Why Healthcare is not a Right

By "Daily Danet"

Recently, Oprah, had an episode about healthcare. Oprah, Michael Moore and other guests continued to refer to healthcare as a right. Many people disagree with this fundamental issue, but have difficulty articulating why. So here is my best effort to explain why it is I believe that healthcare is not a "right."

The classic response is that a right is not something someone gives you, but something that no one can take away. This a good bumper sticker, but it is not terribly instructive if you're not already convinced. I don't presume to solve the problem of escalating healthcare costs. Due in part to rapid advances in medical treatments, ordinary people are being forced to choose between lifesaving treatments that didn't exist only a few years ago and bankruptcy. Rampant lawsuits, anti-healthcare provider forces and those evil profit seekers can be left for another time. A more basic question, however, is whether you (and I) have a right to healthcare.

Rights are not unlimited. Rights can be restricted or even taken away. For example, you have the right to liberty (to walk freely wherever you please). But others can restrict that right in certain circumstances. You cannot, for example, walk freely through your neighbors bedroom at night. That would violate their right to privacy. If you commit a crime and are tried and convicted, your liberty can be revoked completely.

Rights really only make sense in the context of a lawful society. Governments are instituted, as a basic matter, to determine where one person's rights end and another's begins. For example, you have a right to free speech, but others have a right against defamation. If you say something untrue and defamatory about someone, the government can determine whose right trumps.

From the perspective of the government, a right is something that can be ensured to one citizen without taxing (in the broadest sense) another citizen. For example, the government can ensure your right to free speech without any cost to anyone else. No one has to listen (you do not, for example, have the right to be listened to). Nor does anyone have to publish your work. You do not, however, have the right to a full-page spread in the Wall Street Journal. If, however, you can afford to, you can purchase one (or the Wall Street Journal) and say pretty much whatever you want. (Subject, of course, to others' rights to be free from defamation and other torts).

In a (mostly) free and (mostly) just society like ours, rights are plentiful. You have, to name a few, the right to bear arms, the right to your life, your liberty, the pursuit of your happiness. To be sure, however, this does not mean the government must buy you a gun. Nor does it mean government must purchase the things that make you happy. It only means that government cannot restrict these rights without due process of law.

This is the crux of the issue: there is a difference between a right and a need. For example, you need food, clothing and shelter. You have a right to pursue these needs; the government will not prevent you from buying a home, buying food or buying a new pair of jeans. The government does not, however, owe you a house, food or clothing. You have no right to housing, no right to food and no right to clothing.

Consider a small society of 100 people, with laws not too dissimilar to ours. Let's assume 2 of these people are unable, for whatever reason, to afford their own home. Among the other people are a carpenter, a logger, a blacksmith, a painter and a plumber. If the government is to provide those two people with housing, it has to either (i) tax everyone to pay the workmen to build the house or (ii) compel the workmen to build the house for free. Either way, the government must take something of value to provide this need to those who cannot obtain it on their own.

So it is with healthcare. You need healthcare. Everyone does. But in order to provide you with that need, the government has to take from someone else. They either have to tax those who can afford it or compel the doctors, pharmacists and hospitals to provide it for free. You may think, as clearly many do, that this is not such an evil thing. Think back to that "free" house, though. Think how hard those workmen would work if they knew that they either weren't being paid for their efforts, or that some nebulous body called "taxpayers" were paying them. Also, consider how many people would voluntarily buy their own house when they knew that others had gotten one for free. Imagine the standard of construction and innovation that would develop if housing were treated as a right; as something the government needed to provide.

Of course, governments do this all the time. They tax one citizen to pay for another's welfare (literally and figuratively). They tax me to pay for your social security. They tax you to pay for my passport. They tax all most of us to provide for our common defense. The point, however, is that that does not make it a right.

Governments have many purposes. The common defense is one that most people agree on as a valid rationale for taxes. Saving the spotted owl, however, is debatable. So too is providing healthcare.

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Top doctors slam NHS drug rationing

Britain's top cancer consultants have accused the government's drugs rationing body of ignoring the plight of patients forced to sell their cars and remortgage their houses to pay for cancer treatments freely available in Europe. Twenty-six professors blame the severe restrictions imposed by the National Institute of Health and Clinical Excellence (Nice) on its failure to "get its sums right".

Nice refuses, on grounds of cost, to recommend some drugs for patients with advanced kidney cancer. The consultants, who include the directors of oncology at Britain's two biggest cancer hospitals, the Royal Marsden in London and Christie hospital in Manchester, claim there is enough money in the NHS to pay for the drugs.

Their letter to The Sunday Times states: "We now spend similar amounts to Europe on health generally and cancer care in particular, but less than two thirds of the European average on cancer drugs. It just can't be that everybody else around the world is wrong about access to innovative cancer care and the NHS right in rationing it so severely." They say: "The time has come for a radical change in how the NHS makes rationing decisions for cancer."

This weekend Andrew Dillon, the chief executive of Nice, and Sir Michael Rawlins, the chairman, challenged the cancer experts to explain which acutely ill patients should be sacrificed to free resources for cancer sufferers. They said: "There is a finite pot of money for the NHS, which is determined annually by parliament. If one group of patients is provided with cost-ineffective care, other groups - lacking powerful lobbyists - will be denied cost-effective care for miserable conditions like schizophrenia, Crohn's disease or cystic fibrosis."

This week patients from the Kidney Cancer Support Network will demonstrate outside the Nice offices in London against the refusal to fund the kidney cancer drugs Avastin, Sutent, Nexavar and Torisel.

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The Real Census Story

Every August, the Census Bureau's release of the latest income and health insurance figures results in a political uproar, but this year the political class seems almost embarrassed by the good news. Median household income rose slightly in 2007, the poverty rate held steady and the number of uninsured even dropped slightly. Even so, a closer inspection of the numbers shows some dark clouds around the silver lining -- though not of the sort that those warning of another Great Depression usually find.

Begin with health insurance coverage. Census found that 45.7 million people, or 15.3% of the population, were uninsured in 2007, down from 47 million or so in 2006. While total enrollment in private insurance remained stable -- due to population growth -- it eroded slightly in percentage terms, continuing a downward trend. The growth in coverage was mostly concentrated in public programs -- partially due to an aging population shifting to Medicare, but especially in Medicaid. Democrats are already claiming vindication of their post-2008 priority of moving even more people onto the federal balance sheet.

Yet the Medicaid increase isn't exactly a shocking revelation. Each year, a significant portion of the uninsured qualifies for government assistance but hasn't signed up. In spite of 2007's uptick, 24.5% still earned under $25,000 and are probably eligible for help. Some 22% made over $50,000, which is hardly rich, but enough to afford coverage in most states. Meanwhile, about 54% are between the ages of 18 and 34, and many of them voluntarily choose (risky as it may be) to forgo coverage. In other words, the latest batch of data shows, again, that the policy problem of the uninsured isn't as large as election-year opportunism would have it.

This isn't to deride the genuine hardships that the fragmented health-care system metes out to many families. Rather, it's that insurance is more expensive than it needs to be thanks to regulation and other market interference. Many get priced out of coverage, while others -- especially the young -- are induced to gamble on going uninsured.

Most of the gaps in coverage owe to the way the tax code creates problems for the insured while shortchanging everyone else. People who are covered through their employers -- 59.3% in 2007 -- pay no taxes on the value of the benefit, encouraging them to launder their health dollars through third-party insurers while burdening business with increasing medical costs. Meanwhile, the size of the subsidies are smaller for lower-wage workers -- who typically have less generous plans as part of their compensation -- and nonexistent for individuals.

In a lot of ways, the new figures probably underestimate the effects of the tax code distortions. The Census counts people who were insured for only part of the year as "insured." But other studies have shown that the number that are uninsured at some point during prior years -- usually because their coverage lapsed while switching jobs -- reaches as high as 69 million. Restoring the tax parity of health dollars would allow individuals to buy policies themselves, rather than rely on their employers, and take those policies with them wherever they work. It would increase access and affordability for everyone.

In 2007, President Bush proposed doing just that. His reward was to receive no thanks or even credit, though John McCain has picked up and amplified some of his best ideas. Since the Census report points to some deterioration of the artificial job-based system we have now, this is a good moment for the Republican candidate to focus on the improvements that his plan would bring to middle-income and working-class families, as he started to do yesterday.

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