TERMING health care a “basic human right” may seem politically virtuous. But such phrasing oversimplifies the necessary debate over how our health care system could operate better.
The rights-based approach to health care reform is wrong as a matter of U.S. law, history, politics and economics. We can do better than just recycle another round of these empty words.
From a constitutional law perspective, there is no “right” to health care. The unalienable natural rights highlighted in the Declaration of Independence include life, liberty and the pursuit of happiness. But those rights can neither be granted, nor taken away, by government.
Hence, the Bill of Rights focuses on so-called “negative” rights: personal freedoms upon which government cannot infringe, rather than goods and services it must provide. Positive rights may promise universal guarantees, but they would first have to take away other rights from someone else.
Sketching out the legal boundary lines for imposing duties on others to sustain someone’s life or ensure their happiness is far harder to do in practice than through facile rhetoric. At best, this is generally attempted through statutory law entitlements that provide formulas and eligibility criteria for collecting funds from taxpayers to reward qualified beneficiaries with either cash grants or particular services.
Even these political decisions involve imperfect trade-offs, not fixed absolutes, but they usually lack the flexibility to adapt readily to economic realities. Hence, their predictable legacy is a mounting pile of budget deficits and unfunded “owe as you go” liabilities to be deferred as long as possible before being imposed belatedly on future generations.
For health care, the unbounded language of absolute rights fails to deal with the underlying questions of how much does one get, who pays for it, and who must provide it. Any answers involve compromises that need frequent re-examination.
However, our political system has been particularly poor at the task of setting adequate floors or sustainable ceilings. In this case, past performance is a good predictor of future results.
It would be far better to set more achievable, targeted goals that balance reliance on the efficiencies of market production and allocation, competitive incentives for innovation, and accountability for promised results with more generous protection of the most vulnerable members of society who cannot take care of themselves (either permanently, indefinitely or temporarily).
To be sure, our mixed public–private health care system falls short in many regards in achieving these goals. That disappointing record, and options to improve it, merit not just a robust, evidence-based debate, but much greater resolve to actually change it.
Simply mouthing “Health care is a right,” is just another dodge aimed at shutting off legitimate debate over how to deliver it more effectively, efficiently, and equitably. This distracts us from the serious issues requiring more difficult reflection, concentration, compromise and sacrifice.
Moreover, this involves far more than another round of politics as usual. Indeed, we really cannot even begin to fix our troubled politics by overloading it with more tasks than it can manage competently. Given the current gaping distances between past political promises and recent performances, health care remains far too important to be left largely in the unsteady hands of the federal government.
We do have a “right” to insist upon better health for all Americans by pushing for a more accountable health care system in which patients and providers are mutually responsible partners in seeking and producing better outcomes at lower costs. Governments at all levels still have a necessary role in ensuring effective rules for transparent competition and honest dealing, filling in the gaps where markets fall short, and redistributing resources compassionately to the less fortunate.
But if we want to be healthier, we all will have to make better decisions instead of outsourcing them to political intermediaries. In short, you do have a right to health care—if you pay for it, or if you can get someone else to pay instead.