Tuesday, September 1, 2009

Do we have a natural right to health care?

Is health care a human right, as the United Methodist Church says? I don't see how. Human rights, as Americans have always understood them (beginning with Thomas Jefferson and the other Founders) are a fact of nature that cannot be rescinded by human beings. Rights are immutable, indeed, unalienable ("Not to be separated, given away, or taken away" Dictionary.com, as Jefferson wrote in the Declaration of Independence. As a precursor to his Declaration theology that unalienable human rights are a endowment by God, Jefferson wrote in his pre-revolution essay, Summary View of the Rights of British America, " The God who gave us life gave us liberty at the same time. The hand of force may disjoin, but cannot destroy them."

Since his day, and certainly preceding it, the historic American understanding of human rights is the
exercise of individual freedom, especially in the political realm, for both public and personal good. We have historically never understood our rights as encompassing access to services or commodities.

Rights are inherent in each individual equally, they are not divisible. Take the Declaration's famous insistence that among human rights is "the pursuit of happiness." Note that it is the
pursuit of happiness that is a right, not the achievement of it. Nor is one person more entitled to pursue happiness than another, no matter one’s station in life. Besides, happiness (what Jefferson meant was not happiness as we use the word today, but a state of contentment in life and possessions) is not something that can be given us, it is something we have to create.

It does sound all high minded to say that, like rights, health care should be equal for everybody, which I suppose is why clergy are so susceptible to say so. It's more than obvious that no one in the Congress or the White House believes that, though. If they did, the bill awaiting Senate vote would require members of Congress and the rest of the federal government to fall under the "public option" along with the rest of us proles. But they’
ve protected their turf completely and much better turf is theirs than ours. I’ll believe that equal access and care for everyone is a moral imperative when the people who say it is a moral imperative place themselves under the same imperative.

The presumption that health care is a right, and therefore must be equal for everyone, is founded on two critical errors of understanding. The first is that health care is a resource that is simply available for those who need it, or that can be made equally available through proper legislation and regulation. The second error is that medical care and access to it can be rationed by command more equally, economically and fairly than by demand.

Health care is not a resource to be exploited

Medical facilities and doctors are not phenomena of nature, like water or petroleum are. Hospitals don’t just appear. They are produced. Medical care is not a resource that can be "mined" through more regulation to be more plentiful. Medical care is a
service. Specifically, it is a contracted service, in much the same way that legal assistance, automotive maintenance or pastoral care are services. Why? Because men and women choose of their own accord to get medical training. Once graduated, doctors, nurses, paramedics and technicians of various kinds reasonably expect that they will be compensated at a rate greater than their costs to enter the profession, greater than their extremely high overhead to run the practice, and enough to make their grueling hours materially worthwhile for themselves and their families.

This fact has very direct consequences under the Medicare and Medicaid systems we have today.
The Atlantic's business journalist Meg McArdle explains:
[W]e have a comprehensive national health care plan for seniors. Yet we have a shortage of geriatricians, the one specialty that you would think would be booming. Why? Because Medicare sets a single price for the services of geriatricians, and it is low. Since the field is not particularly enticing (though arguably it really should be, since geriatricians have extremely high job satisfaction compared to many more popular specialties), very few people go into it. It's one of relatively few specialties that consistently has most of its slots and fellowships unfilled.
Moreover, the skills and equipment a doctor or hospital possess are their individual property, not the property, even partially, of the state or public. (There are publicly-owned facilities such as VA hospitals, but in operation there is no difference to the general public between them and private facilities). No one has a natural right to someone else's property. To think we do directly violates the Tenth Commandment. As McArdle says, "People have no obligation to perform labor for others. I may not [justly or legally] force a surgeon to save my mother at gunpoint."

That means that to receive a doctor's services, the doctor and a patient must come to a mutually-agreeable arrangement of what medical care will be provided in exchange for a specified fee. This is a commercial transaction no different in type than hiring a plumber, cab driver or lawyer. That medical services often are life critical does not change the fundamental nature of the contract.

We have access to medical care only as long as a doctor is willing to provide it. No one has to become a doctor or continue in medical practice. If any "reform" of the present health care system reduces the rewards of practicing medicine or complicates the practice, fewer men and women will so choose. Access will then go down for everyone and costs will inevitably rise, no matter what the rate-payment of the public option is, because access or its lack is itself a cost and also drives other costs.

Health care is a service

Michael Keehn explains, health care is a service but not a community service. Police and fire departments provide community services. That seems obvious enough, but consider: fire departments do not protect your home individually. The fire chief definitely will let it burn to the ground if firefighting needs are greater elsewhere in the town. Just look at what is happening near Los Angeles as of the date of this post. Police and fire protection are in fact rationed to protect the lives and property of the greatest number of people possible with the resources available. But when the resources (manpower, equipment or money) run out, individuals are exposed to greater danger or loss though the community at large may still be protected.

Individual residents of a city do not contract for their community’s police or fire protection. When you call 9-1-1 because someone broke into your home while you were in bed, you don’t have to sign a contract with the police when they arrive, specifying the actions you want them to take and how much you are going to pay.

In contrast, under the present system medical care is an individual service. Doctors do not provide their services to the community as a whole, but to individuals. Because of that, each patient enters into a contract with his/her doctor specifying the medical services to be received and how much it will cost. This is mostly mediated through insurance companies, of course, which greatly simplifies the contracting process. The result is that a patient 's health is protected in a way that their safety or homes are not protected by the police or fire departments.

Interestingly, the Roman Catholic Church rejects the idea that health care is a human right. The Most Reverend R. Walker
Nickless, bishop of the Diocese of Sioux City, Iowa, explains.
[T]he Catholic Church does not teach that “health care” as such, without distinction, is a natural right.

The “natural right” of health care is the divine bounty of food, water, and air without which all of us quickly die. This bounty comes from God directly. None of us own it, and none of us can morally withhold it from others. The remainder of health care is a political, not a natural, right, because it comes from our human efforts, creativity, and compassion.
Like any human endeavour, health care is finite. It can be properly understood only as such. Any reform that treats medical care as if it can be made infinitely available is a product of cloud-cuckoo land. Medical care, like every other finite thing, must be allocated. The current buzzword for that is "rationed." That’s the foundation of the second critical mistake people are making about health care, that medical care and access to it can be rationed by the government more equally, economically and fairly than by consumers. It can’t, but that's a topic for another post.

Update: Philip Barlow, Consultant neurosurgeon at Southern General Hospital, Glasgow, explains why "Health care is not a human right."

Philip Niles says that the real question is not whether health care is a human right, but "How much health care is a human right?" Good question, since health care is finite.

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