The Rights Angle

The conseqences of a "right" to health care.

David Kelley from the January 1994 issue

(Page 3 of 3)

The Clinton plan for "managed competition" will not escape any of these consequences. On the contrary, it will magnify them. It will be far more destructive of our liberties than anything we have experienced so far.

The plan calls for a further extension of health-care subsidies to those who are currently uninsured and to those who have health coverage less extensive than the proposed standard package of benefits. Where are these subsidies going to come from? The administration has rejected the so-called single-payer system--that is, overtly socialized medicine, in which the government pays all the bills--because it knows that the government cannot pay all the bills. The necessary tax increases would be politically impossible. So the Clinton plan calls for a nominally private system in which regulations force some people to subsidize others.

At the heart of the plan are the local health alliances: government-protected monopolies which will collect premiums and negotiate with health-care providers to offer acceptable plans. Virtually everyone who lives in a given area will be forced to obtain health insurance through the local monopoly health alliance. Health-care providers--private practitioners, HMOs, and others--will not be able to deal directly with individuals. They can offer their services only through the health alliances, subject to the conditions it imposes.

One such condition is guaranteed access: Every plan must be willing to accept any individual who wants it; no one may be excluded for any reason. Another condition is community rating: The price of the plan must be the same for everyone. Consider the effects these provisions will have on incentives. If I know that when I get sick I will be able to enroll in any plan I want, at a price that does not reflect my condition, then I have no reason to pay for health insurance while I am well. If people are free to choose whether to obtain and pay for a policy, the only people enrolling will be the sick, and costs will go through the roof. So the system works only if everyone is forced to participate. That is exactly what the proposal requires, and although the details of the proposal keep changing, this is one point that cannot change.

At the national level, the system will be governed by a National Health Board whose two main functions will be to determine the standard package of minimum benefits and to limit health-care spending by imposing some form of direct or indirect price controls on drug companies, insurers, or health-care providers. The standard package of benefits--the same package for every individual in the country--will be set by interest-group lobbying, as every group in the health-care field will try to get its services included in the package. For example, the current definition of the package includes mental-health and substance-abuse counseling. You may feel that you do not need insurance for these services, but you are going to pay for them.

In short, the administration's efforts to implement a universal right to health care will require a massive exercise of coercion against individuals, far beyond anything we have seen to date.

Moral Foundation

If you believe in liberty rights, then it's inconsistent to believe that there's such a thing as a right to health care. The rights of liberty are paramount because individuals are ends in themselves. We are not instruments of society, or possessions of society. And if we are ends in ourselves, we have the right to be ends for ourselves: to hold our own lives and happiness as our highest values, not to be sacrificed for anything else, not subject to involuntary obligations to serve the good of others.

Many people are afraid to assert their rights and interests as moral absolutes, because they are afraid of being labeled selfish. So it is vital that we draw certain distinctions. What I am advocating is not selfishness in the conventional sense: the vain, self-centered, grasping pursuit of pleasure, riches, prestige, or power. Genuine happiness results from a life of productive achievement, of stable relationships with friends and family, of peaceful exchange with others. The pursuit of our self-interest in this sense requires that we act in accordance with moral standards of rationality, responsibility, honesty, and fairness. If we understand the self and its interests in terms of these values, then I am happy to acknowledge that I am advocating selfishness.

We have to draw the same distinctions when we think about altruism. For it is, in the end, the moral code of altruism that makes people think that need is primary, that need gives one a right to the ability and effort of others. In the conventional sense, altruism means kindness, generosity, charity, a willingness to help others. These are certainly virtues, so long as they do not involve the sacrifice of other values, and so long as they are a matter of personal choice, not a duty imposed from without. I might note in this regard that physicians have historically been extremely generous with their time.

In a deeper, philosophical sense, however, altruism is the principle that one person's need is an absolute claim on others, a claim that overrides their interests and rights. So, as Dr. Edmund Pellegrino declares in JAMA, "A medical need in itself constitutes a moral claim on those equipped to help." This principle has often been asserted by thinkers who are opposed to individualism, and it is the basis for the doctrine of welfare rights. It is the reason advocates of government involvement in health care can take for granted that the needs of patients are primary and that everyone else can be forced to provide for those needs.

No rational basis for this principle has ever been offered. In fact, our needs have to be satisfied by production, not by taking from others. And production comes from those who take responsibility for their lives, who apply their minds to the challenges we face in nature and find new ways of meeting those challenges. Ayn Rand said it best, in her novel The Fountainhead: "Men have been taught that the highest virtue is not to achieve, but to give. Yet one cannot give that which has not been created. Creation comes before distribution--or there will be nothing to distribute. The need of the creator comes before the need of any possible beneficiary." The creator's need, in any field, is the freedom to act, the freedom to dispose of the fruits of his labor as he chooses, and the freedom to interact with others on a voluntary basis, by trade and mutual exchange.

That freedom is a vital need, not only for doctors but for patients. It is only in a context of freedom that one person's need is not a threat to others. It is only in a context of freedom that genuine benevolence among people is possible. It is only in a context of freedom that the medical progress which has brought so many benefits to all of us can continue.

The problems of our current system were caused by government. More government is not the solution. But we must oppose the expansion of government control in principle, by rejecting spurious claims of a "right" to health care and insisting on our genuine rights to life, liberty, property, and the pursuit of happiness.

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