In his previous post, DrRich used a combination of history, logic, and sleight of hand to convince even his most conservative readers that healthcare is indeed a right.
To summarize that erudite posting: The BOSS rule says it’s a right, so it’s a right – as long as we’re talking about a civil (or legal) right, and not about a natural (or inalienable) right.
A civil right is granted, more or less arbitrarily, by a government or a society, to some group of individuals, usually to redress a past grievance, or to attempt to achieve equality in outcomes, or for some other form of social justice. Civil rights almost invariably require a second group of individuals to sacrifice something of their own in order to satisfy the civil rights granted to the first group. So the granting of civil rights (as opposed to natural rights) will often be seen by at least some as being inherently oppressive, but if used appropriately civil rights can be very good for the furtherance of a stable and civil society. (As DrRich has pointed out, even our Founders – the great purveyors of natural rights – explicitly understood the importance of well-designed civil rights.) Civil rights, at least ideally, advance the virtue of justice, just as their creators claim.
So here is DrRich’s advice to conservative Americans. Move on. Stop fighting the “healthcare is not a right” battle. You’ve already lost that battle, and wasting energy on it at this point will only drain your time and resources.
Furthermore, as it happens, healthcare – or more specifically, health insurance – is a civil right for every legal resident in the U.S., not just Because Obama Says So, but because it is indeed the only just course for us to take. This is true because every person now living in the United States is already paying towards the cost of health insurance for people who have insurance, and therefore has a just claim to some of that health insurance.
1) Anyone receiving a paycheck (even those without health insurance) is paying, through payroll deductions, for Medicare for the elderly and Medicaid for the poor.
2) Anyone paying income tax (even those without health insurance) is paying higher tax rates to offset tax-deductible health insurance premiums purchased by businesses for their employees. (That is, employer-provided health insurance is subsidized by all taxpayers.)
3) Anyone buying products in the U.S. (even those without health insurance) is paying higher prices to cover the health insurance expenses of American businesses.
4) Anyone living in America (even those without health insurance) is sharing in the massive debt load we are accruing by allowing healthcare spending to be passed on to future generations.
These health insurance costs, and more, are borne by everybody living in the U.S. Since everyone in one or more ways is helping to pay for the health insurance premiums of most who have health insurance, everyone has a just claim – a civil right, if you will – to some of that health insurance themselves.
In theory, there are two ways of rendering fair this currently unfair situation (in which the uninsured are forced to subsidize the health insurance of everyone else), namely, either to provide a way for those uninsured to get the insurance they have earned, or to make all of healthcare a completely self-funded enterprise, where each person is entirely responsible for all of their own healthcare costs, and nobody without insurance is forced to subsidize those who have it.
DrRich respectfully submits that the latter method – the purely libertarian one – is unworkable. (DrRich will leave it as an exercise for the reader to prove that pure libertarianism is unworkable, but will offer the following clue: it’s unworkable for the same reason pure socialism is unworkable – because any system will fail that relies upon a fundamental change in human nature.)
This leaves us with an obligation to provide a way for the uninsured to become insured. There are several ways in which we might accomplish this, but the specific methodology is not important to our present discussion.
What is important is to establish, right up front, the principles under which we concede a “civil right to healthcare,” and then to insist that the healthcare provided under that civil right remains consistent with those principles.
This will be critical, and conservatives need to be clear on this: Healthcare is not a natural right, or even an entitlement. The civil right to healthcare is not something granted to an individual by the Creative Force, but rather, comes into being solely as a legal right, granted by our legal processes as part of a social contract. Under this social contract, we must insist that healthcare is granted as a consideration given in return for certain obligations the individual makes to society. Those obligations would include contributing toward the payment for any publicly-funded healthcare through taxes (at least, for anyone above a certain income level), and subjecting oneself to whatever limits to publicly-funded healthcare such a system requires in order to maintain societal integrity (that is, to avoid bankruptcy).
This kind of contractual, legal right to healthcare would finally enable us to set transparent limits on publicly-funded healthcare. We could at last be explicit about our inability to provide individuals with every manner of available healthcare under all circumstances from pooled funds. We could finally say, “Here is what we can provide with public funding, and here is what we cannot provide.”
Once these unavoidable limits are explicit and clearly defined, then it would become feasible to design a healthcare system that minimizes the damage done to individuals by the limits inherent in publicly funded healthcare. And truly minimizing that damage would require us to design a system that encourages – and enables – individuals to fund their own healthcare decisions to the fullest extent possible. DrRich has suggested a design for such a system in some detail elsewhere. Others (though none currently in power) have proposed similar systems.
The point is that we can no longer deny a civil right to healthcare – nor should we. For decades the uninsured have been subsidizing the health insurance of most of us who have it, and justice requires that this no longer be the case. But as we stop fighting a civil right to healthcare, we need to take up a more important battle – defining just what we mean by such a right.
We must insist that a civil right to healthcare not only includes the right of individuals to buy with their own money as much of their own healthcare as they choose, but (because there will always be “inalienable” limits on how much healthcare we can buy with public funds) we must encourage the practice, and set the system up to enable individuals to do so, whatever their economic status – and to rely on publicly funded healthcare mainly for established medical services which individuals cannot be expected to purchase on their own.
DrRich is suggesting that the key to making such a discussion feasible is first, to acknowledge that healthcare is indeed a civil right just as our progressive friends insist, and then, to forthrightly embrace the implications of a civil right. For a civil right is fundamentally a social contract (and not an inalienable, non-negotiable, open-ended entitlement), and therefore it is subject to terms.
In summary, DrRich urges his conservative friends to stop fighting a battle that has already been decided, and instead, fight to design a healthcare system that honors a civil right to healthcare in such a way as to support and sustain our truly inalienable rights to individual freedom and liberty.
*This blog post was originally published at The Covert Rationing Blog*