To understand the background of the recent debates on health care it is instructive to look at how this issue is being approached in “progressive” states like Oregon. Last year a Constitutional Amendment was discussed which would declare access to health care in Oregon to be a “fundamental right.” But what is so progressive about a proposal that increases the scope of collective decision making over individual choice?
We can think of a right as a contract between two people in which both parties have agreed to accept the obligations of the agreement because it provides them mutual benefit. Evidence that such rights and obligations exist can be found in a verbal or written agreement. For example, person A is obliged to pay person B a specific amount of money, and person B is obliged to deliver A the product before an agreed date. So far, so good.
But when we talk about health care as a constitutional right we no longer talk about rights in this sense. We talk about rights as the outcome of political decision making. Rights conceived in this fashion do not reflect actual agreement between individuals but political authority. This may not be necessarily problematic when the rights in question reflect the “common good,” but rights that generate massive entitlement programs do not reflect this kind of consensus.
The right to “life, liberty, and the pursuit of happiness” reflects the freedom of individuals to live their lives as they see fit. The only obligation these “rights” impose on others is not to interfere. These obligations can be satisfied by doing nothing and we all have an interest in having such freedoms. Such universal agreement is not possible when we talk about a right to health care. The right to health care does not just mean that people have a right to obtain medical care, but that others have an obligation to supply it. A right to health care will impose obligations that are far reaching in nature and inevitably lead to a state-run health care system where all people are equal in having no choice and health care is rationed by “experts.”
There are many things in life we think as desirable, perhaps even necessary. But from this it does not follow that other people have an obligation to supply these things. During the 20th century there has been an increasing tendency to claim everything we desire in life as a “right.” This does not just undermine the ideal of having a government that serves the common good, it also produces a society where mutual assistance, charity, and self-reliance are increasingly undermined. The movement to make health care a constitutional right reflects a cynical view of the purpose of a Constitution. Instead of protecting fundamental freedoms that all citizens will recognize as just, the Constitution is used to secure greater protection for partisan political issues.
It is guaranteed that a constitutional right to health care will not come about without a political struggle. This itself is indicative that such a right is the outcome of non-unanimous decision making (to put it mildly) and does not represent the common good. If we secure a right to health care this way, it will not reflect right but might. It should go without saying that “might makes right” is not a progressive but an authoritarian principle to organize society. The situation is not much different in the case of current proposals to reform health care. If any breakthroughs will be made it will be in the form of one coalition prevailing at the expense of others.