Warning: there is nothing in this post about grammar. Nothing at all. It is just my current opinion on health care reform, which I have felt rather strongly about for quite a while. As with my previously posted opinions on Proposition 8, I don’t expect this piece will change your opinion drastically. Don’t bother reading it if you think it will skew your opinion of me or prevent you from enjoying the site in the future. If you’re interested, my thoughts are below the fold.

Let me preface this by saying that I am not a rights theorist; I don’t believe that ethics is best explained by appealing to rights. Rights theory holds that an action is wrong if and only if it violates someone’s right to something. The wrongness of killing someone, for instance, arises from that person’s right to keep on living, the wrongness of unlawful imprisonment arises from someone’s right to liberty. Briefly, my problem with rights theory is that I haven’t seen it resolve anything that other moral theories don’t, and it leads to sticky situations when one right comes into conflict with another.  Thus, whether or not one has a “right” rarely directly determines my ethical stance on something; instead I rely on utility maximization, justice, fairness, reason, and the like to reach my conclusions, which happen to be fairly well-correlated with rights theorists’ conclusions.

That said, I think that there are cases where thinking in terms of rights is good and useful. Although I think that rights are not a good foundation for an ethical system, I think they are a valid foundation for a legal system. This is a shared view with a lot of modern governments and constitutions; in the U.S. Supreme Court, for instance, many decisions are reached on the basis of a right to privacy (e.g., Griswold v. Connecticut) or a right to marry (e.g., Loving v. Virginia) or some other right. The problem is that aside from a few easy ones, it’s really hard to determine what rights there are, and how important they are relative to each other.  That’s why Supreme Court decisions are rarely unanimous; one man’s right is another’s privilege.

Even with all that in mind, I was a bit taken aback when I read South Carolinan Senator Jim DeMint’s interview with the Charleston Post & Courier, in which he came right out and said

“I think health care is a privilege. I wouldn’t call it a right.”

I was surprised, because in my mind the default position is that health care is a right.  Saying that it’s a privilege isn’t something that people will accept without some substantial justification.  But DeMint provided none, following up his comment with some rambling about how everyone ought to be able to afford health care, and that the government shouldn’t make it so that people can’t make their own decisions.  If anything, I get the impression from his follow-up that he does think health care is a right and for some reason doesn’t want to admit it.

However, DeMint is not alone in his no-right-to-health-care opinion, and others do try to explain their stance a bit more.  Unfortunately, the others fare little better than DeMint, even when they offer some rationale.   The one that really caught me was John David Lewis’s piece “What ‘Right’ to Health Care?”, in which he unequivocally states that there is no right to health care.  Lewis is a professor at Duke University, so I’d expected a solid argument to back up so strong an assertion.   The thing is, he doesn’t do very well at backing it up either. Don’t just trust that I’m quoting him fairly; you should really read the piece. It’s short. I read it the other night at 2 in the morning without falling asleep. In his piece, Lewis writes:

“The first premise is moral: that medical care is a right. It is not. There was no right to such care before doctors, hospitals, and pharmaceutical companies produced it. Health care is a service, which we all need, and none of us are better served by placing our lives and our doctors under coercive bureaucratic control.”

His argument here is that because medical care didn’t always exist, there can’t be a right to it. This doesn’t seem quite right, though. The Bill of Rights assures us of the right “to petition the Government for a redress of grievances” (1st Am), the right “to keep and bear Arms” (2nd Am), and the “right of trial by jury” (7th Am), each of which can exist only because of the development of government, weapons, and jury trials, respectively. There couldn’t have been a right to a jury trial before the Athenian government produced the idea of a jury trial, and the modern establishment of this right isn’t attested (to my knowledge) until the Magna Carta in 1215. Is there thus no moral right to a jury trial instead of a trial by ordeal or trial by combat, simply because the jury trial has only existed for a small part of human history?

Lewis further argues his point by analogy, arguing that it would be absurd if car insurance were a government-guaranteed right, and that such a right would lead to the economic breakdown of the car insurance system. This is an odd choice of analogy, because car insurance is government-mandated in most states. That means that (in my home states of California and Pennsylvania, at least), by law, there is universal car insurance for everyone who has a car. That’s sort of similar to the proposed universal health insurance for everyone who has a life, except for one thing: few would argue that there is some inalienable right to a car, whereas it’s enshrined in the Declaration of Independence that there is a self-evident and inalienable right to life. And despite Lewis’s apocalyptic predictions about what universal car insurance would mean to the industry, as far as I can tell, car insurers are fairly content with the state of affairs in states with government mandates. But that doesn’t really matter, because Lewis’s analogy between health and car insurance isn’t a particularly relevant one.  It’s no more relevant than an analogy to education, where private universities, like Lewis’s Duke, are performing just fine despite the presence of a public option, like my UCSD or community colleges.

Lewis’s last argument is the awful specter that always comes up in debates about universal health care: that the Brits (or the Canadians, or whoever) have to wait for operations, which are done in small hospitals, and people die there. And yeah, that sucks. But it’s not as though we’ve got a particularly efficient system over here, either. Both Canada and the U.K. have longer life expectancies than we do, Canada’s being a full three years more than ours. Now, that difference isn’t necessarily due to their health care, but it shows that universal health care does not prevent a country from being healthier than we are. And it’s not as though we don’t have people waiting for health care here. Last week, in Los Angeles, a charity was running a free clinic for folks without health insurance. It went on for a week, and wasn’t extensively advertised, yet people camped out on the first night to try to get in, and hundreds of people were told to come back another day. One person who was waiting:

“On the other side of the hall, 83-year-old Ethel Nabors, who has been without teeth for some five years, had just been told after a nine-hour wait that the clinic could not provide her with a new set of false teeth. But Nabors shrugged off the bad luck as she sat in an old Lakers chair to see if a volunteer could realign her dentures, which she had brought with her in a paper sack.”

Look, I’m a lucky guy. I spend my days in an air-conditioned lab with a fast computer, researching things like why people choose to say that or who in a relative clause and what that reveals about cognition. It’s hard work in some senses, but it’s a fair sight better than what most people do. Maybe the best part about it is that I get health insurance as part of my job. I don’t really use it much because I happen to be a young strapping lad and, aside from allergies and lipomas, don’t have anything wrong with me. Yet.

We all know that health is fleeting, and my family history speaks of glaucoma, hearing loss, strokes, all sorts of dire things that await me as my body decides it doesn’t feel like staying young anymore. By that time I expect to be a professor or a researcher somewhere, and I’ll get health insurance then, too. And that means that if I live to 83, and my teeth fall out from all the candy I ate in my halcyon youth, I won’t have to wait five damn years to wait nine damn hours to have someone tell me that I’m not going to be able to get new teeth. No, I’m going to have some friendly dentist hand me some false teeth say, “Here you go, Mr. Doyle, enjoy the new chompers.” And the question I like to think I’ll have in the back of my mind is “What the hell have I done to deserve these that Ethel Nabors didn’t?”

And if my memory isn’t shot by that point, I hope I’ll think back to what my dad’s been going through too, as he’s been having a bear of a time trying to get health insurance since his box factory closed down. He has glaucoma, which is that most dastardly sort of condition: a pre-existing one. Sure, all he needs are eyedrops, but you know how it is: give a man an inch and he’ll take a mile. You insure a man with glaucoma, and soon enough he’ll have arthritis. And then cancer and diabetes and who knows what else!

I kid. Why is it so difficult and prohibitively expensive for a self-employed, middle-aged man who happens to have a single, relatively minor problem with his eyes to get health insurance for the rest of him? More to the point, should it be so? Lewis says that there’s no moral reason for it not to be, but he hasn’t convinced me that there’s no right to health care, and he hasn’t convinced me that universal health care is going to make us worse off than we already are.  Instead, it seems his opinion is “sucks to be you, but I don’t see why I have to care.”

John David Lewis doesn’t need health care reform; he’s a professor at a prestigious school, he’ll be fine.  Senator DeMint doesn’t need health care reform; he’s a major governmental figure, he’s covered.  Even I don’t need health care reform — at least not at the moment. But Edith Nabors does.  My dad does.  And the country does.  Badly.