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Tuesday, February 8, 2011

Is Health Care a Right? Or Merely Economic Egalitarianism?

The Senior US Senator from Illinois, Dick Durbin, said the following just before one of the votes on the health-care insurance reform legislation in December, 2009:

“Thirty million Americans who currently don’t have health insurance  have the peace of mind of knowing that they have health insurance,” Mr. Durbin said. He added, “This is a real debate over whether or not health care is going to be a right or a privilege in America.”

My first reaction after reading this quote was one of perspective—specifically, on how far from this central question of “right vs. privilege” the debate on the health-care legislation had gotten in the obsession over a “public option.”  Health-care can be a right, whether implemented through private, non-profit or public sector organizations (the government funding the poor regardless).   The fundamental question in mandatory health-insurance coverage is whether something that is needed to survive (medical treatment for the sick) is a political right in a society.  If so, then the government has a responsibility to make sure that every citizen has insurance regardless of income.   I suspect that there are many citizens in the US who would say that health-care should not be a right because that right involves economic redistribution.   I believe one poll showed that 87% of Americans who were satisfied with their health insurance said they do not agree to pay for others who would not otherwise be able to afford insurance could have it.  The costly emergency room visits of the uninsured may mean that the insured pay more to have uninsured in society; even so, my point is that we can not assume that rights bearing on sustenance and involving economic redistribution are recognized as rights (rather than as “tax and spend”).   Essentially—and perhaps surprisingly—some people would say that others do not have the political right to life (though some of the same people would say that unborn fetuses have it!).   Unfortunately, given how the debate on health-care insurance has gone, it is difficult to know whether there is a sizable portion of the American society that does not want to recognize that every citizen has a right to basic necessities.   Is political discourse such that it inherently leads to a spirallying out on a tertiary aspect of an issue, rather than on the eye?  If so, how are we to discuss just what are the limits on rights in our society?  Are the rights recognized in law to be byproducts of discussions on implementation (i.e., by business, non-profits or government organizations)?   Furthermore, is a focus on implementation a case of putting the cart before the horse…and letting the horse wander off? 

Thinking of the health-care insurance debate this way—as focused on implementation as if that which is to be implemented follows from it—I submit that there are limits to public discourse.  Hence, Congressional representatives who are led by polls and newspapers may well be a case of the tail wagging the dog.  At the very least, such legislators would not be debating the central questions.   It is dangerous, if not utterly unwise, to legislate this way.   Yet as our system of government becomes more and more democratic (i.e., tailored to the public discourse and polls), we risk running ourselves into a ditch—not looking at where we are going.   Rarely, if ever, did I hear or read references to health-care as a right in the debate.  I heard a lot on process and implimentation, but little on whether a new right that involves redistribution ought to be recognized.  Moreover, we missed an opportunity to debate whether rights that require redistribution are actually rights as distinct from economic egalitarianism.    Not even our elected representatives, who are supposed to act as abuffer to direct democracy (i.e., pulse of the people at the moment), were able to focus on these questions.   Clearly, chasing tails is not the way of leadership.