rights that “are provided to us by others” certainly do not exist for a person in complete isolation, because those rights are clearly dependent on their source, which in such isolation would not exist. Rights provided by others make the receipient of the right vulnerable to the whims and will of the rights’ source; all the power is in the hands of the right-giver. In contrast, rights to action place all the power in the hands of the right-holder, as he/she is, in a way, the source of her/his own rights.

    These two understandings of rights are different indeed. In the realm of government, it’s hard to think of two more diametrically opposing points of view.

    So I’m curious, what makes one person think that a right is merely a right to action, while another person thinks that a right is a right to a particular thing or service? It’s fascinating to me that people can disagree so fundamentally on things that are seem so fundamental.

  6. blraatikka

    Disagreement is more fun that preaching to the choir sometimes. Thanks for your intelligent comments guys.
    WHB, I think we’d agree more than you think, especially in what constitutes justice. However, Grant is correct– my post was primarily about whether health care is a right or not. Some of what you say is irrelevant to that point. I am conscious that the rights discussion in this context may be a red herring distracting from more pressing issues, and I hate to contribute to that. In any event, though, the term “right” is thrown around in this debate, and because I think language matters, it is worth it to me to try and debunk a false appeal to the kind of capital the term “rights” carries, in order to make the debate fair, before I discuss the merits of an actual reform proposal. I am also aware of my biases; I do have health coverage. But, I’ve also been a poor graduate student without health insurance– it was a less than ideal situation, but I never felt I was owed anything by anyone. And my employer provides a way for me to purchase health coverage– it is part of my compensation, and in that sense, I pay for it by foregoing that portion of salary.

    Christopher– I appreciate your perspective, and in particular your admission that health care is not an inalienable or transcendent right, coupled with your position that we should still provide health care as a matter of utility. Like I said, reasonable minds can differ on actual health care reform, and it does make sense to me in some ways to advocate for a public health system, even if it’s not a right. And I’m not saying that the system in some ways is not broken.
    That said, I prefer the elegance of rights to action, in part because nearly every economic activity is based on the meeting of human needs, and your criteria of “befit[ting] the common good” threatens to swallow the entire system. The logic could be applied to not letting companies fail– after all, it’s peoples’ livelihoods!– to Wall Street bailouts, to an obligation of the government to provide housing to all. For starters. These all seem as basic as health care. And in all of these you have to limit the right of others to their labor and property. Do you not think these are rights? How can you balance such government obligations against something that are rights in a non-arbitrary matter?
    I could probably accept universal health care if we had a radical re-prioritization of government budgets so that health care is one of the very few things we all provide for each other. Like I said, it does make sense to me in some ways, and health care seems pretty “basic.” That would mean to me, however, that stimulus plans, the arts and most of everything else government provides for would be an illegitimate use of public funds. And we’d need tort reform. And then I’d still probably have significant problems with it.

    CZF– I figured I’d be accused of being too simplistic, not “jumbled”! No worries though, and I quite prefer your direct approach. All I can do is point you to what Grant says– very, very few things are rights in the sense I mean the term. There are a lot of legal privileges, but these arise from positive law, not natural law. Thus, I can tell you with a straight face that children are not entitled to bus rides as a matter of right. (Neither is public education a right.) Now, I happen to think these things are good, but only after democratically approved.
    I think we most disagree on the means of dispensing what people need. You seem to argue for government’s primary role. I ask you this– what totalitarian system has met its citizens needs better than a democratic system with free markets? Of course, capitalism isn’t perfect, but it’s my view that on the balance is it superior to a more socialistic system. (I hope this doesn’t open up a whole nother can of worms…)

  7. czfinke

    I don’t disagree that democracy and capitalism are the best. In fact, I want my capitalist, democratic government MORE INVOLVED! Because, for better or worse, it is the best.

    Second. I guess, then, I don’t care about natural laws or positive laws. I care about rights and equality, and I think that health care is some kind of right, and everyone should have it, somehow. Natural Law or Rights in this sense generally seems to me to be a term applied after we’ve agreed it should have been there all along. It wasn’t there, but we’ve recognized our error.

    and, honestly, enough with the totalitarian system and the socialist states. I do not want a totalitarian state, and providing health care through a public run, government option which can compete with free market options (or even going to an all public option, which we will never (ever) do), is in no way leading the U.S. to totalitarianism.

  8. czfinke

    post-scripterly:
    when I say I don’t care about natural laws, I don’t mean necessarily that I don’t care, but that we are just talking about something different. Which is reasonable, because we are not the same person.
    Didn’t want to look like a jackass.

  9. blraatikka

    CZF– I understood what you meant about not caring about natural vs. positive law. No worries.
    The reason why I alluded to the totalitarian vs. capitalist dichotomy is because you objected to my assertion that I’m all for charity, by saying “[t]hat implies (to my liberal sensibilities, of course) that the next thing to come will somehow be denying someone something they probably need.” My definition of totalitarianism involves the government providing everything people need (instead of citizens obtaining such through private means, which includes charities)– so I felt like you were making an implicit appeal to such a system.

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