Sunday, August 16, 2009

Is Health Care a Right?

John Mackey, founder of the upscale Whole Foods supermarket chain, has raised howls of protest by saying, in a guest editorial in the Wall Street Journal, that “a careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter... because there isn't any.”

Outraged, an array of left-leaning pundits and organizations is calling for a boycott of Whole Foods. Mackey has become a hate figure for daring to publish a reasoned, temperate opinion on the health care debate that challenges a basic assumption of the left.

It should be noted that a call to boycott is not an argument. It is an attempt to punish dissent. If the left wants to advance the health care debate, it should attempt to refute Mackey’s argument, not simply demonize him. Sadly, a quick scan of responses to Mackey’s article shows a heavy preponderance of invective over argument.

The unexamined assumption that people have a right to health care needs to be debated because so many people share it so unquestioningly. And if you start with that as an assumption, much of the opposition to government-provided health care will seem malicious and obtuse. This is a systemic problem: the left, working on assumptions the right does not share, proposes something; the right, not bothering to elucidate the difference in assumptions, opposes it and is accused of mean-spiritedness and other moral failings. This lack of philosophical curiosity poisons the debate.

I’ve said before that calling health care a right is problematic; maybe it’s time to discuss it a little further. Saying that health care (or decent housing, or any other goods or services) is a fundamental right is problematic because it is tantamount to declaring that you have a claim on somebody else’s labor or time or possessions. The amount of philosophical justification accompanying this declaration is usually approximately zero.

The best discussion of the philosophical grounding of rights that I know of is a book called Persons, Rights and the Moral Community by Loren Lomasky. In this book Lomasky tries to get at the heart of what rights are and why they are generally held to be “untrumpable”—that is, how they are different from mere preferences, which can be thwarted without the perception that a violation has occurred.

The entire argument is beyond the scope of a blog post, but Lomasky does take on the question of positive versus negative rights. Negative rights are those which boil down to saying that you have the right not to be messed with. Positive rights are those which express a claim to something concrete—goods or services. Classical liberalism, roughly speaking the philosophical tradition of our Founding Fathers, held negative rights to be very important but did not recognize positive rights. (Take a look at the Bill of Rights for examples of negative rights.) The line of thinking that goes from Marx through European social democracy to modern American liberalism tends to stress positive rights (while being a touch more selective about negative rights).

Lomasky points out that the fact that something is needed does not imply that one has a right to it. Our list of potential needs includes things which cannot be provided by others, like intelligence. There is no logical correspondence between needs and rights.

Any attempt to define a list of things crucial enough to be regarded as positive rights is necessarily arbitrary. (Just a house? Why not a car, if you live far from where the jobs are?) Philosophical clarity gets lost pretty quickly.

But more importantly, need on your part does not imply a duty of sacrifice on mine—if I have two good corneas and you have none, does your pressing need create a right to one of my (or anyone else’s) corneas? It may be praiseworthy of me to provide you with a good by my sacrifice, but that does not make it your right.

Asserting a right to housing asserts a claim on the labor of carpenters, masons, etc. What gives rise to this claim? A right, remember, is something that cannot be trumped. When a right to a good is legitimately asserted, it must provided. Do those whose labor provides the good deserve compensation? If so, how are they to be compensated? Questions of payment are inescapable, and a positive right is economically indistinguishable from any other good.

Health care goods and services obey the laws of economics even if you don’t think they should. Ask the British National Health Service. An asserted right proves to be inextricable from the grubby reality of overworked doctors and long waiting lists. When doctors in a public health service go on strike, are they violating the rights of the patients who are not served? Philosophical clarity gets lost here, too.

And philosophical clarity is at a premium. As Lomasky points out, an escalation in claims of rights makes public problems more intractable, since when perceived rights come into conflict, a judgment against one party leaves the loser with a sense of grievance. It is an advantage to have a clear criterion for rights and make sure that our legal system guarantees them.

As Lomasky says, an important aspect of the classical liberal position on rights is its modesty: since the costs to others of conceding these negative rights is lower, they are less likely to opt out of the system. A regime of rights will not be respected if it is too costly.

So I think John Mackey is right. Now, none of this means that we should not place a high priority on the provision of health care, education and any number of other socially useful goods to all members of the population. That’s just good government. Urgency in providing desirable social goods ought to be way up there on our scale of public policy values.

But calling real-world goods “rights” complicates their provision by obscuring the very real costs of providing them. Call a good or a service a right, and you still have to figure out how to pay for it. It doesn’t appear out of thin air.

If you’re outraged by this position, so be it. But the burden of proof is on you to show how you’re going to pay for all the good things you think we are entitled to. John Mackey presented a list of reasonable proposals for doing that in his widely vilified op-ed. Before you join the boycott, you might just want to run an eye over them.

Sam Reaves


DavidK said...

How can I disagree with fact?
The 'left' currently believes it holds unlimited power in this country, and to a degree that may well be true. It is 'their' man in the White House. But as your commentary points out, the left is identifying 'new rights' that do not exist. And should anyone utilize the guaranteed right of freedom of speech against the left, then the left attempts to silence them. The left's stand now seems to be "agree, or be publicly beaten into submission," a philosophy so effective in certain other significant nations.
Obama is currently toying with the idea of a national sales tax as his camp now is acknowledging that a nationalized health care system cannot be financially sustained by the current level of Federal income.
The current level of overall taxation in America requires an indidual to pay almost twice the retail price of an item. In otherwords, a person must draw just under ten dollars from a paycheck to buy a five dollar item in order to compensate for the associated taxes. It's a fact, not my opinion - I'm not that sharp.
We simply cannot afford any more taxes, but that fact will have little effect or concern to government at any level. Illinois is on the brink of another round of tax increases, and even here in 'sublime' Freport, our sales tax just went up to eight per cent. No referendum was placed before the voters as Freeport is a Home Rule community and government doesn't need voter apporoval to do anything. And they wonder why there is a movenemnt to abolish Home Rule.
But, back to your commentary. Mackey is only one of a growing number being subjected to attempts to silence them. It is the fact that these attempts appear to be encouraged and accepted that causes me the greatest concern. FOX News has even come under fire lately. I do wonder how long this will be tolerated, or will it be allowed to continue until the majority accept a minority dictating a new philosophy of 'your rights are the ones we tell you you have.'
I may not agree with what someone says, but I was the third generation of my family to serve in the military to protect the rights of those who disagree with me. My son is the fourth generation. I fear that my grandchildren will be serving to protect our government - not our rights. I never knew my father's brother because he was killed in Italy while on patrol during a German mortor ambush. I hope his death wasn't in vain.
Thank you for your commentary, Mr. Reaves. It is not just timely, but reveals many dangers within our country right now.

Sam Reaves said...

It's a lot easier to raise taxes than to cut spending. That's the structural problem that needs work.
As for your deeper fears, I'm perhaps more optimistic than you-- we have a vigorous tradition of public debate that helps us muddle through to the right solution. These things go in cycles. Remember when the left was dismayed because the GOP had taken the House in 1994? The pendulum swings. Keep the faith and keep participating in the debate.

Gator said...

Nice - putting it the way you did, "...because it is tantamount to declaring that you have a claim on somebody else’s labor or time or possessions.", I hadn't thought about it that way, or perhaps I have but not that distinctly. But while I do agree, didn't that ship already sail when the first American was taxed for social programs specifically setup to never benefit that same American.

Ok, so we're socialists that currently believe strongly in the idea of Capitalism (but then Michael Moore and friends are working to change, right?) . What is the balance? I believe as you do, that debate is the way through this, but then as government continues to grows doesn't debate become something that is directly opposed to it, that government works to control and stop? Isn't all this just excuses for a government to grow bigger and fatter, while also becoming well equipped to kill the debate that would oppose it? What checks and balances are in place to stop that?

Sam Reaves said...

Very good questions.
Poorly conceived legislation can do a lot of harm. Piecemeal reform based on a few key principles is best. I'm inclined to favor private provision, but there's a reasonable case for a limited government role. Right now the atmosphere is so poisoned by mutual accusations of bad faith that it's hard to have a rational discussion.