Michael Moore, whose film SiCKO premiers this week, criticizes America’s health-care sector: “We’re the only country in the Western world that doesn’t believe it is a human right to provide free universal health coverage for every one of its citizens.”
Medical care can be as essential to survival as food. But does it follow that people have a right to medical care? Would creating a legally enforceable “right” to health care solve America’s health-care difficulties, as Moore supposes? Or would it add to them?
Suppose Congress created a legally enforceable right to health care. Even if such a measure could win approval, the debate would not and could not end there.
The first difficulty would be to define the scope of that right.
Do we have a right to preventive care? If so, health care spending (and taxes) would explode. Researcher J. D. Kleinke notes that if everyone followed government recommendations, the number of people taking preventive medications for hypertension, asthma, obesity, and high cholesterol would increase anywhere from 2- to 10- fold.
Should mammograms be available to women regardless of their likelihood of developing breast cancer? What about experimental treatments?
With the wide variety of tests and treatments, someone must decide where the right to health care ends, lest the nation be bankrupted. Whoever makes those decisions will wield enormous power over people’s health. Who should have that power? Most nations hand that power to unelected bureaucrats, who ration medical care — often by making even seriously ill patients wait for care.
A second and related difficulty is the question of who pays. By definition, a right to health care could not be conditioned on ability to pay. Delivering on that right would require additional taxes proportionate to the scope of that right.
A third difficulty is the incentives created by a right to health care. Patients would demand far more medical care because additional consumption would cost them little. Higher tax rates would discourage work and productivity, yielding less economic growth and wealth.
Pushing down the compensation of medical professionals would discourage many — and many of the brightest — from entering the field of medicine. Divorcing their compensation from the satisfaction of their patients would reduce the quality of care.
As in other nations, policymakers would discourage medical innovation because every new discovery puts them in the uncomfortable position of either increasing taxes or saying “no” to patients.
The paradox of a right to health care is that it discourages the very activities that help deliver on that right.
A fourth difficulty is how to deliver all this medical care. Declaring health care to be a right does nothing to solve the problem of getting the right resources to the right place at the right time.
Where are doctors most needed? Where will we place hospitals? Who will produce surgical tools? How much should they be paid? These decisions must be made through the political process.
Yet the political process does a poor job of keeping up with shifting needs. Worse, experience in other countries shows that those with political power would enjoy a greater right to health care by virtue of their ability to affect the allocation of medical resources.
Finally, if health care really were a fundamental human right, Americans presumably would have no greater a right to medical care than Indians or Haitians. If we truly believe that everyone has an equal right to health care, we would have to tax Americans to provide medical care to nearly every nation in the world.
The fundamental problem with the idea of a right to health care is that it turns the idea of individual rights on its head. Individual rights don’t infringe on the rights of others. Smith’s right to free speech takes nothing away from Jones. The only obligation Jones owes to Smith is not to interfere with Smith’s exercise of her rights.
A right to health care, however, says that Smith has a right to Jones’ labor. That turns the concept of individual rights from a shield into a sword.
The underlying goal of a legally enforceable right to health care is to provide quality medical care to the greatest number possible. Perversely, making health care a “right” would make that goal harder to attain.
Michael Moore might want to rework his script.
– Michael F. Cannon is director of health policy studies at the libertarian Cato Institute (www.cato.org). This piece is adapted from the book Healthy Competition: What’s Holding Back Health Care and How to Free It, which he co-authored.