Is there a right to health care? Most libertarians and classical liberals would say “no,” and most progressives are shocked by that answer. For progressives, nothing could be more obvious than that everyone deserves access to health care regardless of their ability to pay. Distributing medical care based on wealth is for dystopian science fiction stories, where the underclass gets back-alley doctors and the ruling class gets sleek, modern hospitals. It doesn’t belong in a civilized society. (For more on this topic, see “Government Makes Healthcare Worse and More Expensive.”)
Thus progressives ask, how can libertarians be so heartless as to not believe in a right to health care?
In this essay, I will try to answer that question. While I might not convince you that there isn’t a right to health care, I hope to at least convey that, whatever a “right” to health care is, it is something fundamentally different from the sort of thing we usually call a “right”—so different, in fact, that we probably shouldn’t be using the same word.
I’ll be narrowly focused on that question. This essay is not about how the free market can solve health care, it’s not arguing that health care isn’t crucial to a flourishing life, and it doesn’t claim that America’s health care system is better than systems where people do have a “right” to health care. It’s only about whether it makes sense to call health care a “right.”
What We Mean When We Say, “Rights”
In October 2017, the National Health Service, Great Britain’s single-payer, socialized healthcare provider, announced that smokers and the obese would be banned from non-urgent surgery indefinitely. According to the Telegraph:
[T]he new rules, drawn up by clinical commissioning groups (CCGs) in Hertfordshire, say that obese patients “will not get non-urgent surgery until they reduce their weight”…unless the circumstances are exceptional.
The criteria also mean smokers will only be referred for operations if they have stopped smoking for at least eight weeks, with such patients breathalysed before referral.
The policy change understandably received significant criticism and brings to the fore the true meaning of “right” to health care.
What is a right? Even though “rights talk” permeates our political conversations, most people have never tried to define a right. Sometimes the term is used as a synonym for “important”—thus we hear about a right to clean water, shelter, education, and healthcare, all of which are undoubtedly important.
Yet having a “right” to something means more than that. Saying something is a “right” describes a relationship between individuals. It makes us think about our obligations to each other and the government’s obligations to its citizens. Rather than focusing on what we have rights to, I’d like to focus on the relationships that a “right” creates and the distinction between positive and negative rights.
Rights describe a relationship between at least two people: a rightholder and a duty-holder. If someone has a right, others have a corollary duty. They’re inextricably linked; two sides of the same coin.
Think of a desert island with only Robinson Crusoe, before Friday arrives. Crusoe could tell the trees and the animals that he has a “right” to life, but would it mean anything? A tiger chasing him through the grass is immune to Crusoe’s right-claim. Tigers can’t be duty-holders, so the term “right” does not describe a relationship between Crusoe and the tiger. When Friday arrives, however, Crusoe’s claim that he has a right to life implies something about the relationship between him and Friday. If Crusoe has a right to life, then Friday has a duty not to murder him, and vice versa.
The nature of the corollary duty is what distinguishes positive rights from negative ones. For negative rights, the corollary duty is an omission—that is, duty-holders are required to refrain from doing something, e.g. don’t steal, don’t punch people, don’t kill. For a positive right, the corollary duty is a duty of action—that is, duty-holders are required to affirmatively act, e.g. provide food, provide health care, or provide resources for such things. Understanding this technical, but crucial, difference between positive and negative rights can help us identify four qualities that make them categorically different.
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