The “right” to health care has led to substandard care

Dalrymple again takes on the “right to health care”, this time in the Wall Street Journal:


The question of health care is not one of rights but of how best to organize it. America is certainly not a perfect model in this regard. But neither is Britain, where a universal right to health care has been recognized longest in the Western world.

Not coincidentally, the U.K. is by far the most unpleasant country in which to be ill in the Western world. Even Greeks living in Britain return home for medical treatment if they are physically able to do so.

Read the essay.

(h/t Dave L.)

19 thoughts on “The “right” to health care has led to substandard care

  1. Josef

    Clear thinking in the midst of the emotional button-pushing porridge that we usually get. Bravo Daniels! Like a mental life raft this is.

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  2. Kate

    “The question of health care is not one of rights but of how best in practice to organize it”

    But he doesn’t make any suggestions on how best to organize it.

    “When I then ask my interlocutor whether he can think of any reason why people should not be left to die in the street, other than that they have a right to health care, he is generally reduced to silence. He cannot think of one.”

    They’d be a nuisance driving over on our way to work. I don’t think the silence is due to not being able to think of a reason why people should be left to die in the street, most likely dumbfounded due to the nature of the question.

    Seriously this is not the doctors usual standard, and I’ve read most of his books and listened to your videos and audio tapes, and admire his usual clear thinking. This article however is substandard for him. It smacks of noblesse oblige rather than the thought processes of someone in the caring profession.

    Where does the right to health care come from? Did it exist in, say, 250 B.C., or in A.D. 1750?

    The concept of rights has developed, as concepts do. It’s not a matter of being more or less intelligent than our ancestors.

    I agree with him on the bad equality of health care in Britain, but at one time it was the envy of the world. I agree its not cost effective, and there could be a better way of organizing it, but none of the models of health care in the developed world are perfect, I’d really have like to hear any suggestions from him on how to make improvements from better organisation of health carein Britain, rather than simply beating the NHS over the head with a stick.

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  3. Kate.

    “The government-run health-care system—which in the U.K. is believed to be the necessary institutional corollary to an inalienable right to health care—has pauperized the entire population.”

    It’s not the sole reason for the impoverishment of the nation.

    “inequalities between the richest and poorest sections of the population have not been reduced”

    Thats due to the richest having ability to pay and their ability to go outside the NHS for private treatment. In England there is inequality within the NHS due to a post code lottery, but country wide inequalities within the health service are mainly down to devolution. Like free prescriptions for all in Scotland, and soon NI but not England and Wales.

    Also re: the Greek people returning home for health treatment. That could be down to going there for health care because its cheaper. In Britain private hospitals are excellent but expensive. Huge improvements have been made with a new super hospital recently completed in Manchester, it’s been reported that it will be one of the leading hospitals in Europe. I agree there are dirty hospitals, and many are broken but there are dirty hospitals elsewhere in Europe too.

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  4. Tayles

    _The concept of rights has developed, as concepts do. It’s not a matter of being more or less intelligent than our ancestors._

    We have certainly developed a belief that we should prevent people from dying in the street, but that’s just a evolution of our morality. To call something a right, however, bestows it with a primal, immutable authority – like the word of God – against which no mere mortal can argue.

    What Dr Daniels is saying is that if something is called a right it must be a fundamental human entitlement that has nothing to do with morality, law or thinking of the time. It implies that it is something naturally-occurring and inalienable, which would be available to all but for the conniving of other, less moral people.

    In the case of freedom of speech, this is true, since we would all be able to speak our minds without fear of censorship in the absence of other people’s coercion. Free healthcare, on the other hand, should not be described as a right, since it places a claim on others to provide something that otherwise wouldn’t exist. It’s not a right any more than free ice cream for all is a right.

    In this case, the use of the word ‘right’, with all its powerful connotations, is being abused. It is taking a political ideal, which places a serious obligation on others, and describing it in such a way that we should feel outraged should we be denied it, without ever having to consider why we have a right to expect it, whose duty it is to provide it, and why such a duty exists.

    You may think this is a question of semantics, but it is an important one. Once you start describing political ideals as rights, they become impossible to argue against and place a ridiculous burden on society.

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  5. Kate

    “We have certainly developed a belief that we should prevent people from dying in the street, but that’s just a evolution of our morality. To call something a right, however, bestows it with a primal, immutable authority – like the word of God – against which no mere mortal can argue.”

    But you can’t have it both ways. You are using a moral argument (evolution of morality) to put down primal immutable authority argument(like the word of God.). If as you say morality has developed why can’t it include the belief that everyone is entitled to basic health care? Not to use a moral argument could conclude that people should really be allowed to die in the street, and we can shove them out of the way to get past.

    I agree with you, I don’t think rights are God given, and the burden placed on British society is huge. I think its something like seventy billion a year to fund the rights industry. But that doesn’t change the fact that the concept of rights has changed over time.

    Where I disagree with the doctor is his pointing to Britain as the worst example of socialized medicine in the west. Much earlier in our history socialized medicine worked for us. We were a small island economy with a society that had family type values, and the welfare state was seen as a safety net. The health of the nation was important, so we paid for it out of our taxes because we all used it. It isn’t like that now, because Britain is a border less country, and we’re paying for everyone that comes to these shores. It isn’t worth it any more. But that wasn’t the fault of socialized medicine, which can work under certain conditions. In a small island economy as I described, it doesn’t for us work now though.

    The inequalities he speaks of between rich and poor, is mainly an English rather than a British problem.

    Nor do I agree with him, that health care is akin to expectations of a certain food each Thursday. The ‘right’ of health care is underpinned by need, not wants or political ideals.

    You ask “Who’s duty is it to provide?” It’s the governments duty, due to the history of our democratic politics. We voted for governments with these ideals in their manifestos. As morality developed, so to did our political ideals and our concept of rights.

    If the first duty of government is defence of its citizens, why can’t they be defended from an invading virus?

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  6. Steve

    I don’t see how he’s having it both ways. Our morality can develop to the point where we start believing that we should help the sick, but that doesn’t mean that the sick have a right to be helped. If we suddenly start believing that they do, that is not a moral development but a philosophical development, a mistaken one because health care is not free and there can be no such thing as a right to the fruits of someone else’s labor. Incidentally, this change may lessen moral development by encouraging people not to personally help those in need because they think they have already done their part by paying their taxes and that it is now the government’s responsibility to provide care.

    I can’t speak to much of the facts about health care in Britain, but I was under the impression that socialized medicine worked at first mostly because the NHS inherited all of the medical infrastructure, which for decades they did not pay to maintain and update and that, as a result, the bill is now coming due and the system is straining under the cost. I also think the British people were more self-reliant and had more fortitude in the era when the NHS was implemented. You may not appreciate the extent to which socialism has caused this change by promoting dependence and weakness over time.

    I am in favor of using public funds to protect people from an invading disease, but that doesn’t mean people have a right to it.

    In short, people may start to believe that they have a natural right to a free car, and they may vote on that basis and write it into law, but that doesn’t mean that they do, and it doesn’t mean that there won’t be negative consequences of such a belief.

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  7. Kate

    I doubt the medical infrastructure bill is the whole problem. The system isn’t straining simply due to that, although it may be part of the problem, it’s straining because of bad organisation as the doctor says, thats why I’d be interested to hear what improvements in organisation of the NHS could be made. At one point he mentions the salaries and pensions of health careworkers, but I’m wondering if he is aiming at ‘managers’ who have been drafted in from industry to try to run it better and ended up costing us more. We also have people living longer than they did, which is extra cost. Theres a multitude of reasons why the system is straining.

    I do appreciate that socialism has created dependence and weakness, and that our nanny state has contributed to this. But that is the welfare state, the NHS is not the whole of the welfare state, merely a part of it.

    The British people were more self reliant, but dependency upon the state for welfare payments is distinctly different to the NHS.

    I’m not sure your distinction between moral and philosophical arguments has filtered down into popular thinking. It may be a mistaken philosophical development, but it’s there, it’s taken for granted, and any British government that tries to bring in pure market forces to healthcare will pay the price. I know conservatives are looking to implement vouchers, and in reality free health care in Britain is more of a myth now than a reality. It’s only those who are out of work or families on very low incomes who get totally free treatment, infact even the learning disabled have their benefits means tested and pay a certain amount toward dental and health care, and for some there is also prescription charges.

    Socialised medicine was opposed by doctors at first because they saw it as a threat. I don’t think the medical infrastructure bill of sixty years ago is the problem now.

    The dependence issue is more complex than the doctor has laid out. For example in one of your videos he speaks of a young woman who has hurt her grand mother. He asked the young woman about her mother, and if she’d been in trouble with the police. The young woman replied that she had, and that her mother had been doing the double, working while cliaming benefit. The mother then gave up work rather than quit her reliance upon the state. I know the audience laughed but it’s not funny. They are simply caught in the poverty trap.

    The reason for this is that state benefits are all encompassing and it makes more economic sense to rely upon the state for many poor people, than it does to work. So yes I agree, the evidence is all around that the welfare state has created dependency, but its hardly the fault of the health service on its own.

    My interest in the health care debate stems from involvement with the learning disabled, I simply don’t see how a civilised advanced society can call itself civilised if there is an attitude of let them die in the street, or suff

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  8. Kate

    Continued.

    Also my figure of 70 billion is a mis spelling, its 70 million.

    As to people not giving to charity due to thinking its the governments responsibility. That hasn’t happened in Britain. Thats one thing the doc cannot knock us for 🙂

    I don’t know if its a right, or a political ideal, when I look a forty something downs syndrome adult in the face and know he is suffering from toothache, I’d blast any country that refused to treat him or her. They’re dependent, not they’re not entitled to the fruits of my labour, then they can have it for free.

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  9. Jeff

    Kate claimed, “The concept of rights has developed, as concepts do. It’s not a matter of being more or less intelligent than our ancestors.”

    Words may change, but their conceptual referents do not. The concept “man”, i.e. that thing which it refers to, does not change. The facts which give rise to rights are based on the unchanging and essential nature of man as he relates to the rest society. A “right” not derived from this orginal cannot properly be called a right.

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  10. Tayles

    “If as you say morality has developed why can’t it include the belief that everyone is entitled to basic health care? Not to use a moral argument could conclude that people should really be allowed to die in the street, and we can shove them out of the way to get past.”

    There’s an important distinction to make here. It is one thing to say that we ought to be providing free healthcare and another to say that it is a right. The former is a moral argument, based on the belief that it is inhuman to allow our fellow beings to suffer. The latter is a fundamental entitlement that transcends human morality and shifting social attitudes.

    This may sound like hair-splitting but unless we make such disctinctions certain social ideals become sacred cows, the validity of which no one dare question.

    When the NHS first began, its budget was comparatively small and the burden on it relatively light. Unfortunately several factors have conspired against it in recent times.

    Firstly, it has become infected by the belief that perfection can be achieved through check-lists and procedures, administered by a vast army of bureaucrats. This increases costs but reduces efficiency and productivity.

    Secondly, the NHS has fallen victim to the culture of positive rights. With everything from the ‘right’ to have a baby to the right to the most expensive drugs now seen as God-given entitlements, its remit has expanded to breaking point.

    Thirdly, the political Left’s neverending search for victims has encouraged a growing number of people to describe themselves as sick. I don’t have the figures, but I imagine the number of counsellors, psychiatrists and psychoanalysts employed by the NHS has exploded over the past ten or twenty years.

    Fourthly, New Labour’s creation of a vast client state means a growing number of people are calling upon the services of the NHS without contributing anything towards it in tax revenue.

    Finally, people are living longer, meaning the NHS has effectively become a nursing home to the frail elderly.

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  11. Tayles

    One of the problems we have in this country is how we perceive our relationship with its insitutions. One of the defining qualities of New Labour is its belief that our insitutions – corporations, the state and other powerful bodies – have a duty of care towards us.

    This opinion is informed by the age-old socialist belief that powerful organisations have achieved their power through exploitation and oppression, making their wealth and influence slightly shameful and suspicious. The New Labour approach has been to encourage these institutions to change their wicked ways, accept the immoral basis of their success and become more socially-conscious.

    The result is that we look towards every club, society, employer, small business and corporation, and ask “what are you going to do for me?”. We believe that more powerful others have a duty to look after us.

    You only have to watch an advert on TV to see how many big companies go to great pains to trumpet their environmental concerns, their charitable activity, and so on. Radio stations cannot invite listeners to phone or text in without telling them to pull over to the side of the road first. Everyone has bought into the notion that those in positions of power are ultimately responsible for our welfare by virtue of their relative advantage.

    Of course, the socialist state is seen as the benign, all-powerful institution that overseas our other organisations and ensures they play fairly. The culminative effect of this is that we see ourselves as expectant recipients of aid and welfare from our institutions.

    Far from putting us in control of this relationship, it simply infantalises us. After all, the hand that gives is always above the hand that receives. We are now just foot-stamping children who have forgotten what self-reliance is about. We have merely replaced a voluntary (and therefore equal) relationship with our institutions with one of petulant dependancy.

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  12. Rachel

    I disagree with some of the comments here made about the NHS.

    First of all, TD is right about British healthcare being the worst in Europe. It’s not just the cancer mortalities that he quotes. If you ever get the oppotunity to get treated abroad under any Western European country’s *state* system, you’ll find things are much better. The waiting lists are smaller, hospitals cleaner and doctors better. TD’s lived abroad and worked in hospitals abroad so he knows. I live outside the UK and I see it. You can’t ignore that fact with a phrase like -so what there are dirty hospitals in Britain, there are dirty ones in Europe too.

    I also disagree with the idea that box ticking, managers and targets are the only things to blame. The hellish long waiting lists and incompetance were there 20 years ago. I remember it as I was a sickly child and teenager. The NHS was bad well before New Labour but it was just less bad than now and also less obvious to see, as British people did not travel abroad as much.

    The NHS was better at the start because it inherited both the infrastructure from the old system and also the doctors and nurses from the old system. Doctors and nurses in the old system did part of their work for free or at lower salaries for the poor. They often entered in the profession as a vocation. When that generation died or retired, then doctors just entered the NHS for money and a cosy job where they’ed be paid regardless of their behaviour by the state.
    The biggest problem of all with the NHS is that it is a state monopoly split into regional monopolys and is very similar to the Soviet Union’s type of helathcare.
    I’ed like a healthcare system like Holland, Germany or Israel which are a sort of halfway house between America and Britain, but are actually very affordable and do look after the poor- and learning disabled Kate.

    TD wrote a much better article on the subject a while back where he compared the NHS systemto an Third World African country’s healthcare and said that they both had equality in healthcare but that one gave aspirin in a mud hut instead of aspirin in a building. I just wish I could remember the title.

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  13. Leopold

    I would just like to say that this is an excellent site and very welcome. The quality and intelligence of the comments always seems to me to be very high and they are invariably civil.

    The concept of rights is vacuous yet incredibly emotive and is like tinder to one’s sense of self-righteousness – it should be entirely banished from our political and social lexicon. Its influence has been deeply corrupting. As a society we should be able to realign and argue about the morality and ethics of our legal prohibitions and provisions without resorting to abstract fictions.

    I don’t really have anything further to add but, for the little it is worth, I find Tayles’ argument to be very strong and much closer to the reality.

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  14. Kate

    Rachel and the others Thankyou for getting back. I’m sure our European counterparts do look after their sick and vulnerable. I take Rachels point about that, and know of one young woman with learning difficulties who was in a group sent to Spain to see how they did things there. There is much more emphasis now in the health service on empowering those with a learning disability, and there is much better communication between countries in Europe now than ever before.

    I think there is a copy cat thing going on where different health services in the regions are looking to others and abroad and copying the better aspects of each others care in all aspects of provision.

    I also take your point on box ticking, but everyone in the nation has his or her own opinion on the problems in the NHS. One friend of mine blames all the troubles of the NHS on the fact that ‘matron’ has disappeared, and there are simply no rules in hospitals any more. Another thinks its the franchising out of cleaning that has created dirty hospitals, since there is no ‘in house’ cleaning now.

    Someone did tell me that Europes hospitals had similar problems to ours, but I can’t argue personally either way. The only thing in your comment that I would disagree with is that Europes doctors are better. I doubt that, and haven’t read anything TD has written that would support that view, but while I’ve read quite a lot of the good doctor I haven’t read everything, so I could be wrong.

    Also, isn’t TD British, so we can’t be all bad now can we?

    regards to all, and excellent blog.

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  15. Jeff

    To Leopold:

    Wherein are rights vacuous? And what would you replace them with?

    If, by rights, you mean the positive conception of rights, then I would agree. The negative conception of rights, however, is far from vacuous.

    A right, properly understood, is a moral or legal claim to something to the exclusion of the rest of mankind. The first asserts that a thing ought to be yours and the latter that this claim actually be enforceable. So, in the moral sense, the right of property means one ought to be able to keep the fruits of one’s labor. The legal right to property makes it actually enforceable.

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  16. Leopold

    I think it is important to separate legal rights, and rights, positive or negative, that are, a priori as it were, man’s due by the very nature of being man – this is clearly a fiction.

    If by rights we merely mean legal rights, as you seem to suggest, then arguing for legal changes to the healthcare system in order to accommodate “the universal right to healthcare” is a circular argument. We may argue that there should be a legal obligation to provide it, but we can not argue that there exists a right (what would this right be? and where does it come from?) for all men to it.

    Taking an example of a positive right, say freedom of speech, clearly, again, this is somewhat of a fiction. Man no more has a right to freedom of speech than he does to a pair of new shoes every full moon. Indeed, British society currently curtails freedom of speech in numerous and various ways (contempt of court, hate-speech, stringent libel laws, incitement to violence, etc.) – it seems to be somewhat necessary; although this is admittedly debatable, but when we debate we debate on a practical level, not by referencing some divine right to speak one’s mind – no matter what one’s mind may be – in any and all situations without censure. We may believe that providing a legal right to freedom speech is a fundamentally wise way to organise society, and we way choose to make this a constitutional, foundational right, but, again, this is a legal provision, it is not, and can not be, a “right” in any sense beyond this.

    Man as a creature has no rights, has no entitlements; he only has the law, he only has rights to the degree that society provides them to him. And if the law is unjust and cruel, appealing to human rights is vacuous because, well, they are fictions – they hold no water logically. As I said, if one seeks to realign society along more ethical and moral lines, one would be wise to not appeal to that which has no reality – the moral and ethical arguments are more than strong enough on their own; appealing to rights is, as the Doctor said, wont to reduce moral imagination.

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  17. Jeff

    Freedom of speech is a negative right.

    Negative rights are a prohibition of the initiation of force or fraud, a requirement of civil society. They are not claims to things, but to liberty from compulsion. They say, in short, within this realm you may act as you please, i.e. by right, but not beyond. Rights are the political consequence of the immorality of coercion.

    So, if a man has not rights, then on what grounds do you object to arbitrary rule? The forced confiscation of property? Mass executions? If he has no right to his life or property, then he lives and possess merely by permission. He is, as any man is who does not have a right to his life or the product of his labor, a slave.

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  18. Leopold

    You are quite correct, my mistake.

    “So, if a man has not rights, then on what grounds do you object to arbitrary rule?”

    Moral ones.

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  19. Rachel

    I just want to thank Kate for answering. I also want to say that I did not mean to be anti British when I was complaining about the NHS. Yes I am anti NHS but I think it is just this govenment monopoly system that messes up the medical care in Britain. I did not mean to say anything anti British in itself. I really apologise if I gave that impression. One of the reason I get so angry about NHS (apart of bad personal experience with it), is because I know the British health care system and the people working in it would be capable of so much more if it wasn’t stuck in a soviet monopoly NHS model. You just have to look at other more successful and famous British institutions and businesses that aren’t run as govenment monopolys and that compete so well on the world to see it.

    The main reason I am posting this is that I finally found the link of the other TD article that I was talking about:
    http://www.socialaffairsunit.org.uk/blog/archives/000903.php

    The title is:
    “As alternatives to the NHS are considered, which model of healthcare will Britain adopt?”

    I thought it just might interest others to read it.

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