Is Healthcare a Right?

This question is a political one: it is used rhetorically, with an assumed 'yes' or 'no' answer, depending on the values of the asker. But it's an interesting question.

The simple response is that the question, 'Is healthcare a right?', is nonsense. It's nonsense because the questioner always (in my experience) has not bothered to ask whether the responder understands what is meant by either 'healthcare' or 'right'.

An analogous question is 'Is food a right?'

I choose this question deliberately, because 'healthcare' is an even broader idea that 'food' -- yet it's obvious to everyone that a right not to starve is not the same as a right to gourmet dining. Like food, healthcare comes in many styles and prices. Like food, not all healthcare is actually healthy for the consumer (I say this as a primary care physician who's seen three decades of unintended medical adverse consequences). Just because it seems good doesn't mean necessarily that it is good.

It would be a months-long process to catalog all the things that are called 'healthcare' from wannabes like aromatherapy and therapeutic dance to truly life-saving things like emergency appendectomy and Caesarian section. Obviously, not every treatment tossed into the healthcare basket is essential to anyone.

But even if we can identify a set of health treatments that are actually lifesaving, we still have a problem with the other half of our question: 'Is healthcare a right?

What is a 'right'? Why do we take time and effort to define and debate rights? Are there different types of rights, as there are different kinds of precipitation? If people thoughtfully disagree on any right, can it be a right? That is, can anything actually be a right, if the fact of its being a right is seriously debated?

Still, there must be some things that are, in fact, rights. If there were none, there would be no point in having the word at all. Discussing and debating conflatabulation makes no sense if no one actually conflatabulates, or fabricates a conflatabulator.

What is a right?

First, a right is social. That is, it is relevant to interactions and relationships among people, or with respect to others' values. Someone walking in the woods, or blogging to no audience, may say anything at all. But this is not a 'right' because the words have no consequences to anyone else. Similarly, 'right' is irrelevant to one's thoughts. 'Right' applies to the manifestation of those thoughts in a way that affects someone else.

Second, there are two types of rights: to act, or to receive.
- The right to act is the ability to refrain from saying or doing a thing without coercion to do or prohibition from doing.
- The right to receive is the ability (or implicit permission) to obtain, from others or from one's surroundings, any thing or service.

Third, there are many social mechanisms for establishing and enforcing rights. Some are informal, between individuals and within groups. But a 'right', in any case, is inherently associated with the existence of some (social) mechanism to sustain the right. It is not possible to have a right without there also being an enforcement mechanism.

Enforcement of rights

Now, enforcement can be either re-enforcing, through explicit permission, encouragement, praise, payment, or thanks; or it can be punitive, through disappointment, anger, weeping, blows, ostracism, fines, imprisonment, or the like.

As a corollary, in order to have rights, there must also be things that are understood not to be rights, with consequences between individuals when one persons assumes a right that does not exist. This is not obvious, I think. A trivial example: if it is not my right to speak against a management decision at work, but I do so, then there must be some consequence, even if it's only the scowl of a co-worker, in order to maintain the boundaries establishing who does have that right.

I often see evidence that some people think 'consequences' are only punitive financial costs or liberty restrictions (fines, loss of licensure, jail time, etc.) As we've all experienced, 'consequences' that are strongest in establishing and enforcing behavior are the thanks, praise, approval, good humor, and acceptance of others. In fact the absence of these, or their withdrawal actually stimulate contrariness: the boy who has no nurturance, for example, becomes aggressive and at least socially damaging. And the strongest punishments are not fines and the threat of jail time, but the irritation, anger, withdrawal, spite, or superciliousness of friends.

Ask me again...

So, let's restate our question in a way that makes sense:
- Are there some healthcares that every person has a right to receive?
This acknowledges that there is a vast range of healthcares.

Now, the fact that a right to healthcare is a right to receive, and the fact that every right is social, means that for every such right, someone has an obligation to provide it.

This means that some individual, whether acting alone or as part of a huge healthcare organization, has a obligation to the individual holding the right to treatment.

Money (vs. health)

Now we have to bring in another social mechanism: money. Money is, at its essence, a social phenomenon that gives relative value to the time, effort, ownership, and skill that an individual brings, in creating a material object or providing a service to another.

It is immediately obvious that we have an intersection of two sets of social rights: any rights to any particular health treatments interact with whatever sets of rights exist with regard to the social phenomenon of money.

This is interesting and important, because some healthcares preserve life (are life-saving), and because in any complex society, the exchange of money is also essential to preserve life (as it permits purchase of essentials that each individual can't produce).

This also means that conflicts will occur; not the least is when a penniless individual is urgently in need of life-saving medical treatment that is costly for the provider to offer. The provision of treatment may threaten the existence of the provider while to withhold it more obviously threatens the existence of the sick individual.

How to Guarantee Healthcare is Available

There is only one way to resolve this conflict: to spread the cost of lifesaving healthcares across society through equitable sharing of all such cost, so that providers and their necessary physical resources exist when they are emergently needed; and so that (for example) Bart need not be denied neurosurgery for his epidural hematoma because providing it, at that moment, would bankrupt the hospital.

We see by this the essential difficulties in defining and establishing a right to healthcare. It involves establishing which treatments should be rights-based, and under what circumstances, and it also involves important parallel decisions about how to arrange finances -- how a healthcare system can and should be funded (what quality, what availability, how much reserve capacity; what payment systems), and what is 'fair' -- incomes, payments, and the like.

It's my view that there seems to be no real debate in our society that healthcares needed for preservation of life and amelioration of suffering are rights -- after all, clean water and sewage treatment, the most important healthcares, are without any debate funded by every community, and safe water and sewage treatment are required of individuals living outside of communities. This would imply that the universal provision of catastrophic health insurance would be universally accepted -- there would be debate, though, about what's a catastrophe!

But there is intense and continuing debate, with opinions swirling like the tides in a Fundy estuary, regarding funding mechanisms and levels. Ironically, the very people who are opposed to mandatory private health insurance are arguing as strongly for the socialized medicine of Medicare by saing, "Don't mess with my Medicare." This is exactly the British narcissism, "I've got mine, Jack!" This is not a debate about healthcare; it's purely selfishness.

It is impossible, in this little essay, to resolve which healthcares should be rights, or what the fairest payment mechanisms should be.

I will only observe that the current US system of healthcare payment is the least socially fair of any in the world, and the least efficient as well. Pick a thousand experts and ask each to redesign the system, and you'd get a thousand reforms that is each superior to the current chaos -- and each would be different from the others: inability to reach consensus -- the consequence of 'diversity' in our country -- is the central obstacle to agreement on reform.