One hears a lot these days about a “right” to health care. I bristle at this, because I think the notion of “rights” as anything other than matters of human convention is rubbish. We may, as a society, choose to define our laws such that they include a “right” to those things we deem appropriate: health care, broadband Internet access, full pirate regalia for all adults, or whatever else we like — and of course we have already done exactly that in the case of freedom of the press, bearing arms, and so forth. But until we have made such formal arrangements, any talk of axiomatic “rights” is weightless froth. So while we may yet decide that it is in our nation’s interest to establish a universal health-care arrangement of some sort — and there are good arguments on both sides of the issue — to claim, as matters stand today, a “right” to such a government-supported service is to gabble nonsense.
I mention all of this because Bill Vallicella has just posted a pungent little essay on this very topic. Have a look here.
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I think that Vallicella’s argument on the putative right to health care is unhelpful at best and mean-spirited at worst.
It is true that there is no enshrined obligation on the part of the government to provide for the sick and the needy. It is not a codified right in the same sense as the right against unlawful search and seizure. However, it is also true that there is a shared ethos of certain things which the government ought to do, which has developed over generations.
Among these things are the following: in the event of an epidemic, the government ought to provide inoculations; if someone is mentally ill, the state ought to provide shelter and care for him; if a child is not properly cared for by his parents, the state has the obligation to provide for him; and if someone has a life-threatening disease, the government ought to do what it reasonably can to save his life. These are not legal “rights” in the same sense as the right of habeas corpus, but they are deemed so essential to a civilized society that they have equivalent value.
By his logic, I have no right to be inoculated against polio, rescued from a car accident, or cared for in an emergency room because vaccines, ambulances, and doctors fall under the rubric of a commoditized health care, where “you either provide it for yourself or you hire someone to provide it for you.” Whether getting vaccinated against a pandemic is a right on the same plane as free speech is a distinction without a difference.
Reasonable people can argue about the level of health care the state ought to provide, but to insist that there is no right to health care — or, more precisely, no obligation on the part of the state to provide some basic level of health care — is not reasonable.
Also, his argument that if the government provided universal health care it would therefore have the leverage to insist that people not eat red meat is a fatuity. The government currently has the right to legislate against unhealthy practices. That is why heroin, absinthe, and driving without a seatbelt are illegal. The notion that if there is an economic argument in favor of abstemious behavior that therefore the state would be obligated to enforce it is an absurdity too gross to be insisted upon. Lots of countries have universal health care without banning Krispy Kremes.
Vallicella presumably writes from the position of one who is both insured and comfortable, and he seemingly cares little about those who are uninsured and afflicted. His world is a sad and mean-spirited place.
Hi Peter,
I thought you might weigh in!
I quite agree that Vallicella, as philosophers often are wont to do, pushes the argument to its rational conclusion, which is indeed beyond where most folks, indeed most far-right conservatives, stand on the health-care issue. He does this, of course, in his role as a philosopher, which is to expose underlying assumptions and ambiguities, getting things out in the open so that they can be debated with clarity all around as to terms and meanings.
Ought the government to provide various social services, including paying some attention to the medical needs of its citizenry? Why yes, indeed I think it ought to, as do you. Just what, exactly, is the ideal role for the government to play in providing heath care is another matter, though, and even among those who have studied the question extensively there is enormous disagreement. Let’s have a national debate about it, decide what we want to do, and do it. That’s how democracies are supposed to work. But is free health care a right? Of course not. Using a term like that just polarizes the conversation, and adds nothing. When people insist that this or that is a “right”, they make it quite clear that their minds are already made up. I think the word is more freighted than you seem to; it is often used as a sort of wedge. If it’s a “distinction without a difference”, then it should be no problem to stop speaking of “rights”, and get back to a level-headed examination of what the best role for the government ought to be.
I think you are missing Bill’s point. He is not saying the government ought not to be in the health-care business, but rather that it should not be considered an axiomatic truth that to have your knee surgery paid for by your fellow citizens is some sort of God-given “right”, i.e. a settled fact, and out-of-bounds for debate. I think he is well within his own “rights” to try to sharpen the definition a bit, and bring some rigor to the discussion.
Finally, I don’t think it is nearly as far-fetched as you do to imagine that a government that must bear the cost of all those bypass operations might tip toward the sort of restrictions Bill imagines. As you point out, it already does so. And though you joke about banning Krispy Kremes, the government right here in Gotham now has outlawed the use of certain sorts of fats in restaurant meals. Certainly Bill’s suggestion is far from being a “fatuity”.
But really, Peter, you are responding to Bill’s post! You should be letting him feel the fire of your ire, not me, and should go leave a comment at his place. There are plenty of smart folks over there, and the conversations can get very stimulating indeed.
The fact that New York City bans the use of trans fats proves my case, not Bill’s. His suggestion is that universal health care would lead to a world of rice cakes and carrot sticks because of economic benefits. However, Bloomberg didn’t ban trans fats for economic reasons: he did so for health reasons. There was no economic impact on the city one way or the other, and it wasn’t done as a consequence of universal health care.
My point is a modest one. I don’t think a case can be made that all health care procedures should be covered by universal insurance. For one, we can’t afford it. However, to say that there is no right whatsoever for any taxpayer-supported health care is, in my view, equally unreasonable. There are certain implicit obligations of the state, whose basis comes from a consensus which has developed over the years. Among these is the common understanding that if someone shows up at an emergency room with a heart attack, we don’t send him away because health care is a commodity and he made the wrong choice by not “hiring someone to provide it to him.” If being treated for a life threatening incident is not a right in contemporary America, then I’m not sure what is.
We can then debate where to draw the line in the spectrum between a hangnail and a myocardial infarction. However, to state that the state has no obligation — and its corollary, that citizens have no rights which result from this obligation — misunderstands both rights and obligations.
Hi Peter,
If Mayor Bloomberg can start meddling in restaurant kitchens simply because of his opinions about healthy diets, just imagine what will happen at the Federal level when trillions of taxpayer dollars are at stake.
I agree entirely that an enlightened society ought to provide the emergency services you describe, and I also agree that there is a need for a national debate about what sort of answer we ought to have to the health-care question generally.
I just don’t like talk of “rights”, that’s all. Once it goes beyond its narrow legal sense, I think that all too often the word just becomes an ideological club with which to beat one’s political foes. I’d rather we just stick to debating “oughts”.
I think I shall have to put up a follow-on post to make this clearer.
I’m pretty chary of “implicit” obligations. Call me a rationalist stick-in-the-mud, but if I’ve actually got an obligation, somebody had better be able to provide a reasonable story about its basis, in which case it’s “explicit”. Otherwise, I’ll agree only to take “implicit actions” to satisfy said obligations, pay with “implicit currency”, etc., etc.
Since I mentioned EMTALA over at Bill’s, I’ll just note here that there’s nothing at all “implicit” about the obligation of hospital emergency rooms to provide necessary healthcare to anybody who shows up on the doorstep. It’s a matter of positive law.
Right, Bob. There is a good deal of reasonable disagreement about what the state’s obligations actually ought to be, and for politicians and social activists to jump on a soapbox and start thundering about “rights” doesn’t add any clarity.
1) I never heard of EMTALA, so thanks for pointing out that emergency care is a legally mandated right. Didn’t know that.
2) Re the header: isn’t all froth weightless?
3) I am happy to report that my beloved city of San Francisco is initiating universal health care in phases over the next few months. Basically any uninsured SF resident is guaranteed a basic level of health care at taxpayer expense. The thinking is that the cost of providing preventive health care will be equivalent to the current system of providing emergency care only at taxpayer expense. Better to find out if someone has high blood pressure and treat it than wait for him to do nothing until it is an emergency. When we hear insulting references from the right about “San Francisco values,” I like to think that providing care for the needy is a San Francisco value.
Peter,
Ad 2), if you’ve made as extensive a sampling as I have, you’d see that there is actually some variation. But in practical terms, yes. Guilty as charged.
As long as we’re at it, however, I see no reason why obligations need be enshrined.
Ad 3), I quite agree that prevention is generally cheaper than emergency treatment, and makes for better quality of life all around too. As long as the SF taxpayers don’t mind footing the bill for free healthcare for all, I certainly have no objection; in fact I think it’s swell. I imagine folks are already on their way from all over.
There’s a residency requirement — you have to be a SF resident for six months in order to get into the program. The expectation is that it will be revenue neutral.