Of all the arguments favoring the coordination and control of the healthcare industry by the central planning agency of the state, the healthcare-is-a-human-right argument seems to be the most convincing one, even to those who may favor a free market approach to the problem of coordination of scarce health resources. How can we as a society possibly deny healthcare to someone in need? How can we turn away an orphan or a widow? How can we be so heartless? Doesn’t justice call for the assurance of healthcare to all, especially those in need? Shouldn’t the state assume that task?
Supporters of state sponsored healthcare argue that health is more than an economic good; that it is in fact an essential human right and therefore this right places a specific obligation on every member of society to ensure that every other member has his health needs met. Since health resources are scarce, society must decide who pays for the program, how resources will be distributed and how costs will be contained. This decision must not come from the free market but from a dialogue and a shared moral consensus. (This specific line of argument was made by the late Cardinal Bernardin, as head of the Archdiocese of Chicago, in 1994 in his address to the National Press Club in Washington, DC, but it is common among proponents of healthcare provided or financed by government.)
However, what are human rights? And is healthcare a human right?
When we claim to have a right to something we mean that we have dominion over that something and that others are obligated to respect this dominion. The various versions of the texts leading up to the final draft of the Declaration of Independence reflect this natural rights tradition in America: we are all created free and independent, we have certain inherent natural rights that precede the State and therefore cannot be granted nor taken away by the State, among those rights we have life, liberty, and the means of possessing private property to pursue and obtain happiness and safety.
When person A claims that he owns this watch, person B’s obligation is to recognize this watch as A’s property. B is therefore precluded from taking it from A unless (1) A sell’s it to B, (2) A gifts it to B, (3) A lends it to B temporarily. If B steals it from A, B may enjoy it, but B does not have a right over it because in stealing B violated A’s dominion to the watch, therefore A has the right to demand its return, if necessary use violence against B to claim it back, and in addition, exact a punishment against B.
When person A claims that he has a right to his life, person B’s obligation is to recognize A’s body and refrain from harming it. A’s right to life does not demand action on the part of B. It demands restraint. If A is drowning, A’s right to life does not force B to save A from death. But A’s right to life does force B to not drown A.
Strictly speaking, then, rights place an obligation on others to not act in a way that invades that which is claimed by those rights. A’s right to the watch places an obligation on B to not take away the watch unless conditions 1, 2 or 3 above are met. A’s right to life places an obligation on B to not take A’s life. Rights do not demand action from others to sustain that which is claimed by those rights. A’s right to the watch or to his life does not demand that B support A’s ability to enjoy the watch or his life, for example by requiring that B repair the watch if it were broken or requiring that B financially support A’s lifestyle. Rights demand recognition, respect and restraint on the part of others. Rights do not demand action.
Murray Rothbard uses this negative rights approach in Ethics of Liberty, quoting Father James Sadowsky as follows: “when we say that one has the right to do certain things we mean this and only this, that it would be immoral for another, alone or in combination, to stop him from doing this by the use of physical force or the threat thereof” (p. 24). Similarly, Robert Nozick in Anarchy State and Utopia argues in favor of “side constraints,” that A’s rights constrain or prohibit B’s actions: “The rights of others determine the constraints upon your actions … The side-constraint view forbids you to violate these moral constraints in the pursuit of your goals.” (See Chapter 3, “Moral Constraints and the State,” specifically p. 29).
It is in this strict negative sense of the definition of rights that we must evaluate whether or not health is a human right. If we state that A has a right to health, this right cannot place an obligation on B to act in any way other than to not act, that is, to recognize A’s right, to respect A’s right and to restrain from causing A to become unhealthy.
When supporters of the central coordination of the provision of healthcare by the state say that healthcare is a human right they mean that this right ought to place an obligation on everyone not just to refrain from causing harm, but to act in such as way as to support everyone else’s health needs and to force everyone to relinquish part of their income or wealth to the state so that the state may finance or provide health services to someone else, presumably someone in need.
But we have already concluded that rights cannot place a positive obligation on others to act, but only a constraint or a negative obligation to recognize, respect and restrain from causing harm to others; therefore, a right to healthcare cannot exist other than in a negative rights sense. The state’s claim that a positive right to health exists is only justified by the state’s use of violence or threat to use violence to force its subjects to comply with its demand that someone’s health needs be met. Through the state’s use of violence those who receive state sponsored health services may enjoy the fruit of the state’s expropriation, but in no way can these recipients claim they have a right to the state’s largesse. They can enjoy it but they do not have a right over it. Neither can the state argue that it is justified by the healthcare rights of those in need to expropriate the income or wealth of others. Once again, the state can enjoy that privilege due to its threat or actual use of violence, but it cannot have a right to do so.
Supporters of positive rights confuse justice with charity and in their confusion they improperly establish a system of “compulsory charity.” Saint Thomas Aquinas defines justice as “the perpetual and constant will to render to each one his right” and states that “a man is said to be just because he respects the rights of others” (Summa Theologica, II-II q. 58 a.1). The claim that those in need of food, shelter and health place on others are not claims of justice for the object of justice is rights and rights are restraints on action rather than obligations to act; therefore, justice requires that people be left alone free to enjoy their rights.
The claims that those in need of healthcare services place on others are claims of pity, of compassion, of sympathy, of help, of mercy, of love, but not of justice. The claim of those in need is the realm of charity. Aquinas defines charity as “love which is together with benevolence” and as a kind of friendship in which we actively desire the good of our fellow human beings (Summa Theologica II-II q.23 a.1). Charity places an obligation to desire and actively seek and do good to others through beneficence and almsgiving (Summa Theologica II-II q.31, q.32).
But the effect of this obligation of charity must be bound by human action, that is, by humans acts for an end “which proceed from a deliberate will.” Any act resulting from anything other than a person’s deliberate will may be called an act of man but cannot be properly called human action. (Summa Theologica I-II q.1 a.1, q.6 a.1). Acts of charity as human action are and must always be voluntary. Murray Rothbard is emphatic in this too, stating that “charity is a voluntary and flexible act of grace on the part of the giver” (Man, Economy, and State p. 1258).
“Compulsory charity,” that is, the threat or the use of violence to expropriate the wealth and income of some for the purposes of aiding those in need cannot be morally justified.1 First, expropriation, regardless of its beneficial end, violates the principle of negative human rights or side-constraints. Aquinas states (Summa Theologica II-II q.32 a.7) that when a thing is ill-gotten (for example, through theft), it may not be given away in alms because it must first be restored to the proper owner. Second, we cannot properly speak of charity in a compulsory arrangement of expropriation because coercion violates the voluntary characteristic of charity.
Healthcare services can only be provided and can only be properly justified under arrangements that are voluntary and that do not violate negative human rights. Only two types of arrangements fit this description. One, under a free market in which producers and consumers of health freely buy and sell services. Two, under a charitable arrangement in which organizations financed by voluntary contributions from donors or by their own profitable ventures provide health services to those in need free of charge or at a discount.
We conclude, therefore, that the apparatus of compulsion set up by the state to finance and provide healthcare to those in need cannot be morally justified.2 It may be the “law of the land” and the state’s subjects in all likelihood may have to submit to it under the threat or use of state sponsored violence, but let us be clear, this “law” cannot be derived from any reference to human rights. It is strictly based on violence and coercion and therefore cannot possibly be morally justified.
Gabriel E. Vidal is the chief operating officer of a hospital system in the United States. He has a BA in politics, philosophy, and economics and an MBA in finance.
I have analyzed the economic reasons as to why centrally planned healthcare is not only impractical but impossible here and have reviewed the economic fallacies of President Obama’s health reform proposals here. ↩