No Right to Health Care

I’ve been thinking a lot about health care and the mess I’m about to inherit in the next couple of years as I earn my MD and enter Residency training.  As a student of medical blogs, it’s hard to be keep my head in the sand about such things as they clearly occupy a good deal of the discussions.  So right now I’m addressing the perceived “right to health care.”

I’m against it and here is why.

When we think of our rights, we often think about the Bill of Rights and the Amendments.  The right to bear arms, the protection from unreasonable search, the right to peaceful assembly and the right of free speech.  The common thread in these rights is that they

  • cost nothing to maintain or respect
  • requires other persons to refrain from violating it in order to fulfill it

These are referred to as Negative rights.  If you leave me alone and I leave you alone, we have maintained these rights and violated nothing.  Now if you look at the proposed Right to Health Care, you will notice that this fails both of these standards.  It instead

  • costs a great deal
  • requires other persons to perform a service in order to fulfill it

These are referred to as Positive rights.  Under this right, if I fail to provide you the service of Health Care, I am violating your right to my service.  And now we reach the crux of my argument:

I do not recognize your right to my service.  I instead take this time to remind you of Section 1 of the Thirteenth Amendment which states:

Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.

Dramatic, no?  The Thirteenth Amendment is a perfect example of a negative right and I find it defensible as such.   If you’d like a more contemporary quote, you need go no further than Ayn Rand:

“I swear by my life, and my love of it, that I will never live for the sake of another man, nor ask another man to live for mine.”

I think that the goal of providing Universal Health Care ffor the United States is an admirable one, but I object to the justification used and the way people want to implement it.  But that’s for another post.  In the meantime, if a proponent of Universal Health Care cannot successfully address my simple argument above, then that person needs to seriously reevaluate their support of the idea and their attacks against physicians (both present and future) that object to it.

Though I am training to provide a service, that does not make me your servant.

Wikipedia has a great entry on Positive and Negative rights.

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13 Responses to No Right to Health Care

  1. bones says:

    The “right to healthcare” is primarily a misnomer, a wordgame meant to discourage the populace from supporting an “expensive” and “intrusive” system. However, to address only your question of under what constitutional authority does the government have an imperitive to address this healthcare “right” one needs look no further than the founding document of our government, the Declaration of Independence:

    “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness…”

    Leaving aside liberty for now, one is left with an unambigious statement – “that all men … are endowed … with certain unalienable Rights, that among these are Life, … and the pursuit of Happiness”. In summary all men have a right to life and the pursuit of happiness, both of which are hard if not impossible to acheive by chronically ill, dying, miserable, poor men and women with no chance for relief by the current medical establishment. A right to “life” certainly could be read as a right to be free from dying at any given moment from disease, or the right to be saved from dying due to disease or injury. The right to pursuit of happiness could be read to include the prerequisite physical and mental wellbeing to fully participate in one’s life in order to enjoy life ( and certainly good health is a prerequisite for most to “pursue happiness”).

    My point is that if you want to find legislative and constitutional authority to authorize healthcare for those withotu, it can be read/inferred here, as it can for many other governmental programs. But, we should not have to find “the right”. As physicians it is our ethical duty to care, our moral imperitive to advocate, our profession to treat regardless of ability to pay. As a society we don’t let ( most of the time because we find it amorally repulsive) children starve, we don’t let the homeless freeze to death on the streets, and we don’t let criminals injure or murder the innocent. Caring for our fellow citizens becomes a societal value and is afforded the status of “right” because it is the moral and ethical thing to do, not because the “law” mandates it.

  2. to bones:

    Your interpretation of “Life, Liberty and the pursuit of Happiness” seems out of step. Throughout the document, the Founders list only Negative Rights and, in that context, it is far more appropriate to interpret it as Life: a right to not have your life prematurely ended by another (murder), Liberty: the sum of all Negative rights to follow detailing the ways in which others cannot infringe upon your life, and The Pursuit of Happiness: an existence free from oppression where the rights of Life and Liberty are respected.

    Your right to life is your right to not be murdered. It is not your right to demand medical care any more than it is your right to eat at the best restaurants, have the best personal trainers, or any other measure that can be demonstrated to extend your life or degree of health.

    Your right to the pursuit of Happiness is a contract between you, the State, and the other citizens to refrain from impinging upon each others’ rights so that the pursuit can occur. It is not, instead, a mandate that the State and other citizens (physicians or not) must become involved in maintaining your pursuit. You have no more of a right to demand a Corvette (because that makes you happy) than you have to demand liposuction. But that’s an example of elective surgery, so let’s use the harder test and address Emergency Care.

    You do not have a right to emergency care. It may be provided for you pro bono (at the discretion of a physician, nurse, etc) but you have no claim to it. Like anything else of value that had a cost to produce (in facilities, education, training) you must pay for it. Granted, in an emergency setting it’s hard to pull out a wallet and haggle, but that is what health insurance is for. You have effectively been putting away money for just such a catastrophe. What if you cannot provide proof of insurance because you are unconscious, didn’t think you’d get into an accident today, etc? We have addressed this (poorly) through legislation that mandates that all emergencies presenting to a hospital must be treated. This is a law that we came to as a society and a mandate that we must fund as a society. Whether through taxes, your own insurance, or out of pocket, you are still paying for it.

    And as for your interpretation of my implied responsibility to provide care, I will say again that I do not recognize your right to my service. I do not have an obligation to provide care regardless of ability to pay, and if the citizens find the consequences of that unacceptable, then the fix is not to force me. The fix is instead to promise me that I will receive payment should I provide care. If the government thought that no one should be caught in the rain, then the onus is on government to buy everyone an umbrella. It is not the umbrella maker that now has to give away his product for free.

  3. Editor’s note: two comments were deleted at my discretion for being unprofessional. I invite the author to resubmit them without the personal attacks and acrimony.

  4. S.T. says:

    HEY! Well, I just stopped by your blog today and I think you know how I feel about this topic, but I figured I would leave you a comment anyways. I do understand your point and understand your argument, but I respectfully disagree on your take on what is a right and what is a luxury and why rights are rights and why healthcare is not.

    For example you argue that it requires nothing (I assume you mean financially) to maintain certain rights such a free speech, the right to bear arms, the protection from unreasonable search, and the right to peaceful assembly. I believe that you are not considering that in order to maintain these rights we do expend various resources including money.

    The right to peaceful assembly, for example, does not come cheap by any means. Specifically, the government has to enforce this law continuously every time a group wants to assemble. Permits are required; police force needs to be there, etc. The people that work in the court building that file those papers,that clean the bathrooms to the judge that hears the petition all get paid from our pockets. I am not contending that this right that should be taken away, I am simply stating that it is far from free. Do some further research and you will see that this right costs the people of America millions of dollars annually. We protect the right to free speech and the right to peaceful assembly for Pro-Life supporters, groups that protest against the death penalty and even Neo-Nazi’s. We give them the right to speak out on their beliefs because in the United States we believe that it is every individuals right to be able to speak in public about their ideas, in a peaceful manner. However, peace doesn’t come easy. If you have one group speaking about their beliefs you are going to have another group speaking about theirs. Tension exists and peace needs to be kept. Our tax dollars pay for the police that are there that day. Think about how many protests there are in the country and think about how much money it costs for the police to be there. Also keep in mind every time someone gets sued for using their right to free speech and it gets sent to court (costing money). I found this interesting link, I am weary on the source, but I think in general you get the idea I am trying to get at.

    http://historymike.blogspot.com/2005/12/on-costs-of-defending-nazis.html
    http://www.eff.org/news/archives/2006_08.php

    I am sure that you will argue that we are spending money defending certain rights and it does not cost us anything to say we have them, but what is the point in saying we have them if we don’t defend them and that costs money.

    Moving on from that argument and approaching your statement about servitude. I do understand again where you are coming from. I do believe wholeheartedly that you are right, No person should be forced into a life of servitude against their will. However, I find it highly unlikely that any person would compare a physician in a country that does have universal healthcare to a contemporary slave. As a physician you are choosing your career for whatever reasons money, status, the desire to help others etc, you are not being forced to become a physician. I would also like to use a contemporary quote it was outside Founders library and I noticed it every time I entered the building,

    “Only a life lived for others is a life worthwhile.” Albert Einstein.

    I am not asking that a physician sacrifice his or her own livelihood to give free healthcare. In actuality with universal healthcare the doctors and hospitals will receive more money than they are currently receiving when patients can’t pay. I know that this would mean higher taxes for people, but perhaps the government could rearrange money they spend on weapons and space travel and provide routine annual exams for children.

    Currently, 44.7 million people are uninsured (2003) as per AMSA. This is a problem, when polio or measles come back because the uninsured didn’t get vaccinations; it becomes a public health problem. When the hospital you work in shuts its doors to everyone including the insured and you or a friend loses their job it will become your problem. When a sibling or a friend finds him or herself between insurance companies when they are in a car accident and need rehab it will be a greater problem to you, maybe you will pick up some of the costs for them because you have some money for a rainy day or maybe your friend will never walk again. Dramatic I know. Take for example a young boy who needs a heart transplant, but who as health insurance that does not cover the rehab and he doesn’t get on the donor list and dies, did he not have the right to live or to be given a chance at life? This goes on everyday not just in the movies.

    In 2005, 43 billion dollars will be spent on uncompensated medical care, 2/3rds of this money will be paid by you by higher private healthcare premiums. Private health insurance raises the premiums to cover their 2/3 of the 43 billion dollars. On a larger standpoint we lose money when people die at younger ages. Experts estimate that because of the uninsured’s shorter lifespan we lose between 65 and 130 billion dollars a year. Now, I ask, wouldn’t it be cheaper for us to provide insurance to everyone?

    It is important to note that it isn’t unemployed homeless people that don’t have insurance, but rather blue collar everyday people. They can’t afford to get private healthcare and their jobs can’t afford to provide it for them. These people deserve, not the right to a corvette or liposuction, but to asthma medication so a child can run in gym class, or a pap smear so a women doesn’t die of cervical cancer and leave behind her young children. If you want a nose job, that’s your perspective and I am not stating that we the people should cover that, but if you want rehab after a car accident, you deserve that. Raise the taxes; spend less money on NASA or on the defense fund. The government needs to work for the good of all people. Perhaps I am an idealist, but I would rather do everything in my power to make some sort of change in a system that is simply not working than live with it because it doesn’t affect me directly.

    I do think that the current ideas and the current ideas about universal healthcare are not going to work, but I do believe that a change needs to happen. I believe that the right to live is so fundamental that the writers of the Bill of Rights did not feel the need to include it.

    Ok, I’m stepping down off my soap box now haha. I really do like your argument and I admire your arguments on their merits. I actually just wrote a paper on this for one of my classes so the ideas were all fresh in my mind. If you don’t mind I want to use part of your entry as a part of my portfolio for the class. I’m going to use my response as well. I like that you are taking a stance on something you believe in, but I just can’t agree. You don’t need to post my comment if you don’t want too. Hope studying is going well.

    http://www.amsa.org/uhc/uhcres.cfm- statistics are from here. This is AMSA’s stance on its support of universal healthcare.

  5. Big Al says:

    You will not be required to provide service to anyone, who steps into your office. You will have a number of patients who, and how many , up to you, these you will take care of, or they will go elsewhere, at least this is the system, in Canada, and the UK, so don’t be afraid, of universal health care.

  6. whatnext says:

    you’re a dangerous man, topher. one who thinks instead of “feels.”

    good luck, but reasonable men in America are in short supply. particularly in government. in 21st century America, A does not= A. and all the resources of the “feeling” masses are in play to make sure that action and the logical consequence of that action never meet.

    “What were the weapons in a land where reason wasn’t a weapon any longer?”

    Dagny Taggart

  7. […] Just curious. Mom. For some background, she is responding to my post No Right to Health Care. I wrote it because the more I read about Medicare, Medicaid, and the “funding” of physician services (hat tips to KevinMD) the more frustrated I get. It’s been happening a lot lately. It’s the frustration of having to enter a system that (in my mind) shouldn’t be allowed to function the way that it does. I’m a strong believer in markets. I believe in the meeting of supply, demand, and value complete with a fulminate crush on Dagny Taggart. These days, I’m frustrated over that fact that the value of the service that a physician provides is not strongly coupled to what he can charge, and instead his recourse is to make his salary through volume. I started writing this during exams, so in that spirit I offer you a medico-economic vignette. […]

  8. E.R. says:

    Your point about Negative and Positive rights is certainly interesting, and seems well-founded.

    However, a physician who is paid to do his job doesn’t seem like someone who is trapped within involuntary servitude. What’s the difference if an HMO pays you or a government system pays you?

    And I’ll pose you this. By your argument, food and water should be considered Positive rights – like Health Care, they must be paid for (though I admit they aren’t nearly as expensive), and someone must grow the food and fetch the water. Neither food nor water are protected under the Constitution. Does that mean food and water should not be considered fundamental rights?

    I ask because I’m curious about your stance, not because I have malicious intent.

  9. That something has a cost doesn’t make it a right, positive or negative. What gives something the status of “right” is a societal decision that each of us will respect the “right” (in the case of negative rights) or will pay/sacrifice for the “right” (in the case of positive rights). Food and water are not considered rights. Certainly, they are essential for you to live, but they are not covered under the Constitution. That water is made available for “free” at drinking fountains is instead the end-product of taxes at work. But again, just because you paid for it (or taxes were spent on it) does not make it a right.

    For example, I think you’ll agree that other things that we purchase with our taxes (war, financing presidential campaigns, public works projects) are not rights.

  10. E.R. says:

    You again make a very logical point.

    Really, I suppose the primary reason I have trouble agreeing with your argument is that it simply doesn’t sit well with me to adopt an attitude of Social Darwinism.

    But let me ask this. The Constitution itself doesn’t protect the right to clean air or clean water. I believe these would also need to be deemed as Positive rights, but again feel free to prove me wrong.
    Should they be deemed rights at all, and if so is that only because legislation protects those rights?
    Or do you view these as different entirely, because an individual cannot acquire them as a luxury (for air, at least)?

  11. I don’t subscribe to Social Darwinism. I also don’t see the connection between what I’ve said and this belief. Could you elaborate?

    I want to stop you from rushing to deem things as rights. I get the impression that you think that to protect something, we must deem it a right. This is not so. For example, could you ever imagine running out of beer? Man A wants beer and has money, man B can make beer and wants money, and both are willing to trade. So long as such interactions exist, you need not fear a shortage of beer. It’s the beauty of a market, and it’s why I don’t put much stock in arguments that we have to protect the things that we consider important through legislation (which is what declaring something as a right would entail). The markets take care of this, and there is no reason (or precedent) to believe that you can legislate a system more efficient than a spontaneously formed market.

    Google “I, Pencil”. It’ll open you up to some crazy ideas.

  12. E.R. says:

    I didn’t mean to accuse. Social Darwinism is the theory of social survival of the fittest. I see a connection, because deeming health care a luxury means that only those who are ‘fittest’ in terms of being able to get health care will enjoy survival, or at least healthy life.

    Clean air and water (as well as health care) are defined as fundamental rights internationally.

    Beer, while I’m sure many people consider it important, is not necessary for health/survival. I draw a major distinction there.

    Also, the problem isn’t that we have a shortage of health care – the problem is that we have an imbalance of health care. Man A has money and wants health care, Man B can provide health care and wants money – that works. Man C, however, doesn’t have money, but needs health care to survive. Man B doesn’t want to provide this for free, and shouldn’t have to, but doesn’t Man C have a right to live?

  13. Jeff Kaplan says:

    Access, Quality and Cost – a three-legged stool — healthcare advocates couch these three legs in terms of equity in access, benefit and affordability. Managed care organizations and indemnity insurers repackage the same criteria in terms of restricted networks, disease state or case management (process and outcome measurement), and profit or fund-balances if they are a ‘non-profit’ organization. (Note: non-profits also afford multimillion dollar in bonuses). Doctors see the same conditions as office and on-call hours, patient satisfaction and practice growth, and accounts receivables vs. overhead.

    Regardless, I agree with E.R. and neither will I brook with Social Darwinism; I want balance, and I want it now! [P.S. Interesting blog; I write in parallel, “Reforming Healthcare & Managed Care” on HCPLive.com

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