Do I Have the Right Not to Suffer? Some Random Thoughts on Health Care.

In the second debate, Obama said that access to health care is a right. If so, what does that mean for us? So it got me thinking. Of course, not all rights are the same. Some are inalienable, as recorded in the Bill of Rights. Others are by convention, such as the right of way given to pedestrians at crosswalks. If health care is a right, where does it fall on that spectrum?

Outside of the Anglo-American constitutional tradition, rights are seen differently. Socialist and Marxist constitutions will accord more rights to more people. For example, a right to education is enshrined in the constitutions of many countries, but no such language will be found in the US Constitution, where rights stand as pillars. The non-American constitution, however, will couple the right with an obligation. There may be a right to education in the Russian constitution, but it is incumbent upon the citizen not to impede the education of others and to support the school system.

Sounds good, right? Well, imagine what a strong-man government will do with free speech if citizens are obligated not to abuse the right. For certain authoritarian societies, such a paradigm would be pragmatic and morally acceptable. Americans are not like that, though. At least in principle.

America, the land of frontiers, regards any rights involving self-sacrifice for the good of others as dangerous. Some would argue it’s a slippery slope into communism once you start guaranteeing benefits. Maybe those critics are right, but maybe they have not accurately grasped what kind of slippery slope it is. Are we talking Alpine skiing likely to trigger a Maoist avalanche? Or is it more like a slip and slide (you know, that plastic strip you put down in your yard – you stream the garden hose down it) whereby all the kids in the neighborhood get to have a great day in the sun, complete with laughter, injuries, and Kool Aid?

So you have to ask yourself what health care means to us all and you yourself. What is the cost to you to know that children are not dying simply because they don’t have adequate health insurance. What is the cost to you if you can rest at ease knowing that if you lose your job, your family will still be able to get treatment from a doctor rather than an emergency room. What is the cost to you to know that people with cancer can’t get kicked off their insurance plan simply because their treatments affect the company’s profit margin.

Are we talking about communism? Or is this simple humanity, and the necessary cost to wear the badge of civilization?

This still doesn’t answer the question about whether access to health care is a right worthy of the name. At the same time, it exposes the fact that health care can be understood through many different lenses.

In the school of economics that dominates American industry, health care is treated as a good or service, not much different in principle than the market for soda or for legal services. If you can afford it, you can buy it. If not, then you have to rely on charity (or government charity). Quite clearly, based on the number of uninsured, and the number of people with preventable chronic diseases, the market for health care is broken. Even staunch conservatives (perhaps with the exception of radical libertarians) would admit that intervention is warranted in the case of market failure. No one, however, can write a general prescription for what the proper policy measure should be to fix a broken market. That’s why it’s always easier to just paint the government as the bad guy, rather than admit that we don’t know what to do, either.

Beyond the simple (simpleton?) economics of invisible hands, there is extensive analysis of specialty markets, and of goods that defy the laws of supply and demand. For example, there are so-called natural monopolies like for the manufacture of space shuttles, or certain countries’ airline industry. Also, not all goods are the same. Some defy monetary valuation. Some goods are illegal because of the harm they produce. Some goods are public goods, like roads and courts. Health care seems to fit in with some of these exceptional markets. It does serve a public good. The valuation of health tends to defy monetary value. For example, if I got attacked by someone with a chainsaw and I lost my leg, I could probably get a court to award me several million dollars. Does that mean I could go and trade my leg for the same amount of money? Certainly not. There is no weight of gold comparable to the fine sinew of my leg. If you steal my candy bar, however, I’d be made whole with about a dollar.

There is a religious or moral component, as well. Kantian ethics would formulate a maxim like this: "I will that all should be afforded adequate access to basic health care." There is no internal contradiction. Hume and other utilitarians would cite the benefit of legislatively mandated access to health care with an appeal to the greater good. Christians are supposed to embrace charity. Buddhists are supposed to be compassionate. Etc.

Lastly, there may be more pragmatic reasons to embrace so-called socialized medicine. The USA is falling behind our fellow nations in many health and lifestyle measures. If their more socialized systems work better than ours, we should be fools not to inquire further or at least test the waters. Either that or watch us slide from 28th to 29th or lower on the infant mortality scale. I mean, seriously, this is the richest and most powerful country the world has ever seen. There should be zero infant mortality. It's kind of embarassing when you think about it.

And maybe that's the most compelling reason of all to embrace health care as a basic right. Everyone's laughing at us.