Healthcare is a Privilege, Not a Right

Stephen Kershnar

Healthcare is a Privilege, Not a Right

Dunkirk-Fredonia Observer

March 17, 2019

           

Pope Francis, Former President Barack Obama, and Senator Bernie Sanders all claim that healthcare is a right, not a privilege. Pope Francis states, "[H]ealth is not a consumer good, but rather a universal right, and therefore access to health care services cannot be a privilege.” Former President Bill Clinton did not claim that health care is a right, but that it should be a right.

In contrast, President Donald Trump claims that healthcare is a privilege, not a right. During the campaign, he said, “You wouldn’t give some bozo with zero experience a management position. Why should healthcare be any different?” He also said, “Where I come from, you have to prove your worth. You have some guy with no college degree working a minimum wage job; no ambition, no goals, nothing to show for it. Yet for some reason, the current administration believes he – and millions of people like him, should have access to health insurance. It’s outrageous.” Whose view is correct?    

If there is a moral right to healthcare, then people have such a right regardless of whether the law says they have it and, also, regardless of whether there is a government to enforce it. Rather, such a right would exist as a requirement of justice. If, instead, there is merely a privilege to healthcare, but not a right, then it is not wrong if no one provides it (including the government). It might be good or efficient for the government to provide it, but justice would not require it.

There is good reason to believe that there is no such right. First, consider who the purported right would be held against. The logic of rights tells us that every right is held against someone. If there is a right to healthcare, then there is someone against whom the right is had. There is no one against whom such a right is had. If there were a right to health care, then, as a moral matter, either a taxpayer would have a duty to give money to someone needing healthcare or a physician would have a duty to give his services to her. There are no such duties. A person in need of healthcare owns neither the taxpayer’s money nor the physician’s labor. After all, the physician is not her slave.

Also, if there were such a right, then it would be held against other people or physicians even in the absence of government or law. Remember that a moral right (specifically, a natural or human right) is a requirement of justice and does not depend on whether a government enforces it or a law requires it. It is implausible that people would have a duty to pay for other people’s medical services or physicians would be required to provide such services if there were no government or law.

Second, consider the content of a right to health care. It is unclear what a right to health care would entitle one to receive.

Health comes in a continuum from very sick to very healthy. It is unclear what level of health a person has a right to enjoy. In addition, a government often can’t provide a minimum level of health in the face of severe injury or disease.

If, instead, the right is a right to an amount of healthcare services, it is unclear where on the continuum of services a person might receive that the right ends and a privilege begins. Medical services can range from the bare minimum in disease prevention to very expensive life-saving surgery and receipt of scarce organs for transplant. It is implausible that there is a threshold amount of services a person has a right to after which she has no more than a privilege.  

In addition, consider how the right to health care relates to the other necessities. If there were a right to healthcare, then there would also be a right to food and housing. All are necessary for someone’s life to go well. However, if there are rights to healthcare, food, and housing, then these rights would conflict. A dollar spent on health care cannot be spent on food and housing. If rights cannot conflict, as is often assumed, then there cannot be rights to life’s necessities.    

Third, in the U.S., consider who would have such a right. If there is a right to healthcare, then it is held by only some people or by everyone. The right can’t be held by only some people because restricting the right to some people, but not others, would be arbitrary. If the right were created by law, this would create a legal right, but not a moral one. The latter is what Francis, Obama, and Sanders have in mind. The right to health care can’t be had by everyone because, currently, it is simply too expensive for some people (for example, American taxpayers) to be able to provide quality medical services to the whole world.   

Fourth, the alleged right does not justify any particular type of health care system. Even if people did have a right to health care, this would still not tell us whether there should be a government monopoly on medical services (for example, a single-payer system), government-guaranteed medical services (for example, Medicare for all), government-subsidized medical services (for example, Medicaid for the poor), government-mandated purchase of medical services (Obamacare), or no government involvement in medicine (for example, the free market). If the correct institution is picked out by what makes the average person the healthiest, then the system should be chosen through economic-based rather than right-based reasoning. This is true even if the chooser’s heart bleeds for the poor. Clinton likely confuses economic- and right-based reasoning.     

Such a right could even lead to an apparent contradiction. What if the best way to promote people’s health is to treat them as if they had no right to health care? Perhaps free-market breakthroughs in drugs, preventive medicine, and surgery make people healthier. We might end up in a situation in which the best way to protect people’s right to health care is to pretend they don’t have such a right.  

The fact that Clinton, Francis, Obama, and Sanders don’t understand how rights work and Trump does is no big deal. It will be a big deal if voters think that that these guys’ view is correct and that this tells us which healthcare system to adopt.