Is Healthcare a Right?

I was perusing Greg Mankiw’s blog this morning, when I found a link to a longer piece he has on healthcare. As far as the economics goes, I think this piece is well thought out, though I would personally word a few passages differently.

Strangely though, Greg has a section titled “Healthcare as a Right” under his “The Special Characteristics of the Market for Healthcare”. Where he presents the argument that it seems wrong that someone might not get healthcare because they can’t afford it. Granted, he admits that this is ultimately a question for philosophers, but it still seems strange he would even bring this up at all, given that this claim seems outside of the scope of economics.

So, continuing this weeks discussion on rights, is Mankiw correct? Do people have a right to healthcare?

As with most topics, this is a complicated subject. And there’s been a lot of philosophical discussion on what a “right” is, and what it entails. I just want to point out that when we use the word “right” as a noun in English, we’re typically using it in a way which implies obligations onto others.

For example, “I have a right to life”, implies that you have an obligation not to kill me. When people refer to healthcare as a “right”, I suspect they are trying to convey a belief that people have some sort of obligation to provide others with healthcare.

But do people have such an obligation? Well, a case could be made, on a moral level, that you have an obligation help provide healthcare for your family, and maybe friends whom you know are truly deserving of help. On a legal level, these obligations are even looser, only obligating you to provide for your spouse and children.

However, arguing that someone has an obligation to provide complete strangers with healthcare seems murky. You might be able to argue for an obligation if an orphan, who through no fault of their own, becomes sick and lands on your doorstep asking for help. On the other hand, I think it’s a much harder case to argue for an obligation towards a full grown adult who makes poor decisions his entire life.

Luckily, even though I think it’s difficult to determine when someone has a right to healthcare, I think there is a related and much easier question to answer: who is going to enforce said “right”?

When someone argues that people have an obligation to do something, they’re also implicitly arguing that people who don’t uphold that obligation need to be punished in some fashion. This punishment can be non-violent (i.e. ostracizing someone from the community), or it can be violent (i.e. throwing someone into prison). In the modern context of the debate, people are not arguing for “healthcare as a right” to be enforced non-violently, like the obligation to tip waiters in the United States. People are typically arguing for “healthcare as a right” to be enforced via the state, which is inherently violent.

And using such violence to punish someone because they’re a murderer, thief, or fraudster seems intuitive to me. Using such violence to punish someone because they’re stingy and don’t want to pay for your healthcare doesn’t seem intuitive in the slightest. I highly doubt that you, personally, would violently lock up such a stingy person, but this is what you have to advocate for other people to do when you advocate for state provided healthcare.

So while you might be able to argue that under certain circumstances, some people might have moral obligations to provide others with healthcare. I can’t see a legitimate argument for using the state to enforce said obligations.

I suspect this is what I call a “monkey brain” moment. Where our brains, evolved on the plains of Africa, trick us into thinking something that’s not true or counter-productive.

Our ancestors lived in highly social, small, and genetically close hunter-gatherer tribes in extremely scarce environments for most of humanity’s existence. And in a small tribe like that, it’s easy to know whether or not someone is actually down on their luck, or if they made a series of irrational decisions that makes them deserve their fate. Since it was a significant resource loss, and thus deadly, for our ancestors to just let their fellow tribesmen die. The people who survived were people with such an egalitarian intuition, but because they had this knowledge about their fellow tribesmen, such an intuition wouldn’t develop into a moral hazard.

Unfortunately, applying this sort of tribal mentality to the nation-state seems erroneous, both because we have far exceeded a population such that every member of society can reasonably manage every other member, and because the violence often inherent to this mentality is no longer immediate and apparent. It’s easy to advocate for police to throw me into prison for refusing to pay your healthcare bill, it’s a completely different story throwing me into prison yourself.