Bohanon: Is Health Care a Right?

March 3, 2014

by Cecil Bohanon, Ph.D.

As a former cigarette smoker, I have a nightmare. Somewhere down the road, I get a diagnosis of lung cancer. The doctor tells me the the cancer is treatable, the prospects for a full recovery are better than 60 percent and the costs of the treatments will be around $250,000.

Now let’s change the scenario. The doctor tells me the cancer is difficult to treat, but there is hope. A regimen is available at a cost of $5,000,000 with the chance for recovery under 10 percent. Most people would make the following call: I should get the treatment in the first case, but should prepare to meet the Lord soon in the second case.

But wait, isn’t health care a right? Aren’t I entitled to the best health care available independent of cost?

What constitutes a “right” is a place where classical liberals (aka libertarians) and progressives dramatically part ways. To classical liberals, rights are God-given or natural and “negative” in form. A right implies that one is free to engage in an activity. A right does not guarantee, however, the resources necessary to engage in the activity. My right makes no claim on your property.

An instructive example is religious liberty. I am free to practice my Anglican faith, and you are free to be a Wiccan. Religious liberty, however, does not entail — is in fact at odds with — the Wiccan being coerced to pay for my chapel. Neither of us are entitled to a place of worship, but both of us can, with our compatriots, build and support our respective places of worship.

In a similar vein, a patient has the right to obtain any cancer treatment offered but only if he pays for it, has purchased an insurance agreement that pays for it or can persuade others to pay for it.

Progressives have for some time argued that the notion of a negative right is too narrow. A more expansive notion of a right — a positive entitlement right — is appropriate in the case of health care. Economic progress and wealth allows, indeed, requires that all have health services. This implies that government should seize by force the legitimately held property of some — that is, tax them — to pay the medical bills of others.

Note that by definition positive entitlement rights imply that someone else’s right — a private property right — must be violated. A “right” that by nature takes away another “right” is in my humble opinion better called something else. I propose calling it an entitlement — and insist it not be confused with genuine rights.

Moreover, unlike the “negative” rights of classical liberals, the “positive” rights of progressives can hardly be seen as God-given or natural. If one asserts a “right” to health care, what does that mean? To any conceivable health-care treatment? Here the progressive must equivocate and assert that the actual practice of the “right” must be limited by political constraints. This is at odds with the notion of rights being inalienable as proclaimed in the Declaration of Independence.

To a classical liberal, the rights to worship God as an Anglican or as a Wiccan or to purchase medical services are never legitimately subject to political compromise. One’s ability to pay for a cathedral, a pine grove or a cancer treatment probably will be.

So-called positive rights are an awkward and unwieldy construct. In my opinion, it is better to dispense with them. Defending fellow citizens true rights — the rights to free speech, to freedom of worship, to private property, to engage in free exchange — are matters of justice. Entitlements are not rights at all but rather, at best, matters of mercy.

Cecil Bohanon, Ph.D., an adjunct scholar with the Indiana Policy Review Foundation, is a professor of economics at Ball State University.



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