Do we have a right to health care? Politi­cians, philoso­phers de­bate

The Fresno Bee (Sunday) - - Insight - BY ANDREW FIALA Spe­cial to The Bee

Do peo­ple have a right to health care? Bernie San­ders thinks so. He re­cently in­tro­duced “Medi­care for all” leg­is­la­tion that would ex­pand Medi­care and pro­vide universal cov­er­age. Other Demo­cratic pres­i­den­tial con­tenders have jumped on San­der’s sin­gle-payer band­wagon.

San­ders re­cently tweeted, “Health care is not a com­mod­ity. It is a human right.” A sim­i­lar idea was shared on Twit­ter last year by Pope Fran­cis, who wrote, “Health is not a con­sumer good, but a universal right.” The sen­a­tor and the pope think that health is not some­thing to be priced by the mar­ket and only avail­able to those who can af­ford it.

The right to health and med­i­cal care is of­ten in­cluded in lists of other rights. The United Na­tion’s Dec­la­ra­tion of Human Rights de­clares, for ex­am­ple, that there is a right to “food, cloth­ing, hous­ing and med­i­cal care.”

This idea of rights is dif­fer­ent from what we see in the found­ing doc­u­ments of the United States. The Dec­la­ra­tion of In­de­pen­dence says we have a right to life, lib­erty, and the pur­suit of hap­pi­ness. The Bill of Rights in­cludes free­dom of speech and re­li­gion, the right to bear arms, and so on. Nowhere in the Constituti­on is there a right to food, ed­u­ca­tion, or health care.

The right to pur­sue hap­pi­ness only gives us the right to be left alone to com­pete for work or pur­chase food. Rights that en­ti­tle you to be left alone are called “neg­a­tive rights.” Neg­a­tive rights are pro­tec­tions against in­ter­fer­ence.

The British philoso­pher John Locke is a source. He said, “no one ought to harm an­other in his life, health, lib­erty, or pos­ses­sions.” Locke in­cludes health here. But he is not talk­ing about a right to health care. Rather, his point is that we ought not dam­age other peo­ple’s health.

Neg­a­tive rights cre­ate lim­ited du­ties. We only have a duty not to harm others. A dif­fer­ent idea of rights, so- called “pos­i­tive right,” cre­ate more ex­ten­sive du­ties. A right to ed­u­ca­tion or health care is con­nected with a duty to pro­vide for those things.

The duty to pro­vide may be lim­ited and lo­cal. Par­ents, for ex­am­ple, have a duty to ed­u­cate their chil­dren. Fam­i­lies may have a duty to care for sick rel­a­tives. But most de­fend­ers of pos­i­tive rights go fur­ther and de­clare that so­ci­ety has the duty to pro­vide.

One source of this idea is found in the para­ble of the Good Samar­i­tan. That story begins in a dis­cus­sion of the Golden Rule: “Love your neigh­bor as your­self.” Je­sus praises the mer­ci­ful Samar­i­tan, who ex­tended his love to a stranger. Je­sus ex­horts, “Go and do like­wise.”

Good Sa­mar­i­tanism might merely be un­der­stood as re­quir­ing pri­vate

char­ity. But Je­sus’s idea of broad neigh­borly re­la­tion points to­ward the idea of human in­ter­con­nec­tion and mu­tual de­pen­dence. As the poet John Donne once put it, around the time that Locke was writ­ing, “no man is an is­land.” Donne con­tin­ued, “any man’s death di­min­ishes me, be­cause I am in­volved in mankind, and there­fore never send to know for whom the bell tolls; it tolls for thee.”

The idea of in­volve­ment with hu­man­ity lead to calls for so­cial wel­fare sys­tems. One im­por­tant source is Thomas Paine, the philoso­pher of the Amer­i­can revolution. Paine said that a gov­ern­ment “ought to have no other ob­ject than the general hap­pi­ness.” He pro­posed a sys­tem of ba­sic in­come, sup­port for re­tire­ment, and care for wi­d­ows and chil­dren.

Paine’s ideas — like those of San­ders and Fran­cis — might be de­cried by crit­ics as so­cial­ist. De­fend­ers of neg­a­tive rights do not want to be forced to pay for other peo­ple’s well-be­ing. They will be skep­ti­cal of taxes that are used to sup­port the poor, ed­u­cate the young, or care for the sick. They want peo­ple to be re­spon­si­ble for them­selves and left alone to choose how to spend their money and use their lib­erty.

But those who main­tain that there is a right to health care don’t view neg­a­tive rights as the end of the story. They judge so­ci­ety in terms of how it cares for those who are ail­ing and vul­ner­a­ble. On this view, suc­cess­ful so­ci­eties care for chil­dren and wi­d­ows, the poor, the aged, and the in­firm. And while pri­vate char­ity is nice, the free mar­ket is not go­ing to care for ev­ery­one for whom the bell has tolled.


Demo­cratic pres­i­den­tial can­di­date Sen. Bernie San­ders, I-Vt., re­cently in­tro­duced “Medi­care for all” leg­is­la­tion that would pro­vide universal health care cov­er­age.

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