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The International Writers Magazine - Our Tenth Year: Comment

Is Health Care a Right?
James Morford

Near the axis of the current tumult and shouting over universal health care, lies a philosophical question: is health care a right that should be guaranteed by the State, yes or no? This question is in many ways more important than the facts (mainly based on economics) each side marshals in their favor, for it goes to the heart of the role government should play vis-a-vis its own citizens.

The United States founding document, the Declaration of Independence, guarantees every American citizen life, liberty, and the pursuit of happiness. "Rights," that for all intents and purposes, derive from God.

This idea of "right" is basically negative in nature. In other words, human beings experience with governments should exclude unjustified limitations such as expropriation, death, and torture. Limitations should be placed on government, and those favoring freedom must closely watch the state for infringement of these freedoms, and also make sure that the state prohibits groups of private individuals not take advantage of smaller or weaker private groups. The first ten amendments to the United States Constitution is often looked to as an example of this; thou shall not forbid free speech, the right to worship, the right to bear arms, etc. It has government being the "limit setter" the protector, not the instigator.

This emphasis on "negative rights" infers an absence of some quality, a restriction that prevents a group, governmental or private, from performing a function. Limits are established that prevent people from doing bad things to other people. It removes obstacles and insists people be left alone.

"Positive rights," on the other hand, come about not through covenants, stated or inferred, with God, but by social contract. People must act through their own reason and actions to guarantee the rights of others. It is not as much a "do not" philosophy as a "do" philosophy. Those favoring "positive rights’’ view a person, when deprived of health and welfare and unable to compete in the world, as being treated unfairly. Such people should have that unfairness corrected by government so as to redress the balance. Those favoring "negative rights," however, say there is great danger in state intervention as it often leads to hasty decisions, or actions not based on human experience but abstract speculation, not to mention waste, underproduction, and an autocratic control that diminishes individual freedom for people to act for themselves.

Even human happiness comes into the equation, say those that favor "negative rights," as compulsory mandates can lead to a kind of slavery where the happy slave might not realize his or her actual despair. How can the slave know the joy of creative and life fulfilling work when they no longer need provide for themselves, when they have been reduced to sub-human status by those deeming the life they should live?

Modern history is filled with instances where conflict arises over differences between how much power government should wield over its citizens. Many times it has been a question of leveling the playing field between the haves and the have-nots, often meaning the rich from the poor. Certainly over the past few centuries in the western democracies the "positive right" people have had the upper hand. Through mandates their political systems have tilted toward a philosophy calling for government action. This is opposed by a system with ideals that provide flexibility to many situations. The latter, "negative rights," has a tendency to allow for imperfections, and when needed, institutions that arise organically based on man’s imperfectability.

Those favoring ‘positive rights", look for quick change though governmental actions. Those favoring "negative rights" urge a slower approach and point out that mandates usually become more and more complicated over time. They say history has proven that people who enforce mandates become more and more powerful because they are more skilled in coping with inevitable complications, and thus takeover the state apparatus. When that happens, says the "negative rights" argument, the bureaucracy rules, a rule that is not awarded through an election or merit, but by unforeseen circumstances. Therefore, an insoluble and permanent system arises. And everybody loses.

This sad situation, says the "negative rights" people, occurs when people put into practice ideas such as minimum income, housing care, and, of course, health care. How societies design the extent of these "rights" is tied into history. Due to its lack of feudal history, an outstanding example is the United States. In the late l8th Century the United States was a land of immigrants, and although, as every nation since time began, it had a class system, it wasn’t nearly as structured nor as rigid as that found in Europe. No vested privilege in kings and queens and dukes and earls, nor a landed aristocratic gentry, nor a vast lower-class with little power. There was not the cry for "positive rights" as there was in a country like France with its more ossified class system. By the l9th Century Europe began to radically change and European nations adopted many "negative rights," and at the same time began creating more "positive rights" than those found in the United States. The rights arose from a social welfare state system that by the 20th Century was more advanced in degree than that of the United States. This situation has persisted, to one degree or another, to the present day.

Although something of a simplification, many Americans do not look at "rights" as does the European. There are many different examples, but let us look at two, both extreme yet instructive.

Not so long ago the Czech Republic government decided to introduce a co-payment of less than $2 per doctor’s office visit in their universal health care insurance program. Across the nation the outcry nearly toppled the Czech government. Health care was a "positive right" to the Czechs, not something the government could or could not take away, nor require payment. It was guaranteed by the evolving social contract that had been handed them by history.
Now let us look at an example of "negative rights" many Americans believe in. Novelist Ayn Rand said medical doctors are, . . . "traders, like everyone else in a free society, and they should bear that title proudly, considering the critical importance of the service they offer." Health care is nothing but another example of a free economic exchange. There is nothing special about it. Government should not interfere in the exchange.

And what does the world basically think? Evidence favors the "positive right" argument, as can be seen in the United Nation’s Universal Declaration of Human Rights, where medical care is considered a right of all people.

Therefore, if one believes the United Nations conclusion, health care is a basic human right whoever has to pay for it and administer it, and in one way or another that means people pay tax to the government for performing the service. This, of course, means giving up individual control to some grey ill-defined group known as the "medical commission", or the "government medical board", or whatever it may be called in any given place.

Choosing between these two rights is not easy to make, and is a strong reason for the extreme emotion one sees on either side of the argument. It is not just all about economic advantage. Both view themselves on the side of a justifiable "right," and therefore find it difficult to compromise what they consider a basic truth. They are right philosophically, ethically, and morally, and that has meant, and in the United States at least, still means, a long and protracted controversy filled with unusual vehemence.
© James Morford September 2009

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