Aug 16

Why Health Care isn’t a Right

Positive and Negative Rights:

When someone has a right to something, this always creates obligations in others. My right not to be killed creates an obligation in others not to kill me. My right to be compensated for my labor in accordance with the terms of a contract creates an obligation in my employer to pay me for my work. It is common in discussing rights to differentiate between positive rights and negative rights. A negative right is a right that creates an obligation in others not to interfere with us. A positive right is a right that creates an obligation in others to provide us with something. To fulfill the first sort of obligation, all we have to do is refrain from interfering in the lives of others against their wishes. To fulfill the second, we have to accept a burden of providing something to someone and carry through on an action.

Natural vs. Contingent Rights:

Natural rights are rights that we possess merely in virtue of existing. Contingent rights are rights that we acquire in virtue of the specific circumstances we are in. The right to life and liberty are generally thought to be natural rights. We don’t have to do anything in order to acquire them, nor does anyone else have to do anything to us in order to be obligated not to violate them. A right to be paid by your employer, however, is contingent. If I walk into a building and start working, I don’t have a right to be paid. In order to create that obligation in another, there has to be an agreement between parties creating the obligation. Similarly, we don’t have a right to charity from others. The difference between a charitable contribution and a payment of a debt is that the former is voluntary while the second is morally obligatory. This is why charity is praiseworthy, while paying one’s debts at least ought to be expected.

Against Natural, Positive Rights:

While people certainly obtain positive rights in a large number of circumstances, there is debate over whether or not any natural, positive rights exist. There is good reason to believe that they don’t. This reason is that any such rights would seem to violate our general right to liberty. If, merely in virtue of the fact that you exist, I am required to act in such a way as to provide you with some benefit, then I am not free to live as I see fit, because I must put forth whatever effort is necessary in order to fulfill my obligation to provide you with the good or service in question. Negative rights merely require us to leave one another alone. Positive rights place requirements on us even when we aren’t interfering with anyone else. This interference in how we choose to live our lives in spite of the fact that we have done nothing to create any need in those to whom we are presumed to be beholden seems to require a great deal of effort to justify. I find it unlikely that such justification can be found, or that we possess any rights to be given goods or services merely because we exist.

What about Children?:

One case that seems like it may be an exception is the case of children. It seems at first glance that a child has the right to be provided with what she needs to survive by her parents. I think, however, that this right is actually contingent. Specifically, I think it is grounded in the fact that the parents are responsible for the fact that the child has the needs in question. By bringing a child into a world while knowing that it would need to be cared for in order to survive, you create an obligation to provide for that need in the same way you would be obligated to provide for the medical needs of someone you injured. This explains why we are obligated to provide for the needs of our own children, but not for the needs of other’s.

Health Care:

If health care were a right, it would seem to have to be a natural, positive right. We haven’t done anything to one another that would seem to justify a requirement that we pay for one another’s health care. Since we aren’t responsible for the bad health of others, it seems quite implausible that we are nonetheless obligated to provide for fixing or improving their health. We may, of course, choose to do so, and we could, if we wanted to, all agree to pay for one another’s health care, but I see no reason to believe that we are all naturally morally obligated to do so.

Does that Mean we shouldn’t Provide Health Care?:

Not necessarily. Rights aren’t the only reasons to act. There are at least three sorts of reasons to help others that could justify deciding to pay for the health care of some people. First, there is the basic fact that it is good to alleviate suffering and to help one another. This provides a strong moral reason (although not an obligation) to do what we can to help one another obtain the health care we need. Second, it is good for us to express our concern for one another and to demonstrate compassion and charity. Creating a morally decent citizenry should include encouraging us, when possible, to help those in need, including medical need, when it is in our means to do so.

The problem with both of these reasons to act is that while they certainly justify a great deal of charitable action on the part of individuals, typically we don’t recognize such moral considerations as justifications for state action. Since state action is inherently coercive, using it to require people to be charitable in the way that you would prefer them to be rather than allowing them to decide for themselves how to use their own money is a violation of their rights. Therefore, while I strongly encourage the development of charitable actions to help those in great medical need, justifying state intervention in health care requires a different approach.

Here, we come to the third reason we may choose to help one another pay for health care: because we believe it is in our best interests to do so. One reason we form social contracts is for mutual benefit. Therefore, if we believe that we would all be better off if we chose to pay for health care through state action, we could create an obligation in one another to pay for it in the same way we create an obligation in one another to pay for the security of the nation or the building of highways. This avenue of argument seems to be the best avenue for arguing in favor of government health care. From what I understand about the issue, I tend to find the arguments for the view that government health care would be a better option than private health care unpersuasive, but since many, if not most economists disagree with me on this point, I am far from willing to be dogmatic about the issue. If good practical grounds for government involvement in health care can be found, then that would provide reason to adopt it. The arguments that rest on rights, however, seem to have little basis, and the arguments that appeal to other moral considerations, while they provide good reason for charitable action, aren’t the sort that justify government action.

In the meantime, here’s a practical suggestion for those who are interested in helping others pay for insurance. When I get my electric bill, there is an option to donate money to help pay for the cost of heating for poor people during the winter months. The electric company will take donations and use them to lower the heating bills for low-income families. This procedure doesn’t require forcing others to pay more for their service, but it gives people an opportunity to be charitable if this issue concerns them. I see no good reason not to offer a similar service to those who otherwise couldn’t afford health care. If you want to contribute to your health insurance company to offset costs so they can provide for those who are in financial need, then there is no reason not to do so. Encouraging insurance companies to set up charitable funds for this purpose would be a non-coercive and convenient way for those who care deeply about providing health care to those in need to choose to help provide it.


  1. Jeremy Pierce

    I’m assuming you’d have an exception for cases where the person didn’t knowingly or voluntarily bring a child into existence, and I don’t just mean rape cases (because choosing not to have an abortion in such a case raises more complications). I just mean a case where someone is the biological parent without any knowledge of it until after the fact, e.g. I deposit a sperm sample for safekeeping, and my doctor uses it to conceive a child. The biological mother then sues me for child support.

    What’s interesting to me is how this compares with cases where most pro-choice people think abortion is justified. A woman has no obligation, according to their view, to care for a child she conceives as a result of rape or failed contraception, since she didn’t take on the obligation to raise the child. I think your overall approach nicely fits with that sort of view. But if so, then I think you have to oppose current child support laws, which don’t allow a man that kind of option. He has no say in whether a woman carrying his biological child has an abortion, and yet he has the obligation to care for the child if she chooses not to. This is something that advocates of “reproductive freedom” have rarely had any interest in reforming, even though it has all the features of the cases that they seem willing to fight for with extreme rhetoric when it comes to abortion rights except one — that it’s a man’s obligations that get created. But should that make a moral difference when it comes to the obligations that get created on your behalf by others?

  2. admin

    I do want an exception like that, since the idea was that positive obligations track behavior for which we are morally accountable, while negative ones typically exist independently of our behavior. In the case you describe, I think the obligation goes with the doctor, since it was their intervening act that actually caused the pregnancy.

    I’m uncertain what I think about cases of failed contraception, because I don’t know what I think the risk threshold should be to legitimately claim that you haven’t taken on an obligation. After all, even in, say, a car accident that you didn’t intend but did bring about you still seem to have some liability. I guess I think that if abortion is acceptable in cases of failed contraception then it’s also true that fathers who would have desired that an abortion be performed after contraception failure shouldn’t be held legally responsible for caring for the child. At least, I think this is true if the woman had good reason to believe that the man would want her to have one in that eventuality. If she didn’t know this, then I think this would constitute a failure to have a meeting of the minds. In that case I think I would lean toward the view that in order to avoid the responsibility, it was beholden on the man to clearly state his desire prior to having sex, since most women aren’t willing to have an abortion even if they support a right for others to have one.

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