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.