For the moment at least, healthcare is at the center of the American news, as President Barack Obama and fellow Democrats try to enact legislation that would radically change the American healthcare system. Although Obama has avoided any mention of a right to healthcare as justification for the change — and instead pointed to the impact of escalating health costs on the Federal budget — liberals have long argued that healthcare is a basic human right, and many continue to use the presumed existence of such a right as a clinching argument to end all debate on the matter: if healthcare is a human right, one that inheres in human existence itself, it can only be the gravest of injustices to fail to recognize it and to provide for it, the consequences be damned.
Theodore Dalrymple addressed this idea in his 2001 book
An Intelligent Person’s Guide to Medicine with a clarity of thought and language that has recently been hard to find:
The first step is to dismiss out of hand the absurd idea that anyone has a right to healthcare. No one has a right to healthcare. Indeed, where could such a right come from? The increasing tendency in modern society to treat all goods, and all human desiderata, as the American Declaration of Independence treats life, liberty and the pursuit of happiness is extremely foolish, for reasons I shall explain. The problem of the metaphysical origin of human rights will not go away. It should be remembered that the American Declaration of Independence asserted the rights to life, liberty and the pursuit of happiness in the belief that all men were created equal and that these rights were endowed upon them by their creator. In other words, the Declaration was, if not a religious, than at least a theist, document. Take away God, and the origin of the rights asserted becomes completely mysterious.
If we do not believe in God (and of course it is also perfectly possible to believe in God without believing in the right to life, liberty and the pursuit of happiness, or in any other rights whatsoever), we have to find some other transcendent source of our supposed human rights. And the fact is that, while an ever-increasing proportion of the population believes it has rights, of ever-growing number and complexity into the bargain, an ever-decreasing proportion of the population believes in God.
It might, of course, be argued that the source of our rights is in our human nature. But there are undoubted difficulties in this view of the matter. The headhunters of Borneo are indubitably human, but they do not believe in (and would not even understand) the right to freedom of religious worship, let alone the right to healthcare. What we believe to be our rights are in fact the philosophical product of a particular culture at a particular time. But rights must, by the very nature of the concept, transcend both culture and time: they are universal, or they are nothing. Either we must believe that our society has discovered pre-existing rights, rather as Koch discovered the tubercle bacillus, and that therefore we stand at the pinnacle of human moral endeavour, or that in fact our supposed rights are fictions, which we made up to suit ourselves. In the former case we are guilty of the most terrible arrogance (though, interestingly, those who most strongly believe in human rights also pay most lip-service to the contradictory ideal of multiculturalism), while in the latter case we are reduced to lying and pretence. We pretend the rights we have awarded ourselves (or that governments have awarded us) have transcendent origins, but we know perfectly well that they have not. Like most pretences, this one can be kept up a while, so long as no one agrees to talk about the metaphysical legerdemain, but not for ever. The truth will out, with a consequent loss of faith and an access of moral confusion.
If there is a right to tangible goods (such as food, housing and healthcare), someone has an obligation to provide them, since they do not arrive as free gifts of God or nature. They are, in fact, the products of human labour. The obligation to provide others with the fruit of one’s labour is indistinguishable from slavery — except that one has the option to do nothing, since food, housing and healthcare (among other necessities and desiderata) are one’s rights. A man who chooses not to work therefore merely shifts the responsibility for providing these things from himself to others, as it must be his right to do if these things are in themselves truly rights.
The idea that tangible benefits are and should be conferred as of right exerts a most lamentable effect upon the human personality. The reason for this is obvious. In a world of rights, there is no reason for gratitude or indeed for kindness. Social arrangements will be so perfect that no one will need to be good; nor, of course, can there be any dire consequences for those who are bad. There is no reason to be grateful for what is received as of right, since it is precisely that — a right. At the same time, resentment is aroused when those things which are believed to be rights (an ever-increasing number) are not received. Neither ingratitude nor resentment are an attractive human characteristic: and the consequences of the doctrine of rights, with its attendant ingratitude and resentment, are to be seen in British hospitals. A right being by its nature inalienable, it does not matter how its possessor behaves: he can smash up a house and demand a new one (‘It’s my right’), and he can abuse and assault hospital staff and demand medical attention (‘It’s my right’). In these circumstances, therefore, it is not surprising that 40 per cent of British general practitioners are assaulted by at least one patient a year, or that a nursing sister to whom I spoke recently told me that a patient in her ward informed her, after she had been assaulted by another of her patients, that this was what she was paid for.
There is, and can be, no general right to healthcare.
It does not follow in the least, of course, that healthcare should not be available for people. The satisfaction of rights does not exhaust moral duties. A society in which the ill are well treated is better (at least in this regard, though not necessarily in others, since health is not the whole purpose of human existence) than one in which they are not. No one would want to see a society in which the ill were denied help: but this is because human kindness, decency, solidarity and sympathy demand that we succour the sick, not because the sick have rights.
The question of how healthcare should be provided cannot be answered by an appeal to a single simple desideratum: for example, that everyone should receive the same level of healthcare, in the name of equality or equity. Equality is not much a value in itself, for it would be satisfied by a system in which everyone received the same appalling healthcare and died at the same early age. Would a society in which no one received good healthcare be better than one in which half the population did? Egalitarians, but surely no sensible person, would answer that it would.
At the very least, egalitarians would have to add a condition to their demand for equality: that the healthcare to which all should have equal access must be good, or better than good. But in that case, equality is no longer the sole moral yardstick by which a healthcare system should be measured. If an unequal system nevertheless provided a better overall level of care, then it might with reason be preferred to one that gave the same, but inferior, level of care to everyone.
Now compare the clear logic of the preceding passage with a transcript from a portion of
this recent, brief debate, hosted by National Review, between the liberal writer Chris Hayes and the conservative writer Reihan Salam:
Will Cain: So let me start with you, Chris. Do Americans have a right to healthcare?
Chris Hayes: Well, sure. The problem with arguing about rights is that it’s a sort of axiomatic thing. I mean, how you argue for a kind of first principle like the fact that people have a right to healthcare is a little difficult. But yes, as just a basic moral principle, I think that everybody… you know… the right to live a life as unburdened as possible within, obviously, the constraints of cost, etc. by the vagaries of illness, crippling chronic disease, etc. is just a basic human right.
<:od>So immediately after arguing that the existence of a sound, philosophical basis for the right to healthcare is highly doubtful, Hayes immediately claims that it nonetheless exists. In fairness, the conservative position on many ideas (certain moral standards, for instance) is that, while it is difficult to find a rational reason to justify them, we nonetheless presume their existence, but that view relies almost entirely on a respect for tradition, since those standards have existed for hundreds if not thousands of years. Hayes, of course, doesn’t have much tradition to fall back on. The push for positive rights in general, and the right to healthcare in particular, has a history in America dating back no more than 70 or so years and remains outside mainstream American thought.
To be charitable, it is possible that Hayes means to say that there is no such thing as a right to healthcare but that common decency and human kindness could be served by the provision of it, but if true, this would demonstrate that Hayes may not understand the fairly significant difference between the two justifications, insofar as the latter makes everything dependent on practical considerations (he did qualify his statement by reference to cost) and the former implies their irrelevance. Of course, it might also be true that, in such a short debate with a limited amount of time to make his case, he simply phrased it poorly (I would probably do no better). At worse, it could be that, although Hayes doubts any metaphysical basis for the existence of a right to healthcare, he is simply unable or unwilling to give up the rhetorical advantage that such a belief provides to his side in the debate.
Regardless, liberals on the whole have pointed to the existence of such a right for decades.
Will Cain: Well, it’s a positive right, right?
Chris Hayes: Yeah.
Will Cain: I mean, that’s what it is specifically. And Reihan, we have a lot of positive rights. We have police protection. Does healthcare not fit in to that?
But police protection is certainly not a positive right. The provision of police services flows out of the negative right that citizens have not to be harmed (via physical assault, burglary, etc.) by their fellow citizens. If it could be determined that this negative right were best protected in some fashion other than by a police force, we would no longer regard the police as necessary, much less as a positive right.
Reihan Salam: I don’t think it does, because I think that a right to healthcare implies a right to health, and I think that’s a dangerous idea. I think that one thing that you’ve seen with the, for example, socialization of pensions is the idea that, well we’ve socialized your pensions, ergo we actually need to get more involved in your intimate life. Similarly, you know, if we’re going to provide you with a right to healthcare, then I think that implies that, well, you know, you’re obese, or you’re creating other social demands. And so there becomes a public health framework. And there’s nothing intrinsicallly wrong with it, but I think that there’s a real danger that the state starts to interfere ever more with your intimate life and your personal choices. So I think that, yes, there’s a prudential case for a basic social minimum, for insurance reforms, that kind of thing. But to imply a right to healthcare I think takes us down a dangerous road.
Leave aside Salam’s assertion that “a right to healthcare implies a right to health”, which I think is questionable at best (although it is probably inevitable that some would make that illogical leap), and note his concession that “there’s nothing intrinsically wrong with it”, which is surely a far cry from Dalrymple’s clear explanation of the philosophical absurdity of the idea.
Chris Hayes: Well, we should also just say that there is a right to healthcare that’s acknowledged, which is the fact that you can’t turn people away from emergency rooms, right? So unless I misunderstand Reihan, and I don’t think I do, I don’t think anyone would advocate the fact that if someone is shot or hit by a car and they show up and can’t pay that we just turn them away. So we acknowledge that there is a basic kind of framework that we do have to provide emergency care to everyone, and part of the problem with the system is that we don’t build up from that to sort of approach care in a more holistic fashion that I think would actually be in the long-term a lot less expensive.
Again, Hayes does not distinguish between moral responsibility and the kind of inescapable philosophical demand that requires recognition in law. For him, the choice seems to be that we either establish a legal right to healthcare or we allow the poor to die. He does not seem to believe that compassion and charity can exist even when it is not legally required.
As to his contention that endowing all citizens with an eternal right to healthcare, and thereby freeing them of responsibility for their own health, will make healthcare less expensive, to say nothing of making people healthier, what need be said? Perhaps only this…
More Dalrymple, please.
