Is there a right to health care?
Our arguments about health policy frequently highlight the question. The liberals at Slate magazine have answered yes, and the conservatives at the American Spectator have said no. Actress Laura Dern has affirmed such a right, and Republican Rep. Raul Labrador denied it. Miss USA has been on both sides of the question. And all of this was just in May.
As much as people argue, it’s not a very good question — not, at least, in our society, in which nearly everyone agrees that all people must have access to some basic level of health care. Because of that consensus, conservatives who deny a right to health care don’t really mean it, and liberals who affirm it can’t use it to clinch the case for their favored policies.
One problem is that the word “rights” can be understood in many ways. Fairly often it refers to “negative” rights: The right to speak freely is a right to speak without being subjected to government interference or to violence. Any right to health care would by contrast be a “positive” right. When we are thinking about positive rights, we sometimes have in mind enforceable claims to governmental provision of a good, service or asset. Almost all senior citizens in America have this kind of legal right to a Social Security check.
But positive rights do not always have this character. The Catholic Church, for example, affirms a right to education, but clearly does not mean that the government must directly supply schooling to all children. It would prefer to provide that education to many children itself, or through affiliated organizations, and opposes any “school monopoly” held by the government.
Catholic teaching has also sometimes endorsed a right to medical care, as in the 1963 encyclical Pacem in Terris. But the catechism dispenses with the language of rights in rendering the point: “Concern for the health of its citizens requires that society help in the attainment of living — conditions that allow them to grow and reach maturity: food and clothing, housing, health care, basic education, employment and social assistance.”
The church, in my admittedly biased view, gets this right: The “right to health care,” properly understood, means that public authorities have a duty to foster conditions in which all people’s medical needs are met. There are, however, a variety of ways governments can meet this obligation.
A central government can directly provide health services or health insurance; it can rely on markets while providing subsidies to the indigent; it can regulate those markets more or less heavily. Different people legitimately disagree on the best way to proceed, or think that the best way to proceed will vary depending on a society’s particular circumstances.
Those disagreements are neither unimportant nor merely technical. They involve such moral questions as how much freedom individuals should have in making their own decisions pertaining to health care, and how important it is for people to be free of financial anxiety arising from it.
As important as these disagreements are, our debate about health policy takes place among people who almost all agree that society has to find a way to see to it that everyone’s basic medical needs are met. That is true even when conservatives make dumb comments that appear to break this consensus.
Take President Donald Trump’s budget director, Mick Mulvaney, who recently said that while we should provide a safety net for people who get cancer, “that doesn’t mean we should take care of the person who sits at home, eats poorly and gets diabetes.” Yet he isn’t proposing to abolish Medicaid or Medicare for such people, or to eliminate the legal requirement that emergency rooms take all comers.
Liberals and conservatives argue about the existence of a right to health care because both sides believe, erroneously, that it necessarily entails the extensive welfare state that only the former want.
Both could benefit from reading what Edmund Burke had to say more than 200 years ago: “What is the use of discussing a man’s abstract right to food or medicine? The question is upon the method of procuring and administering them. In that deliberation I shall always advise to call in the aid of the farmer and the physician rather than the professor of metaphysics.”
Ramesh Ponnuru is a Bloomberg View columnist.