Privilege Or Right

Is healthcare a right or a privilege? With the advent of the Affordable Care Act in 2010, and the next presidential election less than a year away, such a profound philosophical question is no longer confined to mere academic debate, but instead already has, and will continue to have, major policy implications. Proponents claim that countries such as the United States, which remains one of the few industrialized nations that does not not guarantee health care coverage to its’ citizens, represents nothing less than a medieval moral monstrosity. Critics, however, contend that universal health care efforts run contrary to the founding ethos of the United States, and represents a dangerous usurpation of state power. This essay aims to
carefully examine the crucial philosophical and ethical merits concerning both sides of this important debate. The debate over whether health care constitutes a right or a privilege can be largely understood as a philosophical difference between positive and negative rights. Negative rights can be defined as rights that involve “freedom of interference from others,” while positive rights “demand goods and services.” For instance, freedom of speech, or the right to bear arms, can be understood as negative rights, while the right to a minimum wage or health care constitute positive rights. Hence, opponents consider universal health care as a dangerous affront to the founding ethos of the U.S., which emphasized negative liberty to a comparatively greater extent, as reflected in the original draft of the Constitution. As Thomas Jefferson famously wrote in the Declaration of Independence, while one has the unalienable right to the pursuit of happiness, by no means are people entitled to the goods and services that might guarantee such happiness. Further, many maintain that a right to health care essentially requires infringing upon the rights of others. After all, if health care is a right, that entails doctors and other healthcare professionals being required to provide health services, while ordinary people, most notably through taxation, are required to subsidize others health care. Both outcomes, opponents maintain, constitute an egregious assault on the fundamental American values of individual liberty, economic freedom, etc. Advocates, however, generally contend that health care is a right, because it is not only a crucial contributor to one's sense of well being, but also because health care is a fundamental component of one’s ability to ultimately exercise other freedoms, including the right to life itself.
Without proper physiological or psychological health, one’s pursuit of happiness is almost certainly compromised to a significant extent. Further, if one’s basic health is not in order, they cannot fully exercise more complex freedoms, such as economic liberty, freedom of speech, voting rights, etc. After all, most people would agree that all children deserve the right to a public education, even though this this right undoubtedly constitutes a positive right. Further, welfare programs such as food stamps, public housing, etc. are also designed to ascertain that people have access to other essentials such as food, water, shelter, etc. Hence, proponents view universal health care as a natural and necessary extension of the social safety nets and other progressive measures that were established in the U.S. starting in the 19th century and continuing today, and takes aim at the notion that there is no such legal or moral precedent for universal health care in American
history. Opponents, however, have also decried universal health care efforts as promoting an abdication of personal responsibility, lending credence to the notion that the U.S. is increasingly becoming a ‘Nanny State.’ After all, what right does someone who knowingly embraces behaviors that will have significant ramifications for their present or future health, such as cigarette smoking, unprotected sex, unhealthy eating habits, a sedentary lifestyle, etc. have to compel others to essentially pay for their mistakes? Further, if one decides it is not in their best interest to purchase health insurance, they should be allowed the freedom to do so. Of course, advocates counter that accidents or diseases are often not the product of intentionally reckless behavior, but of mere misfortune, and thus should not be punished. In political philosophy, this idea is known as luck egalitarianism, which contends that people should not be worse off based on conditions they cannot be held responsible for. Hence, proponents contend that denying one’s right to health care is primarily a discrimination issue, perhaps even tantamount to denying someone’s right on the basis of other uncontrollable characteristics, such as race, gender, sexual orientation, etc. Another crucial point of contention is what exactly constitutes health care? Advocates of universal health care typically vituperate their opponents as resigning themselves to a world in which people are left to die in the streets. Yet, is a right to health care merely limited to the minimum care necessary to to ensure survival, or do its’ proponents envision a more expansive definition? What about preventative care, psychological counseling, experimental treatments, plastic surgery, etc? Given the expensive and rapidly rising costs of modern health care, perhaps providing a right to health care is simply financially impossible under any reasonable definition of the term. More importantly, is it ethically acceptable to compel people to subsidize others access to care that is more luxury than necessity? Many advocates of a right to health care also base their argument on a utilitarian premise, which contends that policies should be designed in order to maximize the well being of the greatest number of citizens. After all, many Americans have faced personal bankruptcy, a sharply diminished quality of life, or even death based on their inability to access health care. Why not, proponents contend, should we not make every effort to alleviate such immense suffering, particularly if it all that it mostly requires is that healthier, wealthier, and more fortunate people sacrifice (through say, increased taxes) comparatively less? Opponents, however, find even a utilitarian basis dubious. As Medicaid, the Veterans Health Administration, Britain's National Health Service, etc. illustrate, publicly provided health care is typically of far lower quality compared to private insurance. Hence, would universal health care actually ultimately maximize the majority of Americans happiness? Further, in the case of inevitably limited health care resources, how does one objectively determine who is more deserving of such resources? These are important questions that universal health care advocates must ultimately grapple with. After carefully examining arguments from both sides of this debate, I still find it very difficult to determine whether health care constitutes a right or a privilege.
Such an answer is highly dependent upon one’s precise definition of rights, and whether one’s conception is limited to negative rights, or also encompasses positive rights. As a matter of practical policy considerations, I think handwringing of whether health care constitutes a right or a privilege tends to obfuscate the more far more important question of whether universal health care will ultimately augment the well-being and conscious experience of the majority of the American people, or not. In other words, one’s definition of rights is highly subjective and lacks any metaphysical basis of being correct, and thus it would be dangerously misguided for public policy to be contingent upon finding the correct answer to this question. Hence, if I had to choose, I embrace the notion of health care being a right, to the extent that it would likely improve the general welfare of the American people. That being said, however, I also concede that supporting state efforts to expand healthcare, while still maintaining that health care nevertheless does not constitute a right, are not mutually exclusive
positions.