Health Care Debate Asks the Wrong Question


Debates over the Patient Protection and Affordable Care Act or universal health care often devolve into a debate over whether health care is a right or a privilege. This is not surprising; rights have been imbedded in our nation's history as far back as the founding fathers, and even the British philosopher John Locke. Both liberals and conservatives are guilty of boiling issues down to this level. Whether you believe health care is a right or not, I am here to convince you that you are asking the wrong question. If we stopped using this question as a framework for debate, we would understand the other side much better.

Imagine a debate between two friends — a conservative and a liberal — over health care as a right. The liberal says, “Health care is a right, not a privilege!” The conservative responds, “Health care is a privilege, not a right!” Neither party is likely to gain any ground because framing issues in terms of rights is a non-starter. When the liberal says, “Health care is a right,” it means they think the government should ensure universal health coverage. When the conservative says, “Health care is a privilege,” it means they are opposed to the government providing universal health coverage. But, both parties presumably understood that going into the debate.

So why do people insist on framing the health care debate — among other issues — in terms of rights? Libertarians and conservatives have an advantage for defining issues in terms of rights because it provides them a bright line for supporting or rejecting a policy. If you religiously believe that the sole purpose of government is to protect life, liberty, and property rights, then you do not need to consider the arguments for public education or universal health insurance. You can easily reject them.

However, liberals believe that the purpose of government is not to protect any rights in particular, but to make its citizenry better off in the aggregate. Rights to life, liberty, property, free speech or religion, and a public education are not justified because they are handed down by God or exist in a state of nature, but because they provide a net benefit and pave the way to a just society. The first upshot is that rights are socially constructed, so it does not make sense to talk about their “existence.” The second is that, when you are evaluating policies, what matters are the consequences. The question of whether health care is a right can only be decided by looking at what sorts of consequences follow from establishing universal health insurance.

So, should we make health care a right? Again, for liberals, the question is whether guaranteeing health insurance would result in a net benefit. The answer: It depends how you do it. It is very apparent that other nations with universal coverage achieve better outcomes at a lower cost. My favorite model is Singapore’s system, which combines mandatory health savings accounts, competition between public and private health care, mandated price transparency, a focus on disease prevention, and low-cost catastrophic health insurance provided by the government. With this program, Singapore achieves American health outcomes at a quarter of the cost. It is hard to reject evidence of this kind, unless bound by ideological commitments.

The rights framework for discussing policy is antiquated, ideological, and divisive. All sides of the political spectrum would benefit from a discussion that is focused on costs, benefits, and evidence.

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