Comment of the Day: “Morning Ethics Warm-Up, 6/30/17.”

As he usually does, when he’s feeling frisky,  reader Extradimensional Cephalopod (above right) has dived into the issue of “health care rights” with gusto and perception. As I often do whether I’m feeling frisky or not, I have some cavils about the assumptions being made at the outset.

A right is a moral or legal entitlement to have or obtain something or to be able to do something. Moral and legal rights are two different things. When someone says, as did my friend on Facebook that started this debate. “I believe health care is a right,” he had to be asserting a moral right to healthcare, since a legal right to health care doesn’t exist. If he said, “I believe health acre should be a right,” then he would have clearly meant a legal right. That’s a policy issue. When someone argues that there is a moral right, then they are making the case for a legal right that doesn’t exist. The law in an ethical society ought to protect and advance moral rights, and society must agree what those rights are. Thus when he says, early on, “Note that a right isn’t something we owe Note that a right isn’t something we owe people just because they exist.,” he signals that he is describing legal rights only.   Moral rights are what we owe  people just because they exist. That’s why the Declaration begins with Jefferson saying that “we are endowed by our Creator” with “unalienable rights.”

Here is Extradimensional Cephalopod‘s Comment of the Day on #5 in the post, “Morning Ethics Warm-Up, 6/30/17.”

Let’s start at the beginning. We need to define the phrase “healthcare is a right”.

A “right” is a protection or entitlement we collectively decide to give to people at the expense of our some of our freedoms because we think that society will be more robust, sustainable, able to advance, or generally pleasant to live in as a result. That’s very similar to the basis for ethics, as far as I can tell. A right is a meta-law, a limitation on what laws can be made. Rights may be conditional. Note that a right isn’t something we owe people just because they exist. It’s something we decide we owe them because we want to live in a world where people have that right–because it’s safer for us, or because it means the world will still be there for our descendants, or because it allows civilization to progress to something better, or because we want others to be happy, or all of the above. This will be important later.

Therefore, when we say, “healthcare is a right”, what we mean is “in order to make society more robust, sustainable, able to advance, or generally pleasant, we choose to sacrifice some of our individual freedoms to provide everyone with healthcare.”

We’re half done. Now, what is “healthcare”?

Let’s actually distinguish it from health insurance, because we’re smarter than Congress. Health insurance, like any insurance, is a gamble, in which people periodically pay a small amount of money to an insurance company, which will pay them back a larger amount of money (whatever is necessary, to the limit of what they are insured for) if the person’s health is in danger in a way that neither of them can predict. The idea is that the insurance company can’t predict who needs the money, but they can predict how many will need money and how much, statistically, so they accept enough money from people that they can afford to pay the people who end up needing more money.

The whole insurance model is based on two assumptions: 1) The money people can collectively afford to pay the insurance company, averaged over time, is greater than the total amount of money people will collect from the insurance company, averaged over time; 2) neither people nor the insurance company knows what misfortune will befall an individual person.

This second point is what people get mixed up. Ignorance and chaos are a fundamental part of insurance. If people knew they wouldn’t need insurance, they wouldn’t buy it. If the insurance company knew that they would have to pay out for a particular person, they wouldn’t do business with them. That means that people with preexisting conditions will not be able to get insured for those conditions, which is perfectly fine, because only a great fool would try to try to implement socialized healthcare through the insurance industry, as opposed to keeping it separate. (Would separate socialized healthcare affect the insurance industry? Yes, the companies and their customers will make different decisions based on its presence. That’s economics, and that’s alright. Forcing insurance companies to pretend they don’t know things and distorting their premiums and payouts just needlessly complicates an already complicated system and prevents both the insurance and the socialized healthcare from functioning effectively.)

So, if health insurance is its own thing and should be left alone, what’s healthcare? Healthcare is external assistance by medical professionals to maintain or improve the health of an individual (physical, mental, et cetera). Let’s keep in mind that we have technological limitations on healthcare. We can’t stop people from dying of certain things, including senescence (old age). Some people have very expensive injuries or diseases. We are faced with a problem of limited resources and how best to allocate them: a cost-benefit analysis. This would be impossible if we declared that healthcare was a right because everyone inherently deserved it. Of course everyone “deserves” healthcare: “X-person deserves to receive Y” means “the world would be a better place if all people with the relevant qualities X has received Y”. Yes, the world would be a better place if everyone received healthcare. The real question is, seeing as how we can’t provide healthcare to everyone at this time, how much better can we make the world with the healthcare we can provide?

For starters, we might be able to agree under the Veil of Ignorance that we don’t want people to be randomly burdened at birth with the expenses of medical conditions, so we could distribute the cost across taxes. This sounds easy. The hard work comes in when we have to decide how much we’re willing to pay, how serious a condition has to be before we decide to collectively pay for it*, how poor a person has to be before we chip in, what sorts of procedures we’re willing to cover (taking into account their probability of “success”, which requires expert knowledge that is sometimes cutting-edge and subject to change), et cetera. That’s all up for debate; my job is done when people start talking intelligently about the issue.

Ultimately, “healthcare is a right” becomes “in order to make human society more robust, sustainable, able to advance, or generally pleasant, we collectively choose to sacrifice a certain portion of our income in order to improve people’s quality of life by providing them with certain medical assistance for certain purposes to maintain or improve their physical or mental well-being even if they cannot afford said assistance and are not or cannot be insured for it.” That’s something I think practically everyone can get behind. All we need to do now is hash out the details with clarity and negotiation.

Are there any questions, objections, counterpoints, or addenda?

*See also Quality Adjusted Life Years (QUALY), a concept in effective altruism used to compare the effectiveness of charities.

14 Comments

Filed under Citizenship, Comment of the Day, Ethics Alarms Award Nominee, Government & Politics, Health and Medicine, Law & Law Enforcement, Religion and Philosophy, Rights

14 responses to “Comment of the Day: “Morning Ethics Warm-Up, 6/30/17.”

  1. “Ultimately, “healthcare is a right” becomes “in order to make human society more robust, sustainable, able to advance, or generally pleasant, we collectively choose to sacrifice a certain portion of our income in order to improve people’s quality of life by providing them with certain medical assistance for certain purposes to maintain or improve their physical or mental well-being even if they cannot afford said assistance and are not or cannot be insured for it.”

    But we cannot get behind this, because this is not what people mean when they say, “healthcare is a right.” They mean, literally, all healthcare is a right, meaning abortion is a right, and sex-change operations is a right, and living on a ventilator semi-brain dead but not quite is a right, and getting a liver transplant after drinking the other one into mush is a right, and,spending an absurd proportion of resources devoted to health during the final years of life is a right, and having 4 X the children you can afford (which IS a right,) is accompanied by your right to make Me and everyone else pay for those kids’ vaccinations and measles and mumps and emergency operations even though my family decided how many kids we could afford and are still scraping along, paying for him.

    We can’t get behind it because this legal right leaches the liberty out of life for the entire society, making it a dull and grey bee hive where all of life is devoted to paying for “rights” of base survival, and capitalism, aka what creates innovation, wealth, fun and the stuff that makes life worth livingis impossible, except that society drifts into a Scandinavian torpor where guaranteed jobs, healthcare, food and shelter is all anyone cares about IF WE ARE LUCKY, and in the worst analysis, end up poor, dominated by Big Government and dead anyway..

    We can’t get behind it because it doesn’t work over the long term, and we have plenty of evidence of that, if its supporters were honest, which they are not.

    • Chris

      Abortion is already a legal right in the United States.

      • But the jury’s still out on whether or not abortion is “health care”. Hence Jack mentioning that “universal healthcare” is an amorphous undefined blob that anyone who wants some personal but not necessarily health related matter in their life paid for by the others.

        You know this because the context of Jack’s comment is clear.

      • It is not established that it is a right that the government can make me finance, however.

        • Chris

          I’m not following. Whether the government can make you finance things is a totally separate question from whether something is a right. People have the right to own guns, yet we don’t subsidize those. Yet we do subsidize oil, which is not a right.

          But then I suppose the left has added to this confusion; when leftists say “healthcare is a right,” we usually mean it should be subsidized, even though those two concepts are distinct. I don’t think I ever realized that bit of trickery until now.

          • “when leftists say “healthcare is a right,” we usually mean it should be subsidized, even though those two concepts are distinct. I don’t think I ever realized that bit of trickery until now.”

            But you should have realized it.

            The Left consistently labels as “rights” items it wants the public to pay for.

          • Exactly, and that’s exactly the trick: it’s a right, so the state must makes sure one has access to the right regardless of means or class.

  2. Good dive into thinking about calling “health care” a right.

    Any chance to migrate my response or should I cut and paste?

  3. Thanks, Jack. If moral/fundamental rights are based on ethics and derived the same way, then I agree with your and texagg04’s statements about them.

  4. A response from the original comment:

    “A “right” is a protection or entitlement we collectively decide to give to people at the expense of our some of our freedoms because we think that society will be more robust, sustainable, able to advance, or generally pleasant to live in as a result.”

    I don’t think so. My freedom of speech isn’t a right that imposes one iota against your liberties. My right to bear arms doesn’t impose one iota against your liberties.

    I think you are literally discussing entitlements and benefits solely.

    The extent to which we can *exercise* our rights are limited at the barrier where that exercise imposes on another’s fundamental rights to Life, Liberty and Pursuit of Happiness insofar as their enjoyment of those don’t impose on my enjoyment of them.

    I don’t blame you for this confusion, one of the essential strategies of the Leftist worldview is to recast entitlements and wealth redistribution as a “right”. But at their essence, those definitions are dishonest.

    “It’s something we decide we owe them because we want to live in a world where people have that right–because it’s safer for us, or because it means the world will still be there for our descendants, or because it allows civilization to progress to something better, or because we want others to be happy, or all of the above.”

    I think that’s just a verbose rewording of Utopian idealism…the kind of utopian idealism that requires central planning and ends in gulags, secret police, and misery.

    “Therefore, when we say, “healthcare is a right”, what we mean is “in order to make society more robust, sustainable, able to advance, or generally pleasant, we choose to sacrifice some of our individual freedoms to provide everyone with healthcare.””

    No, it isn’t a sacrifice of individual freedoms to do so, it’s a redistribution of wealth. And yes, societies must collectivize some of the services essential to that society – namely those services that wouldn’t ever develop naturally in a free market in the time frame necessary for the service to fulfill the demand. This is why militaries are collectivized. This is why fire and police are collectivized.

    I might be amenable to arguments that there is a societal need to collectivize the costs for *immediate*, *life threatening*, *emergencies* ONLY. But it would have to be well argued and if accepted would have to be ever on guard against scope-creep as more and more arguments are made to include more procedures as “life threatening” or “immediate”, when one or both characteristics don’t actually apply.

    • Extradimensional Cephalopod’s response to mine:

      I think there’s some semantic confusion based on our different definitions of “freedom”. Starting from scratch: “freedom” just means a lack of limits on my behavior. Apart from the laws of physics, biology, and logic, my freedom could be limited by the threat of other people retaliating against me for things that I do. The government can enforce my freedom to do certain things by limiting the behavior of others, punishing them if they act to retaliate against me for things that I do.

      For example, in a lawless society, I have the de facto freedom to punch a person in the face and get away with it, if they have no friends. In U.S. society, we legally give up that freedom by agreeing to ascribe to people the right to not be punched in the face. I can no longer expect to remain unpunished after punching someone in the face even if they have no friends. We are all no longer legally free to punch people in the face, but we are free to do things without fear of being punched in the face. (The Nazi-puncher from a while back apparently didn’t understand why we make this sacrifice.)

      Some governments have the freedom to suppress speech. Our government has sacrificed that freedom in the process of creating the right to free speech, putting legal limits on what the government can tell people not to do. Same with the right to bear arms. It’s not my freedoms that are restricted here, but those of the government. Or, if you prefer, we create minority rights by taking away the freedom of the majority to simply take over the government and impose its collective will, through the tyranny of the majority.

      I’m actually not reframing entitlements as rights. I’m going the opposite direction, reframing the so-called inalienable rights as entitlements that we agree are indispensable for the world we think is ethically best. Some people think that blasphemy brings the wrath of a deity down upon the whole community, and therefore according to their worldview, it is most ethical to suppress such speech. I think their worldview is inaccurate, but the fact that they choose not to give people the right to free speech is ethically consistent with what they believe to be true.

      “I think that’s just a verbose rewording of Utopian idealism…”

      No, it’s just the intent to make the world a better place. Utopian idealism happens when insufficient thought is given to the practical implementation.

      “No, it isn’t a sacrifice of individual freedoms to do so, it’s a redistribution of wealth.”

      Again, semantics. In this case, it’s the freedom of “doing whatever I want with this money instead of paying it in taxes.”

      I can see the argument for the government not socializing healthcare at all, and letting private charities take care of those who can’t afford their medical costs. I’m just pointing out to both sides that we are not inherently obligated to socialize healthcare, but neither would it be unreasonable to choose to do so anyway. Fundamentally, it’s a question of relative values. To navigate this issue, we need politics mindset, which deals with negotiation, compromise, optimizing solutions based on the feelings and priorities in a system of people, and aligning people together to support the outcome.

      Does that make more sense?

  5. Some of you have seen this before…

    HEALTH CARE, A “RIGHT”?

    I’ve been thinking long and hard about this growing argument that healthcare is a right, here’s my opinion…

    Let’s start with a few reasonably simple definitions.

    Right: A moral or legal entitlement to something.

    Human Right: An entitlement that “belongs” to every human being.

    Civil Right: The entitlement of a citizen to based on law.

    Health: A person’s mental or physical condition.

    Healthy: In good health.

    Care: (as related to health) the services rendered by members of the health professions.

    Service: The action of helping or doing work for someone

    Now let talk about some reasonable knowns.
    1. The human body is the “biological vehicle” that carries our essence through life.

    2. Healthcare is a service providing maintenance and repair to biological vehicles.

    3. The level of maintenance needed to maintain any individual biological vehicle is determined by genetics and the amount of use or abuse that the specific biological vehicle has endured.

    4. Physicians are professionally trained and licensed service personnel specializing in maintenance and repairs of biological vehicles; the purpose for their service is to relieve pain and suffering, restore functioning, or prolong life.

    5. No one has the “right” to be healthy, not you, not me, no one!

    6. Cost associated with maintaining an individuals’ personal biological vehicle is the responsibility of the individual or the legal guardian of that individual.

    7. You do not have the legal right to a service that you cannot pay for, how much and how you choose to pay for services performed is up to you and the provider of the service.

    Now the big question; are health care services a right or not?

    In my opinion health care services are not a human right (hate me if you must) and they are not currently a Constitutional right. Since health care services are a service, I don’t think they should be a right. Making a service a right would open up a whole new Can-O-Worms.

    For the sake of argument let’s look at what would change if we actually had an Amendment to the Constitution making health care services a right, how about something simple like…

    “A healthy citizen population is necessary to the security of a free State, the right of the people to health care services shall not be infringed.”

    Think about it, does that change anything?

    Having the “right” to health care services doesn’t define who pays for the health care services performed, just like having the right to keep and bear arms doesn’t define who pays for the arms you have the right to bear. Having the “right” to health care services doesn’t define the level of services or if those health care services are competent, just like the 2nd Amendment doesn’t define the type or quality of the arms you have the right to bear. Having the “right” to health care services doesn’t define that the medical provider must be the state, just like having the right to bear arms doesn’t define that the state be the provider of the arms you have the right to bear. Like the 2nd amendment, an amendment about health care would say the right of the people to have access to health care services shall not be infringed, or something along those lines. Having the “right” to health care services doesn’t mean a thing if there are no doctors providing the services to the people, just like having the right to bear arms means nothing if manufacturers of arms and ammunition cannot provide their products to the people.

    In my opinion, making health care services a right changes nothing and it’s wrong; the right itself wouldn’t make health care more accessible to anyone regardless of social status or wealth. In my opinion, access to emergency health care services is available right now as a de facto right; anyone can call 911 and get emergency medical treatment from professionally trained medical staff including emergency room services. There is the Emergency Medical Treatment and Labor Act (EMTALA) which makes it a legal obligation to provide services to everyone coming into an emergency department requesting examination or treatment for a medical condition regardless of their insurance status or ability to pay; this is an unfunded mandate passed by Congress in 1986 that essentially makes emergency health care a de facto Civil Right (as defined above) and dumps 100% of the cost of that unfunded mandate on the medical facility performing the emergency service, which in-turn increases the overall cost to everyone using the facilities that are required to perform these unfunded services.

    Special Note: Thank you goes out to John Billingsley for additional information that I used in this comment.

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