By Dr. John M. Livingston | Medical Policy Adviser
I thoroughly enjoyed inauguration weekend. To witness power being transferred to a new generation of Idahoans and fresh young legislators eager to represent their constituents uplifts me.
Unfortunately, we heard the echoes of past debates when proponents of Medicaid expansion again asserted that all people have a right to healthcare.
What does that really mean?
Where do rights come from and who gives us rights?
Conservatives (classical liberals) believe that there are two forms of rights: natural and legal. Legal rights are predicated on a belief in the sanctity of natural law and all legal rights are legitimized because they originate from concepts of natural law and natural rights.
When philosophers talk of natural rights, they understand that such rights are given to us by God (the Judeo-Christian understanding of rights) or the rights are inherent in our own humanity—an understanding of the ancient Greek and Roman philosophers Cicero and Aristotle, to name a couple. The concept of natural rights was further commented upon by the early church philosophers like Augustine and Aquinas, codified in The Magna Carta, and refined in concepts of The Common Law and our own Declaration of Independence.
John Locke believed that in every human there was a desire for liberty and that the natural rights of life, liberty, and the pursuit of happiness—through the pursuit of property (Locke's and Jefferson's thoughts)—was part of the human soul.
It was the belief of our Founders that because these rights were given to us by God they could not be taken away from us by governments.
Aquinas commented frequently on the nature of rights. He recognized the need for human actions and interactions to be predicated on an understanding of the duties and responsibilities that are a part of the transaction between the giver and receiver of rights.
Natural rights are based on the concept of "free will" and should be based on conscience and reason and not on emotion and coercion.
Contemporary philosophers Locke, David Humes, and Thomas Hobbs believed not in reason and free will, but rather that "our reason is slave to our passions."
President Barack Obama rightfully cited the fact that the U.S. Constitution was predicated on and incorporates the "dispositive nature" of the natural law.
When we claim to have a right to something we claim dominion over it. We have dominion over our own lives, liberty, property and happiness. By exercising our free will appropriately we can realize our full potentials as persons. Because these natural rights predate the State they cannot be legitimately taken away from us by the state. "Dispositive rights" place an obligation on others, including governments, as defined in our own Bill of Rights, to not act in any fashion that would forfeit our dominion over our claim to that right.
It is thus in our understanding of natural rights that we must ask the question of whether healthcare is a basic human right. If an individual's healthcare is a natural right, it cannot force people to act.
On the other hand, I do believe that health is an individual right, the domain of which is the asset of the individual and in that regard ,no individual or government has the right to act in a way that takes away the individual's responsibility for their own health. The obligation is always to not act.
Those who want to argue that healthcare is a right must argue from a positive rights position: that the state should force citizens to respond to the demand that someone else's healthcare needs—not health which is an individual's domain—be met. Such force is a positive obligation and by definition not a natural right.
These arguments, grounded in western philosophy and Judeo-Christian thinking, should be thoughtfully considered by everyone, including those making the arguments that healthcare is a right or that centralized healthcare systems—single payer—is the best way of distributing scarce resources. Any economic system that requires coercion in order to secure compliance is going to fail.
There is another misconception from the political left as concerns healthcare.
Phrases like "common good" and "public good" are economic terms and as such should be discussed from an economic and not philosophical point of view.
To deem a good or service a common good, specific criteria need to be met. And keep in mind that medical care is a good and a service and individuals in that industry need to be paid both for the value of their "human capital" and for the prices of the materials they distribute.
A public or common good cannot be used or distributed selectively. If one person receives the public good, everyone must receive that good.
This leads to the second characteristic of common goods, which is "jointness of consumption.” This means that when one person consumes the good, a scarcity will not be created—scarce resources will remain the same. An example: the air we breathe. When one person takes a breath it does not take away from another person's ability to take a breath.
The final criteria for common goods would be that the "neighborhood affect" whereas the investment in a public good will have an equal benefit for everybody. When the police patrol your neighborhood it benefits all the neighbors.
So healthcare in the economic sense is not a public good.
The Judeo-Christian tradition of charity is not fulfilled by government welfare programs like Medicaid. Nowhere in the Bible is the government described as being the conduit for charity. In my Catholic Catechism charity is a covenant between the giver and the receiver that God is party to—"What you do for the least of my brethren you do unto me.” We are, in fact, told to "Render unto Caesar that which is Caesar's.”
So arguments that healthcare is a "right" or "common good" need to be understood, confronted, and relegated to the waste bin.
Finally, the government is the least efficacious means of distributing resources.
Today in our country, 35 million people are voluntarily giving in-home care to 55 million seniors and those with disabilities, at an unreconciled cost of over $550 billion per year. That comes at no cost to taxpayers or the government and that figure is about the same cost of the federal government’s portion for Medicaid. Furthermore, think about the opportunity costs of unfulfilled income to the volunteers.
Healthcare is not a right.
Healthcare is not a common good.
The private sector and charitable nonprofit organizations are the best tools to distribute scarce resources and healthcare is a scarce resource.
Until we understand these basic principles of philosophy and economics, public policy will fail to address the healthcare needs of our people.