Playing Devil's Advocate

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"After fifty years of growing government programs, health care costs continue to rise. The U.S. government now controls nearly half of all health care dollars, and the crisis is becoming acute. The plans we are seeing from Washington are not innovations, but rather extensions of the government interventions we have embraced for three generations.
But rather than assume that more government involvement is the answer, should we not at least consider that the source of the problem may be those very interventions? And, more deeply, should we not even consider that the reason for this decades-long pattern is not economic, but moral: the idea that people have a "right" to medical care?
Historically, the huge rise in health care costs began in the 1960s, when Medicare and other programs threw billions of dollars into the industry. Fiscally, Medicare is approaching monumental insolvency, with liabilities in the range of twenty-trillion dollars. To create another bureaucratic labyrinth now -- which advocates are proud to say will cost only a trillion dollars over ten years -- all but guarantees higher prices, and a greater crisis in the next decade.
But such economic arguments have not stopped the train to further government interventions, and we should ask why.
The reason is that advocates of government medicine are upholding health care as a moral right. The moral goal of a "right" to health care is blinding people to the cause and effect relationship between government actions and rising prices.
But the very idea that health care -- or any good provided by others -- is a "right" is a contradiction. The rights enshrined in the Declaration of Independence were to life, liberty, and the pursuit of happiness. Each of these is a right to act, not a right to things. "To secure these rights governments are instituted," which means to secure the rights of each person to exercise his or her liberty in pursuit of his or her own happiness.
By this understanding of rights, no one may force you to act in ways contrary to your own interests, as long as you do not demand that they act contrary to their own interests. There is no right to a good outcome -- no right to food, clothing, shelter, or economic security -- only a right to pursue that outcome, with the voluntary cooperation of others if they wish to offer it.
But consider what a right to a guaranteed outcome would mean. It would require an infringement upon the lives and liberty of those who are forced to provide it. If there is a right to food, there must be farmers to provide it -- or taxpayers forced to pay for it. Government medical plans with unique privileges, such as Medicare, institutionalize force against those who are to provide the claimed "right." And yet, neither the principle nor the consequences are changed if the force is spread out over millions of people in the form of a tax return.
These two concepts of rights -- rights as the right to liberty, versus rights as the rights to things -- cannot coexist in the same respect at the same time. If I claim that my right to life means my right to medicine, then I am demanding the right to force others to produce the values that I need. This ends up being a negation of personal sovereignty, and of individual rights.
To reform our health care industry we should challenge the premises that invited government intervention in the first place. The moral premise is that medical care is a right. It is not. There was no "right" to such care before doctors, hospitals, and pharmaceutical companies produced it. There is no "right" to anything that others must produce, because no one may claim a "right" to force others to provide it. Health care is a service, and we all depend upon thinking professionals for it. To place doctors under hamstringing bureaucratic control is to invite poor results.
The economic premise is that the government can create prosperity by redistributing the wealth of its citizens. This is the road to bankruptcy, not universal prosperity. The truth of this is playing out before our eyes, as medical prices balloon with every new intervention, and we face the largest deficits in human history.
If Congress wants to address health care issues, it can begin with three things: (1) tort reform, to free medical specialists from annual insurance costs of hundreds of thousands of dollars; (2) Medicare reform, to face squarely the program's insolvency; and (3) regulatory reform, to roll-back the onerous rules that force doctors, hospitals and pharmaceutical companies (who produce the care that others then demand as a "right") into satisfying bureaucratic dictates rather than bringing value to their patients."
-John David Lewis
Associate Professor of Philosophy, Politics and Economics, Duke University