DrRich Explains The Right To Healthcare

DrRich | August 22nd, 2011 - 7:09 am


If we are ever to gain control of our healthcare spending, which is a necessity if we are going to avoid an economic catastrophe during the next couple of decades, we have to come to some agreement, as a society, on a few essential questions.  Chief among these questions is whether healthcare is something we must consider to be a right for all Americans.

The question of whether healthcare is a right has become a very contentious one. One side passionately declares that of course it is a right, as healthcare is so critically important that how could it be otherwise? And the other side, with equal conviction, asserts that nothing can be a right that creates an involuntary burden on another.

That is, advocates on either side of the argument maintain their respective positions as being axiomatic, as primary and irreducible truths – which does not allow much room for discussion or debate. So instead of dispassionate discussion, we get vituperation. For, when one’s opponent denies an axiomatic truth, he declares himself to be beneath contempt, and unworthy of any degree of respect.

Regular readers will know that DrRich is a peacemaker.  Accordingly, he will attempt an apology for each of these mutually exclusive, fundamentally principled positions. He will follow this by a description of the pragmatic (as opposed to principled) position on the matter taken by our current leaders. Then finally, humble as ever, he will offer the “real” answer to the question of whether healthcare is a right.

The Conservative Position

Conservatives (and in most matters, DrRich is among this lot) think of “rights” in terms of “natural rights,” that is, in terms of rights which accrue to every person by virtue of the fact that they are members of the human race. Natural rights are generally considered to descend from the Creator (as the Declaration of Independence explicitly says), or at the very least from the inherent nature of the universe, and thus are not subject to addition or subtraction by any human authority – such as by governments.

Because natural rights are granted equally to every human, it follows that there is no such thing as a right that imposes obligations or limitations on the natural rights of others.

A right to healthcare would most certainly require an abridgement of the rights of others, and so there can be no right to healthcare.

The Progressive Position

Most Progressives do not explicitly deny the existence of natural rights, because doing so would cause them embarrassment when they assert their own inherent and unalterable “truths” (such as the superiority of “diversity” over all other human virtues). However, at their core Progressives do not (and cannot) actually subscribe to natural rights, since the Progressive program virtually requires a Central Authority to assign and distribute and enforce various differential “rights” to various groups, in order to achieve social justice.  And achieving social justice is the central requirement for Progressives to reach their ultimate goal of a perfect society.

To Progressives, creating healthcare equality among all Americans is critical to social justice. And so, it becomes axiomatic for them that healthcare must be a right.

It becomes immediately evident that any such “rights” granted under the Progressive program will necessarily create involuntary obligations upon at least some individuals. So it is likewise immediately evident that any “right” for Progressives will fundamentally violate the essence of a “right” for Conservatives.

This impasse, which occurs at the very first step of the discussion, is what prevents Conservatives and Progressives from engaging in any fruitful discussion of whether healthcare ought to be a right.

The Practical Position (The BOSS Rule)

Our current leaders have taken a more practical position on the question of a right to healthcare. They rely on the fact that “rights” are often bequeathed not because of some overarching principle (as with Conservative or Progressive thought), but rather, because of issues of practicality – or more straightforwardly, because the sovereign authority has the desire and the power to do so. They point out that throughout human history innumerable “rights” have been promulgated by the expediency of raw power.

We need only consider, during the course of human events, such widely acknowledged rights as the exceptional rights of the aristocracy (especially the divine rights of kings), the unique rights of the clergy, or the special rights of the Politburo (or the Congress).  The fact is that all of these rights clearly imposed more-or-less oppressive obligations on, and limited the individual rights of, the people. But that is not the least matter of concern. Rights become rights because the exigent authority has the desire to create them, and the capacity to exert violence wherever necessary to enforce them.

In this light, one might say that healthcare is a right in America simply because of the BOSS rule (Because Obama Says So). If Obama says healthcare is a right (and he has said so, many times), and has the raw power to back it up, then, by God, healthcare is a right.

The Correct Position

It is easy to see why the “healthcare is a right” debate has become so contentious – people mean entirely different things when they use the word “right.” A right to a Conservative is a natural phenomenon, awarded equally to all people and fundamentally unalterable by human hands. A right to a Progressive is an essential social construct, enumerated by enlightened leaders, which is necessary to further the principle of social justice. And to some non-ideologues a right is whatever the sovereign authority says it is.

To DrRich, none of these constructs are useful to solving our current problem of healthcare spending.

The Conservative position – that because healthcare cannot possibly be a natural right, therefore there is no right to healthcare – not only seems callous to a large segment of Americans, but (as DrRich will shortly demonstrate) is wrong. The Progressive and Practical positions – that healthcare is a right either because it is necessary to further the supreme cause of social justice, or simply because the Central Authority decrees it to be so – leave us in an untenable position when it comes to reducing healthcare spending.

That untenable position occurs because, when a “right to healthcare” is bestowed by the government, under either the Progressive program or the BOSS rule, that right is open-ended. It immediately takes on the characteristics of an entitlement, a grant bestowed on individuals by society because of the group to which they have been assigned (such as: citizens, residents, people over 65 years of age, a particular racial or ethnic group, etc.) That entitlement is to “healthcare” – that is, for whatever we can get the authorities (by whatever political maneuvering we choose to engage) to agree that “healthcare” includes, whether it is well-baby checks, artificial hearts, chemotherapy, extravagant end-of-life care, hair transplants, or cosmetic surgery. A right like this – an entitlement – is rarely taken away, or even limited, once granted. Entitlements are soon seen by their recipients (and by the vested interests that quickly spring up to defend those entitlements, such as the bureaucracy that regulates them, the companies that supply the products for them, and the healthcare professionals that administer them) as something that is owed forever, as a natural, God-given right, which can always be expanded, but never ever restricted.

DrRich, therefore, finds all these positions on a right to healthcare to be unhelpful. For this reason DrRich proposes a new position on a right to healthcare, a position which he humbly calls the Correct Position.

To wit: all Americans have an implied contractual right to healthcare. We have this right because we have long since entered into a contract under which, in exchange for implied considerations, we’re all paying for it.

Under the present healthcare system, a system we have devised over the past six decades through our duly elected representatives, every person living in the United States is sharing in the cost of healthcare for every person who receives healthcare. Since every American, in one or more ways, is paying for the healthcare of every American who receives it, every American has a just claim – a contractual right – to their fair share of that healthcare.

Let us list some of the ways in which Americans all share in the cost of all healthcare:

1) Anyone receiving a paycheck is subject to payroll deductions to pay for Medicare for the elderly and Medicaid for the poor.
2) Anyone paying income tax is paying higher tax rates to offset tax-deductible health insurance premiums purchased by businesses for their employees. (That is, employer-provided health insurance is subsidized by the taxpayer.)
3) Anyone buying products in the U.S. is paying higher prices to cover the healthcare costs of American businesses.
4) Anyone living in America is sharing in the massive societal burden we are creating by allowing healthcare spending to be passed off to future generations, by way of the national debt.

These costs, and more, are borne by everybody living in the U.S. And since all Americans are paying the cost of all healthcare – even the cost of so-called “private” health insurance – we all have a right, in the form a consideration under a contract, to claim some of that healthcare for ourselves. To deny this fact would void the contract.

It is important to note that this argument for a right to healthcare is fundamentally different from the arguments typically given. This contractual right is not “granted” to an individual by a beneficent society because of some inherent characteristic of the recipient, but rather, it exists solely because the individual is party to a social contract, created by the peoples’ representatives, under which healthcare is a consideration given in return for certain obligations the individual makes to society. Those obligations would include paying for the publicly-funded healthcare through taxes, and subjecting oneself to whatever limits to publicly-funded healthcare such a system requires in order to maintain societal integrity.

It is critical to understand that this kind of contractual right to healthcare enables us, legally end ethically, to set necessary limits on what we mean by healthcare. The “right” to healthcare is a contractual right, and not a natural right or an ethical requirement.  So, under that contract,  as in any contract between consenting parties, we have a duty to specify the limits of our mutual obligations, that is, to specify what we mean by “healthcare.” Furthermore, we have a duty to specify what we mean by “healthcare” in such a way that fulfilling the contract does not bring about national bankruptcy or otherwise cause societal destruction.

There would no longer be an obligation to provide individuals with every manner of available healthcare under all circumstances, but only to provide individuals with that level of healthcare which is provided as a public benefit to all other individuals, under the terms of the social contract. (An entitlement to healthcare, in contrast, traditionally is an open-ended promise in which “healthcare” comprises anything and everything one might think has any possibility of restoring every bit of health.)

To summarize, as DrRich sees it we have already created a contractual obligation to provide publicly-funded healthcare to all individuals, by virtue of the fact that we have burdened every individual in America with the cost of healthcare for anyone who is now receiving it. In contrast to the Conservative position, DrRich’s formulation recognizes a right that truly exists, by virtue of a contract that is unarguably in force, and that has been enacted over a long period of time through the offices of the people’s elected representatives. And unlike the Progressive position, DrRich’s formulation does not entrap us into an open-ended obligation to pay for all “healthcare,” however our collective sentiments may entice us to define that term.

We might as well own up to our responsibilities by openly recognizing : a) the universally-shared payments we all make to the cost of American healthcare: b) the right of all Americans to the considerations that arise from this universally-shared burden; and c) that it is right and proper for us to establish clear limits to the obligations borne by all the parties, as we must do with any legitimate contract.

The open recognition of this contractual right to healthcare will finally give us the framework we need for a public discussion on setting necessary limits on publicly-subsidized healthcare spending.

And this, DrRich most humbly submits, is the correct answer to whether healthcare is a right.

9 Responses to “DrRich Explains The Right To Healthcare”

  1. Doc99 says:

    But please read:

    Medical Care As A Right: A Refutation
    Sade, RM NEJM Vol 285 No 23 1971 p 1288-92.

  2. Dr. Rich,

    This is easily the most cogent analysis of this that I’ve seen. Very reasonable.

  3. Jupe says:

    “Let us list some of the ways in which Americans all share in the cost of all healthcare:”

    Don’t forget:

    5) Everyone who has insurance or pays a hospital out of pocket (at ~10X the price insurance companies pay) pays for the uninsured who show up at death’s door in the ER, where the ER staff is legally obligated to try to save their life regardless of the patient’s ability to pay.

  4. Health care is really not an entitlement but a personal responsibility of us all. When was the last time you saw something for free not taken for granted and truly appreciated?

  5. Phil Marquard says:


    I guess I am one of those ‘conservative – natural rights’ champions who holds to the view that your rights end where my wallet begins.
    If you come to me asking for help with your medical bills, I can voluntarily help if I am in a position to do so but don’t you dare demand it of me just because you have nothing and I have something!!!
    Just because Medicare and Medicaid programs were legislatively imposed in the government’s vain attempt to ease the burden of medical costs to the elderly and the poor and just because the government forces my participation at gunpoint does NOT make for a contractual right to those same services. By the way, the government concedes I have a right to such services when my age or income level warrants the government to pay for them – and not BEFORE!!
    I believe you are contending that since I am coerced to pay for grandma and illegal aliens to get medical care for free now, I am entitled to health care benefits as well. That’ll work but only if the pile of money needed to fund a national health care scheme increases 3 to 4 fold or if rationing happens in ways that would make your head spin.

    I once saw an ad where Chrysler showed that $2,000 dollars of an automobile’s cost was attributable to health care costs of the employees making that car. Using your logic, that would logically suggest anyone buying goods where it could be demonstrated that a part of the cost of those goods was to pay for medical care of employees entitled the buyer of those goods to medical coverage as well. Since buyers of American goods go well beyond our borders, then every European, Chinaman or Indian buying a Chrysler would also be entitled to healthcare.

  6. Michael Duben says:

    This post represents so far the only instance when I do not agree with your analysis, The assertions that all Americans are sharing the cost of the healthcare system is simply not true. A substantial proportion of US population pays no income taxes at all, recieving welfare checks instead, so your arguments 1) and 2) are wrong. When they buy US products, they pay with money that’s not really theirs, so the argument 3) is out the window. In addition, if paying higher price for a product b/c it contains a built-in healthcare expense etitles you to healthcarre, then everyone, including illegal aliens and foreigners, have the same “right”. As to 4) – a huge part of our national debt is the housing bubble. Does your argument #4 then means that everyone has a right to ahouse?

    • DrRich says:


      First, if this is the only instance in which you do not agree with the stuff I have written here, you have my deepest sympathies, since that fact will indicate that you are despised by all Progressives and many Conservatives, and therefore you don’t get invited out much.

      Second, your points are well made, and to give them justice will take more than a response in the comment section of this blog. As time permits (and, as it happens I am mired in five – five! – income-producing endeavors at this time, of which this blog is decidedly NOT one) I will attempt to answer you in detail in an actual posting. The short answer is that I do not believe my arguments lead us to the conclusion that the government owes everyone a house. What has led us to that conclusion is Barney Frank and the CRA.


  7. bob knopp says:

    I would suggest a reading of Norman Daniels “Just Health Care” and Rawls “Theory of Justice” as appropriate foundations for establishing a right to health care. Rawls work doesn’t specify health care but Daniels does.

  8. star dust says:

    Healthcare is a “BASIC HUMAN NEED” Just like food and water! It is not a personal responsibility because 50+ million people cannot afford private health insurance! You are one pink slip away from having no health insurance and being bankrupted by medical bills! The number 1 cause of bankruptcy is medical bills! Yikes! When will America wake up and see EVERYONE NEEDS HEALTHCARE! RICH, POOR, and MIDDLE CLASS! Why should my tax dollars pay for MEDICAID, MEDICARE, STATE WORKERS, GOVERNMENT LEADERS, PRISONERS, VETERANS when TAX DOLLARS WONT PAY FOR MY CARE????? I HAVE TO PAY A FORTUNE FOR IT OR GO WITH OUT??? MANY CITIZENS GET HEALTHCARE THROUGH THEIR JOB BUT DON’T REALIZE HOW OUTRAGEOUS IT WOULD BE IF THEY HAD TO BUY IT PRIVATELY! Healthcare should be Universal paid for by all paying tax dollars….

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