Is Health Care a "Right" or a "Moral Responsibility"?

By Maggie Mahar, Health Beat. Posted October 10, 2008.

I have to admit I often have found the language of health care "rights" off-putting. Yet the idea of health care as a "right" is usually pitted against the idea of health care as a "privilege." Given that choice, I'll circle "right" every time.

Still, when people claim something as a "right," they often sound shrill and demanding. Then someone comes along to remind us that people who have "rights" also have "responsibilities," and the next thing you know, we're off and running in the debate about health care as a "right" vs. health care as a matter of "individual responsibility."

As regular readers know, I believe that when would-be reformers emphasize "individual responsibilities," they shift the burden to the poorest and sickest among us. The numbers are irrefutable: Low-income people are far more likely than other Americans to become obese, smoke, drink to excess and abuse drugs, in part because a healthy lifestyle is expensive, and in part because the stress of being poor -- and "having little control over your life" -- leads many to self-medicate. (For evidence and the full argument, see this recent post.) This is a major reason why the poor are sicker than the rest of us and die prematurely of treatable conditions.

Those conservatives and libertarians who put such emphasis on "individual responsibility" are saying, in effect, that low-income families should learn to take care of themselves.

At the same time, I'm not entirely happy making the argument that the poor have a "right" to expect society to take care of them. It only reinforces the conservative image (so artfully drawn by Ronald Reagan) of an aggrieved, resentful mob of freeloaders dunning the rest of us for having the simple good luck of being relatively healthy and relatively wealthy. "We didn't make them poor," libertarians say. "Why should they have the 'right' to demand so much from us?" Put simply, the language of "rights" doesn't seem the best way to build solidarity. And I believe that social solidarity is key to improving public health.

Given my unease with the language of rights, I was intrigued by a recent post by Shadowfax, an emergency department doctor from the Pacific Northwest who writes a blog titled "Movin' Meat." (Many thanks to Kevin M.D. for calling my attention to this post.) Shadowfax believes in universal health care. Nevertheless, he argues that health care is not a "right," but rather a "moral responsibility for an industrialized country."

He begins his post provocatively: "Health care is not a right. ... I know this will piss off" many readers, "but I wanted to come out and say it for the record. ... My objection may be more semantic than anything else, but words mean things and it is important to be clear in important matters like these."

Anyone who says that words are meaningful has captured my attention. I'm enthralled. After all, words shape how we think about things. Too often, we automatically accept certain words and phrases without realizing that they define the terms of the argument.

Shadowfax then quotes from a reader's comment on his blog: "Jim II said it well in the comments the other day: 'Rights are limitations on government power.'

"Exactly," writes Shadowfax. "When we use the language of 'rights,' we are generally discussing very fundamental liberties, which are conferred on us at birth, and which no government is permitted to take away: free speech; religion and conscience; property; assembly and petition; bodily self-determination; self-defense, and the like. Freedoms. Nowhere in that list is there anything which must be given to you by others. These are freedoms which are yours, not obligations which you are due from somebody else. There is no right to an education, nor to a comfortable retirement, nor to otherwise profit by the sweat of someone else's labor."

Normally, I would object: Americans do have a right to an education. But Shadowfax is defining our "rights" in a very specific sense: Our constitutional rights make us, as individuals, free from something -- usually, interference by government, our neighbors or the majority in our society.

Shadowfax then turns from the idea of rights to what people deserve: "Some societies, ours included, from time to time decide that its citizens, or certain groups of them, should be entitled to certain benefits. Sometimes this (is) justified by the common good -- a well-educated populace serves society well, so we guarantee an education to all children. Sometimes this is derived from humanitarian principles -- children should not go hungry, so we create childhood nutrition programs. Health care would, in my estimation, fall into the category of an entitlement rather than a right. ..."

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Maggie Mahar is a fellow at the Century Foundation and the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006).

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