I’m becoming more and more convinced that the talk of health care as a ‘right’ is so vague as to border on willful and culpable obfuscation. I certainly advocate a rich and complex description of ‘rights’ talk, such that simply calling something a ‘right’ doesn’t end the ethical or political discussion. Some ‘rights’ are more fundamental and basic than others, and various ‘rights’ require things of various actors.

But when it is asserted that access to health care is a ‘right,’ what precisely is the claim? Is it analogous to the claim that access to food and water, too, are rights? Very often these rights are equated in contemporary discussions: food and water, shelter, and health care.

One the one hand, however, it’s very odd to assert that health care, at least as practiced in its modern form (with X-ray machines and flu shots) is a right, at least in the sense that it is something that the human person qua person has a claim upon. If that’s the case, then all those millions of people who lived before the advent of the CAT scan were all the while having their rights ‘denied’ them (whether by God, fate, cosmic chance, or oppressive regimes bent upon keeping us from advancing medical technologies). It would also follow that all of those living today without access to these advanced technologies, simply by basis of their geographical and cultural location, are having their rights similarly denied. (This raises the troubling implication, not to be explored in any detail here, that the debate about health care in the industrial and post-industrial West amounts to a series of tantrums by the coddled and privileged about the requisite level of health care, which by any standard already dwarfs what is available to the global poor, who do not have access to what has the best claim upon ‘rights’ talk, even the most basic health care services.)

This raises the further question, if it be granted that health care is in some sense a right (which I am not opposed to granting), “What precisely does that right entail?” Clearly we can’t mean, in the context of the history of humankind, that this is a right to arthroscopic surgery or titanium hip replacement. That would be a bit like saying my right to food means that I have a claim to eating filet mignon. Just because someone else can afford to eat filet mignon doesn’t mean that my right to not starve gives me a similar claim upon filet mignon.

Similarly, just because some people can afford the greatest medical care available in the history of humankind (whether by the providence of God, fate, or cosmic chance), it doesn’t follow that I have a right to health care in that particular form. My basic claim to health care merely on the basis of my humanity is something more like the right to ramen noodles than it is to filet mignon.

This only describes what I am due by rights. It’s the least that’s required by the standards of justice.

And what might love require? “He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and took care of him.”


  • http://palamas.info Fr Gregory

    Jordan,

    Thank you for your observations.

    I am in general agreement with your argument but I must confess I was unclear what you meant by the last paragraph: “And what might love require? ‘He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and took care of him.'”

    Could you please elaborate? As I said, I’m not sure the point you are making here.

    For the rest of your post though, I think you make a good and important point. A right to health care does not necessarily entail a right to the latest medical technology or treatment–but this (I think) leaves unanswered what do we mean by “basic health care”?

    And again, my question is not a criticism of your thought but reflects my own lack of clarity about what is and isn’t meant by providing people with health care.

    Again, thanks for the post.

    +Fr Gregory

  • http://blog.acton.org/ Jordan J. Ballor

    Fr. Gregory,

    All I meant was that “rights” language is usually the domain of justice, but that what love requires often goes above and beyond that. The Good Samaritan it seems to me went above and beyond mere justice in doing what he did.

  • http://wandering-aramean.typepad.com Meika

    Jordan,

    I understand your argument, though I don’t agree that most people are intentionally trying to cloud the issue (some, sure, always). Some rights ARE more fundamental than others. But what if we couched the discussion rather in terms of responsibilities than rights? No, you may not have a RIGHT to chemotherapy, but as a wealthy nation do we have a responsibility to ensure that someone diagnosed with cancer receives some sort of treatment regardless of ability to pay? I would say yes, though there’s no question that figuring out the details would get very, very complicated and sticky.

    You’ve mentioned the British health care system a number of times (and I keep meaning to ask my British friends their opinions on it), but I’m curious if you’ve ever looked into the Japanese system. They have national insurance as well, and though I was under it in part, I don’t completely understand it. What I do know is that while I was pregnant, I received two or three prenatal visits paid for by the government as well as one visit to the dentist. This seems to be a good example of a baseline level of care – you knwo that obviously this isn’t the standard recommended level of care during pregnancy, but the government has set a baseline that it will provide for all its people. Not surprisingly, perhaps, their maternal and infant mortality and morbidity rates are much, much lower than our own. It may be another interesting data point, at any rate.

  • http://blog.acton.org/ Jordan

    Meika, I haven’t looked at the Japanese system. Although I’m certainly no expert on transnational comparative health care systems, I do think it’s well worth looking at how things have worked in other places, and why. On that score, you also have to be sure to take into account the particular cultural and social factors that may be factors in one place or another. So just because one model has “worked” in one place, doesn’t mean that it can be migrated wholesale into someplace else.

  • Roger McKinney

    Meika, my daughter spent a semester in France and discussed health care with her host family who really like the French system. The French, Japanese and most nations with national health care systems also have wage and price controls for all aspects of healthcare, too. The state controls the prices of drugs, hospital charges and doctors’ salaries and that keeps the costs low enough that it doesn’t bankrupt the nation.

    With our system of limited supply (controlled by the AMA) and unlimited demand (provided by Medicare), costs have gotten out of control. National healthcare will bankrupt the Federal government. We need to move to a more free market health care system in order to control costs, or establish wage and price controls. No one is discussing either option at this point, so the future looks rough.

  • Don Condit

    Roger, Perhaps you could substantiate how the American Medical Association controls physician supply? The data suggest to me the shortage of physicians, particularly in primary care specialities, is a consequence of federally placed price controls. Decreasing payment for physician services in anticipation of Medicare insolvency in 8 – 10 years creates incentives for medical students, with debt loads of $100 – 200k, to pursue better paying specialty residencies. Primary care residency positions go unfilled, but not because of AMA influence. This is particularly onerous because 70% of health care spending is related to factors influenced by personal decisions. Patients are losing their best advocate toward healthier lifestyles and ally in alleviating information asymmetry in the medical market.
    Take a look at HR 3400 rather than HR 3200 as a better option.

  • Roger McKinney

    Don, I agree that a major shortage of PCP’s taking Medicare patients exists because of the guv’s payment policies, but that isn’t what I was referring to. Why are young doctors saddled with $200,000 in debt? The AMA controls medical schools through licensing and artificially drives up the costs of medical school to ridiculous levels. But in spite of those costs, medical schools turn away thousands of would-be doctors every year. Why aren’t there more medical schools, and why don’t existing ones expand? Could it be the AMA’s certification processes? I know that some states have tried to start new medical schools that lowered the cost of educating doctors but were shut down by the AMA. Also, the AMA got Congress to pass greater restrictions on foreign doctors practicing in the US.

    Even more basic, why do doctors need a bachelors degree to go to medical school? That makes no sense at all. It’s an artificial barrier.

    The AMA operates like any other trade association, like the ABA and associations for engineers. They all want to restrict the supply of new professionals in order to raise their own salaries. They do that by bribing Congressmen with campaign contributions to pass their laws. It’s no different from the real estate agents getting laws passed that require a college diploma to sell real estate.

    I predict that the AMA stranglehold on the supply of doctors will be broken in the future, but the process will be ugly. Congress will pass some kind of universal health care, but rapidly rising costs will bankrupt the Federal government. The Feds will respond with wage controls on doctor salaries and price controls on procedures. Doctors will refuse to work for those wages because of their high debt loads from medical school and Congress will authorize a competitor to AMA licensing of schools and doctors. Every other country in the Western world has wage a price caps on medical care. It’s only a matter of time before the US adopts them.

    But why does the AMA no see this coming and do something to prevent it? It’s digging its own grave.

  • NOB

    Conservatives love to say that there’s no right to health care, and then they turn around and complain (without warrant) about the waiting times, and the rationing, and the depressed innovation that will supposedly accompany universal health care.

    So let’s be clear: conservatives think that you don’t have a “right” to health care… unless you’re rich enough to afford superhuman medical care, in which case you have an unalienable right to that care, even if respecting that right means that millions of other people can’t get basic, affordable coverage.

    That’s the American way: spend billions of dollars keeping rich grandmas alive for a couple extra weeks, but make it too expensive for the poor and the sick to see a doctor for their hypertension or diabetes. You wonder why the U.S. ranks dead last among industrialized nations in terms of medically preventable deaths: it’s because the rich have a right to health care, and the poor have the liberty, ah yes the blessed freedom, to go without basic treatments.

  • MaryAnn

    Was the good samaritan a government beurocrat? My guess is he was a private citizen answering the call to charity. The “right to health care” has been misunderstood, just as the “right to pursue happiness” has been. We have the right to be unencumbered by the federal government in our pursuit of happiness, not the right to be happy. We have the right to be unencumbered by the federal government in our pursuit of health care, not the right to health care. As individual, private citizens we have a moral responsibility to take care of ourselves, and to look out for our neighbors. And we used to do that, before the federal government stepped in. Churches and other charitable institutions used to help take care of those people who were unable to care for themselves. Today, the gov’t makes it all but impossible for these institutions to stay in business. Governments exist to expand while constricting the freedom and liberty of citizens.

  • NOB

    Really? Charities “used to help take care of people.” That’s news to me… here I thought charities were still around!

    One sees this argument a lot. “If only government would stop helping the poor, me and my church would help the poor.” To which my response is always: “Hey, no one’s stopping you. Children go hungry, lack medical care, lack school books, live on the streets. Go help them now, by all means.”

    Government and private charity combined can’t, apparently, eliminate poverty. We’re supposed to believe that the mere existence of government programs so depresses charitable giving that charity alone, sans government, would do better? Hey, I think I agree with you that that’d be preferable to the current situation. But I think it’s a fantasy.

    You’d have to believe, again, that there are people out there who say to themselves “I feel sympathy for the poor and hungry, but I think government is taking care of all of them already, so I won’t give to charity.”

    But wouldn’t someone who actually feels sympathy and thinks about the less privileged (a rare someone indeed) also be the type of person to realize what is obvious, namely that poverty exists everywhere, under every system of government to some varying degree, and that therefore they ought to continue to give to charity? Seems more likely than not.

  • Roger McKinney

    NOB, The data show that greater government spending on poverty does reduce charity, not because people have decided that the state will do the job, but because people have less money to give. In the US, around 80% of charitable giving comes from the Christian right (about 30% of the population), and it amounts to close to 2/3 of the federal budget. Non-religious people tend to let the guv do the heavy lifting, regardless of what might seem reasonable. Most charitable giving goes to education, especially colleges. It would be nice is more went to health care for the poor; and it would be nice if the irreligious would cary their fair share.

  • sini ngindu bindanda

    Thanks a lot for your articolo. Reading throught it I may confess you that I don’t understand what you really mean.
    I have impressione that according to you it is not necessary to start with the attempt to facitate and allow everybody to have access to health care. I understand that according to you a right to health care means to wait until all the elementary rights are covered and all the medical technology access to all not only to your country but also all over the countries allienated. Is good your care to all the human kind if it is sincere. But I thank that it must start somewhere before to be spread to all the aspects of the life of your country and then all over the world.
    I really don’t understand well when you quote the good samaritan. The good samaritan as I am concerned did what your government is attempting to do to every and maybe improvment your come soonafter.
    Since they know as Desmond Tutu said maybe quoting someonelse: “They know the power of a country not seeing his rich people, but his poors; they know the beauty of a town, not by seeing his streets but by seeing what wright they reserve to his prisonners and where the spend their life in prison”. According to other peoples since your countries sustain wars everywhere in the world because of the strategy momopoles it is ovvious that all the developped countries who are right to have benefit of every good it is a dream to others to pretend to it. The first cure they could have is to cease sending them wars.
    Anyway, I am very hoppy of your article thought I did not catch you properly.

    Sincerly yours,

    Rev. SINI NGINDU BINDANDA