TGIF: The Mythical Right to Medical Care

This clever video juxtaposes footage of Bernie Sanders and the late Milton Friedman to create a debate over whether the central government should take over medical care in America. Sanders condemns as a "national disgrace" the lack of a medical care guarantee for all -- rich, poor, and in between. Medical care, he insists, should be "a right of citizenship." Then, echoing someone in the audience, he changes that to "health care is absolutely a human right."

The remarks by Friedman from the '60s and '70s chosen for the video address the efficiency problems with government-run medical services, including the inevitable restrictions on consumer choice. Politicians and activists may feel good when they passionately declare that the government should guarantee all people medical care. Unfortunately, such declarations neither create nor deliver quality care justly or efficiently. Friedman was a long-time advocate of the separation of medicine and state. In his 1962 book, Capitalism and Freedom, he called for, among other things, the end of medical licensing, and he defended that view in these recorded remarks before a group of presumably uncomfortable doctors at the Mayo Clinic.

Since Friedman spoke as an economist, not a political philosopher, in his remarks, I thought I'd say something about the rights issue that Sanders raises. To pick a nit: Sanders needs to make up his mind. Is medical care a right of American citizenship or a human right? I don't see how it can be both. The term human right suggests universality, while a right of American citizenship does not.

But let's leave that and look at this purported right. The first thing that occurred to me is that this "right" doesn't match its billing. Medical care is not like air or water; it doesn't appear naturally. On the contrary, the many services and products that constitute medical care must be created through human effort.

This ought to pose a problem for the right-to-medical-care set. A declared right to medical care would camouflage something even more ominous: a right to the labor of doctors, nurses, technicians, developers of medicines, inventors and producers of medical devices, and so on.

That raises a question: do those people have a say in the matter? If the answer is yes, then there goes the purported right; they would be free to decline to go along. But if the answer is no, they are no longer free people, but slaves. Don't we all agree that slavery is bad? (Well, almost everyone. Slavery still exists today, including in Libya, thanks to the U.S.-led regime change in 2011, and many other places. The number of slaves today is larger than in previous times, but it gets nowhere the attention still given to American slavery, which was abolished 158 years ago.) Abraham Lincoln correctly said that "if slavery is not wrong, nothing is wrong." It follows that if self-ownership -- the opposite of slavery -- isn't right, nothing is right.

Is Sanders calling for slavery?

No, no, he and his allies will protest. No one is talking about slavery. No one wants anyone compelled to produce medical services and products. (I'm not entirely sure about that. Would they not endorse conscription for doctors if enough of them opted out of Medicare and Medicaid because of the bureaucratic intrusions?)

If they don't favor slavery, what do they mean? They mean that the government should guarantee payment for medical services for all. (As if the government would pay for something without dictating terms.) But how can the government guarantee payment? Society's medical bill is huge (partly because of government intrusion on both the supply and demand sides), and politicians and bureaucrats certainly don't personally have that sort of money. So they'd have to get it from somewhere else, and we know where that is: the pockets of the people living in America. All that politicians and bureaucrats can do is rearrange existing wealth according to their own preferences. (Actually, it's worse than that; by intervening, they impede the creation of new wealth and innovation in the medical field.)

One way or another, the government would have to transfer wealth from the people who create it to bureaucrats. If the chosen method is taxation (and if it didn't create a tax revolt), the transfer would be straightforward. The dollars the government takes and spends are dollars surrendered under duress by the individuals who earned them. Okay, taxation is not slavery, but it is extortion.

On the other hand, if the government borrows the money, the Federal Reserve would monetize the debt by inflating the money supply, driving up prices (and distorting the structure of production). Depreciation of the money would constitute a transfer of purchasing power from consumers to bureaucrats. That's just a hard-to-see form of taxation. (By the way, without the power to tax, the government would be unable to borrow.)

Sure, everyone theoretically would eventually get some kind of medical attention (if they lived long enough; you know how government monopolies are), but would the system be worth it in terms of lost liberty and utility? It's not as though free people wouldn't arrange for decent medical services, insurance, mutual-aid associations, and philanthropy if liberated from government domination. (Bulletin: we don't have a free medical system.) 

Sanders and the Medicare-for-all brigade endorse an untenable situation in which two or more sets of people are in a conflict over the same money: those who earned it and those whom the legislators and bureaucrats claim to be serving. We ought to be able to agree that they can't both have a valid claim to the same money. (How could the earners, who include entrepreneurs, business owners, managers, and employees, not be entitled to their earnings?)

For a rights theory to do its job -- which is to define the moral-political zone in which each individual can act and flourish in peace -- rights must be mutually consistent, or compossible, as the political philosopher Hillel Steiner puts it. That means the test of any rights theory is this: could all people exercise their rights simultaneously without conflict? Under classical-liberal natural-rights theory, they could. Under the progressive theory, they could not. Thus the progressive theory fails.

Sanders's view would eviscerate the Lockean principle that each person is an end in himself and not merely a means to other people's ends. Sanders & Co. effectively repudiates self-ownership and the rights to life, liberty, and the pursuit of happiness, which is really a single right: the right to be free from aggression.

No right to medical care exists. Everyone has a right to engage in peaceful and consensual cooperative activities aimed at obtaining medical care. But a right to medical care per se? No way, not if we value liberty -- and quality medical care.