Introduction
The issue of whether health care for all is a “right” and therefore should be provided free by social services, or whether it really should be considered as a personal responsibility, has recently been the subject of much heated debate. This essay discusses some of the views expressed and opinions offered, and illustrates why perhaps the answer is not as clear cut as proponents of either argument would have us believe. However, the following paragraphs will show that in fact it is really a personal responsibility, even though there should nonetheless – in a democratic society like ours – be a safety net providing basic care for those who through no fault of their own simply do not have the resources to be self-sufficient in this regard.
The Key Points
The first issue that needs clarification is that of what is meant by a “right”. People are inclined to blithely state that we all have right to free health care. That is a misuse of the term. The word “right” implies possession of a freedom to do something or to act in a certain way. When someone states they have a “right” to free health care, what they are actually claiming is an “entitlement” to be provided with it. In the Reading paper entitled “Medical Care as a Right: A Refutation”, contained in Munson’s book (1979), Sade stated that rights as a concept is based in morality and in politics (457-461). His definition of a “right” is also based on a freedom to act in a certain way. He claimed that the basis of morality in that regard is that as a living being, man has a right to life. He pointed out however that the freedom to live does not of itself ensure that man will enjoy or sustain life. In terms of rights, man has the right to choose to act in a certain way, to make his own decisions as to how to act in order to best sustain life. Those are “natural rights” according to Sade. He explained that in free society, a man can exercise his rights to provide to others goods or services that have economic value, in exchange for similar goods or services provided by others. There is no fundamental “right” to obtain services or goods from others without trading something in return.
In the case of medical care, Sade stated that defining its provision as a right is immoral, because the receipt of that care is “neither a right nor a privilege.” The care is a service provided by medical professionals to those who wish to purchase the service from them, so that they can support their own lives from that income. If the situation were such that the patients owned the right to the care, that translates to the patient owning those services without needing to trade something in return. As Sade pointed out, the health care policy in the U.S. is now at the point where public policy has declared a universal “right” to health care, with the adverse consequences that implies for both medical professionals and patients, including loss of freedom of choice on both sides.
In the same Reading, though in the paper by Arras and Jameton: “Medical Individualism and the Right to Health Care” an important point made by the authors is that when doctors take the Hippocratic Oath, they are pledging to always do their best for the individual patient, not for state or the government or to provide help to as many people as possible (462-471). Essentially, the role of the state should be to safeguard against malpractice or fraud, etc, but not to compel doctors to treat specific patients, nor to force individuals to consult only specified doctors for example. The paper reiterated the principle that health care as a service belongs to those who create and provide it, and that to give us all a “right” to that care equates to imposing on others an obligation to provide it. The authors also pointed out that any right to health care is by no means the same as stating a right to health itself, which no medical system can yet offer.
Of course, as the authors propounded, the medical professionals have in most cases reached their present standards of expertise and knowledge through years of education and medical training, much of that either funded or subsidised or supported through state-based systems, implying a certain obligation on their parts to repay that debt to our society. However, that need not mean that those professionals should work for no return. Conversely, if they are paid by the country’s health care system, one would expect them to abide by its rules and regulations, treating people entering that system as patients needing their medical care and expertise.
That principle in itself does not suggest that we all have any right to health care, merely that the physicians should not have a right to refuse to treat people if they take the government’s dollars. It could be argued that patients treated on that basis should be only those that contribute / have contributed to the state health care system by payment of taxes, etc. However, that would by definition exclude those who have not or cannot pay taxes (such as new immigrants, the unemployed, homeless, etc), which in a caring, democratic society would surely be unacceptable, or – at the very least – contrary to Christian principles. So, in summary, whilst health care professionals in a state health system probably have a duty to provide health care to the public, that does not automatically mean that every individual has a right to health care.
The second extract from Munson’s book, taken from Chapter 8 “Paying for Health Care” includes a Reading: “Is There a Right to a Decent Minimum of Health Care?” by Allen E. Buchanan (525-529). Buchanan offered the view that it is not necessary to prove any right to health care in order to receive what he calls a “decent minimum” of care for all. To justify that view he put forward four arguments, which are summarized here:
- The evidence of previous unjust treatment of minorities (e.g. African Americans);
- The goals of public health policies imply a moral / constitutional duty to provide equality of care and protection;
- Our needs of a capable workforce and national defense system imply a national minimum standard of health care;
- A charitable duty, helping to provide basic minimum standards of health care, must sometimes receive government support, e.g. by regulation.
An article by Mahar (2008) focused on the same topic as this essay. Entitled “Is Health Care a "Right" or a "Moral Responsibility"?, it had a sub-title giving a clear message: “One thing is certain: Health care is not simply a privilege.” Mahar went on to state that the people who emphasize individuality responsibility in this regard are effectively – in her view – saying that those most likely to suffer poor health (the poor, the obese, the drug and alcohol users) should not get health care as a right, though she herself is unhappy with the concept of the poor having a universal “right” to be looked after by society. She quoted an emergency department physician known only as “Shadowfax” who had declared that rather than being a right, health care is “a moral responsibility for an industrialized country.” He went on to say that the only individual rights we have are what he referred to as “our fundamental liberties” which we have from the moment we are born, and which the government cannot take from us. In that category he included the freedom of speech, of religion, of conscience, ownership of property, and others. He emphasized that the list does not include the right to anything given by others, in other words your freedoms are just that; they are not obligations due to you from someone else. On the other hand, he maintained that civilized societies such as ours may determine that some or all citizens have entitlement to certain benefits. Shadowfax considered that health care falls into that category, but considering that entitlement as a collective one, but not an individual right.
Maher herself stated that people are entitled to the provision of at least basic health care, and that physicians should be prepared to undertake some work on a charitable basis, although admitted that at present the system is not equitable, while there are doctors in private practice who refuse to treat the poorer citizens in our society. She concurred with her source Shadowfax that the health care system should be reformed so that – because all of us are vulnerable to illness and diseases – we should pool resources to help each other.
Another concurring view that health care is not a right came from Salsman (2012) in his article “Memo to the Supreme Court: Health Care Is Not a Right.” Referring to the legal and oral submissions to the Supreme Court reference the “ObamaCare law”, Salsman commented that it is obvious that both sides assume health care is a “right”. In his view, health care is not a right, but instead is “a valuable service provided by intelligent, hard-working professionals with years of painstaking education and training.” He further maintained that those professionals have their rights – the rights to liberty, freedom of speech and the pursuit of their own happiness, etc, and that they have no obligation to become our “servants.”
Salsman also made the point that in that Supreme Court case those medical professionals are presumed to have some sort of selfless duty to serve and treat patients. In his view that constitutes a form of slavery. He blamed the escalating health care costs on increased government intervention and control, citing the above inflation increases in health care costs in general since Medicare and Medicaid were introduced in 1965. He concluded his article by suggesting that if health care becomes a universal “right”, it can only do so by violating the rights of others.
A recent article, again supporting the view that health care is not a right, was published by Williams (Dec 2012) in the Washington Post. Noting that as people become older they realize that life is the most valuable asset they possess, he posed the question: who has the responsibility to protect that life? In considering whether it is the responsibility of the individual concerned or the society in which they live, Williams averred that the truth is somewhere in between the two. In fact he suggested that individuals should accept some of that responsibility so that society functions only as a “safety net.”
Unfortunately, according to Williams, the government has instead headed at full speed for what he called a “fiscal cliff” of a mandatory national health care plan that will serve only to worsen the shortage of doctors, and produce a further decline in our health care system. He concluded by reiterating that we can never have health care as a right, though we should always have a duty to take care of our fellow human beings.
Conclusions
Expanding on that consensus view, there were also cautionary statements that whilst health care is a service that individuals should take responsibility for, it should also be available from the state as a sort of safety net for those who cannot – perhaps through no fault of their own – pay the appropriate costs of the mandatory health care system that the state will have in place. Those are also the views of this researcher.
Works Cited:
Mahar, M. “Is Health Care a "Right" or a "Moral Responsibility"? AlterNet. (2008). Web. 12 December 2012.
Munson, R. Intervention and Reflection: Basic Issues in Medical Ethics. Belmont, California. Wadsworth Publishing Company, 1979. Print.
Salsman, R., M. “Memo to the Supreme Court: Health Care Is Not a Right.” Forbes.com. (2012). Web. 12 December 2012.
Williams, A. “Is health care a right? And whose responsibility is it? Washington Post. (Dec 2012). Web. 12 December 2012.
