Britain, as a signatory to the European Social Charter, long ago agreed that health care is “a basic human right.” Yet fractious debate over health policy continues across the pond.
Last month, for example, one local body of Britain’s National Health Service made headlines with their decision to withhold non-urgent surgery for people who smoke, or are obese, and drew fire from the UK’s Royal College of Surgeons for not being supported by enough evidence.
General consensus that health care is a human right is no panacea for health care policy. Still, liberal rhetoric in the United States about the issue often seems to center around affirming that European consensus.
The right to health care is, by its nature, a positive right — a wonderful-sounding but (especially in the context of our divided political environment) malign concept. Where negative rights (like the freedom to speak, assemble or bear arms) only require allowing human action, positive rights impose a duty to coercive action.
The threat of this duty superheats the debates needed to make reasonable policy proposals, and explodes the political coalitions needed to put such proposals into action.
At their best, positive rights merely emphasize a certain policy’s importance to us as a society. A “right to the privilege of education,” like that written into North Carolina’s constitution, reminds us that we think education is such a good thing that the government ought to ensure it happens.
At their worst, positive rights inflame what should be cool-headed policy debates. To deem something a positive right is to make a vast claim. It’s to say that X (whether X is a school, hospital or a road) is so important that government has a duty to take whatever action (usually coercion in the form of taxes) to provide it. Such reasoning alarms those who aren’t so sure the government needs to provide X.
The problem here is that the latter group of skeptics is often numerous, and reasonable. Frequently, there is a good case to be made for why X (or parts of X) shouldn’t be paid for by the government.
For example, I think our federal government could do a lot to improve the public good by organizing basic health care for everyone, but I worry a more expansive “Medicare for All” program might undermine the market incentives that make the United States a crucial engine of medical and pharmaceutical advances.
