In the continuing debate over the American health care system, a lot of ink has been spilled in the discussion of what constitutes a human right. On the political Left, it is common to hear claims that health care is a right, that no one should have to die because they can’t afford care. It sounds compassionate; it sounds humane. After all, what kind of a person would wish death on poor people?
Conservatives usually answer these claims with arcane and academic discussions of natural rights philosophy, appeals to John Locke and John Stuart Mill, and similarly unpersuasive tactics. Is it any wonder that we continue to inch closer to complete government control of medicine, given the imbalanced nature of the argument?
However, there’s a practical question that I wish the “health care is a right” crowd had to confront more often. The question is: “How much health care?” Obviously, health care is not a single, monolithic good. It consists of thousands of smaller goods that we lump under the umbrella of medicine for convenience. From routine doctor visits, MRIs, and X-rays to brain surgery and organ transplants, these are all medical treatments that have wildly varying costs. To further complicate things, not all treatments of the same kind are the same, because doctors vary in their skill levels and reputations. If you have a right to heart surgery, do you also have a right to one of the best heart surgeons in the world, or will someone fresh out of Hollywood Medical College do just fine?
The real-world case of a boy with a rare blood disorder may force us to confront this question, however heartbreaking it may be. A teenage boy in Iowa has a form of hemophilia that costs a million dollars per month to treat. The cost of covering the illness has not only increased insurance premiums for other Iowa residents, but has already caused at least one major insurer to withdraw from the area. Even for a major company like Blue Cross Blue Shield, a million dollars per month is a heavy burden, and it is simply not economically feasible to cover the illness when it means passing the cost along to thousands of other customers.
The practical implications of this situation shine a harsh light on the so-called compassionate view of medicine. The assumption that insurers have to cover everybody is not only costing the teenage boy his coverage, but is also harming all the Iowans who suffer from the exit of Blue Cross. Trying to force companies to cover more people is actually resulting in coverage for fewer.
So I ask again, if health care is a right, how much health care? Is anyone entitled to force others to spend a million dollars per month on their behalf? Indeed, is there any limit to the cost a patient is justified in imposing on others? The point is not to denigrate the young hemophiliac; his case is truly a tragic one, without any easy answers. But if we’re going to model the health care system for the entire country on a notion of rights, we have to be clear about what those rights actually mean. The Iowa case is a rare one, but costs have continued to rise under Obamacare. It is conceivable that at some point in the future, the costs of insuring all Americans will be so great that no company will be willing to undertake the job. What happens to the “right” to health care then?
This is always the problem with so-called “positive rights,” “rights” that require someone else to provide you with a good or service. At a certain point they crumble, when the needs of consumers outgrow the abilities of producers. Of course, conservatives and libertarians would argue that health care is no right at all — it is merely the interaction of willing buyers and consenting sellers, like any other good in the market. This is my own view, but simply stating it is unlikely to persuade those who disagree with me. Instead I would ask them to consider the case of astronomical costs and explain what happens when one person’s right to free care is so expensive that it breaks the entire system.
Sadly, unless we turn away from socialized medicine and begin moving towards market-based health care, I fear that the case of the Iowa hemophiliac will soon cease to be an isolated one.