Overview and Instructions
If you have not done so, be sure to read the
Case Analysis Structure Overview
1. Explain the case at hand back in your own words.
o This should be no more than one paragraph. It’s just a quick summary so I know how you’re understanding the case.
2. Explain the theories of the two philosophers that are assigned in that particular week.
o This should be where you show that you understand the arguments of the philosophers that are covered in a particular topic. So if you’re writing on the Welfare Case Analysis, you’d explain the arguments of Walzer and Murray.
o This should be completely neutral — just a succinct presentation of the arguments that isn’t influenced by or that mentions the case.
o This should be at least two paragraphs, and probably more like four.
3. Present an argument applying the philosophers’s arguments to the case at hand.
o Here you should take the work you did in task two and apply that to the story. So if you were writing on Welfare, you might say that Walzer’s theory would give the aide to person X because of reason Y and then justify that. You’d then do the same with Murray.
o This should be at least two paragraphs, and could easily be four.
4. Present an argument explaining why one philosopher has a better solution to the case at hand.
o Do to this you need to explain what you think a successful solution to the case would demonstrate and then show hoe one of the philosophers does this better than the other.
o This should be two paragraphs.
5. Explain what you would do and why.
o This should be exactly one paragraph.
In this case analysis you have five tasks:
1. Give a clear and concise explanation of the case at hand.
2. Give a thorough, philosophical exegesis of the relevant aspects of Bradley’s and Peikoff’s arguments. (Click here for some tips on how to do a successful exegesis.)
3. Present an argument applying the relevant philosophers to the case at hand. This should include an argument justifying in which world each philosopher would place Jim and why.
4. Present an argument explaining why one of the philosophers can be viewed as offering a more successful solution to the case at hand.
5. In no more than one paragraph, explain what solution you would propose for Jim.
Consider Jim. Jim has worked in middle management his entire life. He had the option of paying into his company’s managed healthcare system but decided he wanted to keep the money instead and invest it in case he ever needed acute medical treatment. Unfortunately, on his 40th birthday, Jim decided to buy a red Corvette with that money. 6 months later, Jim went to a doctor to see why he was feeling so awful. The doctor diagnosed Jim with emphysema, diabetes, and kidney failure. All three of these conditions are the result of Jim’s lifestyle choices: smoking, poor eating and exercise habits, and excessive drinking. These conditions are chronic and will require treatment for the rest of Jim’s life including cutting-edge lung and kidney treatments and weekly meetings with a nutritionist, endocrinologist, cardiologist, etc.
Here are the two possible healthcare “worlds” for Jim (he must be “placed” in one of them):
A. Participate in a universal healthcare system, paid for by income taxes, which doesn’t provide Jim with the latest and greatest medical technology but does meet basic standards of care.
B. Participate in a pay-for-service system, which allows Jim to pay for whatever treatment he wants and/or can afford but will not treat him unless he pays for the service.
Overview and Instructions If you have not done so, be sure to read the Case Analysis Structure Overview 1. Explain the case at hand back in your own words. o This should be no more than one par
Bradley’s “Positive Rights, Negative Rights and Healthcare” Excerpts “Positive Rights, Negative Rights and Healthcare” Excerpts by Andrew Bradley from the Journal of Medical EthicsLinks to an external site. Abstract In the current debate about healthcare reform in the USA, advocates for government-ensured universal coverage assume that health care is a right. Although this position is politically popular, it is sometimes challenged by a restricted view of rights popular with libertarians and individualists. The restricted view of rights only accepts ‘negative’ rights as legitimate rights. Negative rights, the argument goes, place no obligations on you to provide goods to other people and thus respect your right to keep the fruits of your labour. A classic enumeration of negative rights includes life, liberty, and the pursuit of happiness. Positive rights, by contrast, obligate you either to provide goods to others, or pay taxes that are used for redistributive purposes. Health care falls into the category of positive rights since its provision by the government requires taxation and therefore redistribution. Therefore, the libertarian or individualist might argue that health care cannot be a true right. This paper rejects the distinction between positive and negative rights. In fact, the protection of both positive and negative rights can place obligations on others. Furthermore, because of its role in helping protect equality of opportunity, health care can be tied to the rights to life, liberty, and the pursuit of happiness. There is, therefore, good reason to believe that health care is a human right and that universal access should be guaranteed. When US politicians speak of the need for healthcare reform and universal coverage, they often do so using the language of human rights. Health care is identiﬁed as a right and its provision must therefore be guaranteed by the government. Although politically popular, the belief that health care is a right is not uncontested. Opponents of government-mandated universal coverage may argue that health care is not actually a right and so any effort to guarantee its provision by governmental means is misguided. In this paper, I will examine a libertarian or individualist argument that (1) limits the domain of ‘rights’ to only three: life, liberty, and the pursuit of happiness and (2) rejects the status of health care as a right. I conclude, following Henry Shue’s reasoning, that the argument is ﬂawed and then refute some counterarguments that the individualist or libertarian might apply. Next, I will discuss how life, liberty, and the pursuit of happiness relate to Norman Daniels’ ‘equality of opportunity’ argument for healthcare rights. Finally, I will present cases from the USA. and other countries where the arguments I have discussed have been used in practice. A RESTRICTED NOTION OF RIGHTS Opponents of government involvement in ensuring universal healthcare coverage often argue that the notion of rights must be limited to ‘negative’ rights. Negative rights, unlike ‘positive’ rights, do not impose an obligation on others to provide you with something. A good enumeration of those negative rights, according to Leonard Peikoff and others, can be found in the US Declaration of Independence: life, liberty, and the pursuit of happiness. These rights share a common feature in that they guarantee the right of individuals to engage in certain activities without interference from others. For example, imagine that having a nice garden makes me happy. It is my right to own a plot of land, choose the ﬂowers I want, and arrange them as I please. Anybody who steals, digs up, or tramples my plants violates my right to pursue happiness. However, the right to pursue happiness does not mean that others must actively support me in my gardening activities by providing me with gardening supplies. In other words, the pursuit of happiness is not a positive right in which other people are obliged to help me along. Taken together, the three rights of life, liberty, and the pursuit of happiness mean that you are free ‘to act, and to keep the results of your actions . to keep them or trade them with others, if you wish’. They do not grant you the right to be given the work product of other people — you may only obtain their work product on terms that they agree too, as in a business transaction. The rationale for this restricted notion of rights is simple: when we extend the domain of human rights to include positive rights, we infringe upon the rights of other people. Suppose health care is a right. If it is truly a right, then it would be unacceptable if people were unable to obtain it. The government must therefore ensure healthcare access for all, including those who are too poor to buy it on their own. As the government does not actually produce anything that it could sell to raise money, it will surely have to levy a tax to help support universal coverage. This taxation to provide unearned goods to one group of people, Peikoff argues, is an immoral infringement of the right of the taxed to keep the fruits of their labour. He takes a particularly harsh view, saying that a system in which you have a ‘right to anything at others’ expense means that they become rightless’… CRITIQUES OF THE LIMITED NOTION OF RIGHTS A gut reaction to the libertarian or individualist argument proposed by Peikoff is that if the government uses taxes to ensure the rights of individuals to get an education or obtain food, why could it not also help provide healthcare access? However, Peikoff would simply deny that individuals have a right to education or food when it comes at the expense of others. If you want education or food without earning it through your own labour, you must rely on charity. Henry Shue’s response to the alleged distinction between positive and negative rights, which I will illustrate next, provides a better response to Peikoff. Again, what makes the rights to life, liberty, and the pursuit of happiness special in Peikoff’s argument is that they are rights that guarantee your ability to act, not to have others act in a way that beneﬁts you. In other words, these rights can be secured without putting a positive obligation on others to, for example, provide me with gardening equipment or pay taxes so the government can give me gardening equipment. What is the purpose of government then? Presumably government acts as the impartial body that punishes those who would interfere with the rights of others. After all, without an arbiter, the whole concept of rights becomes a paper tiger. Who exactly pays for the governmental apparatus that secures these rights? The government tracks, prosecutes, and punishes those who violate the rights of others. It provides a visible police force to investigate crime and help deter criminals. The police ofﬁcers patrolling the streets, detectives investigating crime, lab technicians evaluating evidence, prosecutors presenting evidence in court, and judges presiding in court to ensure a fair trial all must be paid. That payment comes from taxes that are levied on individuals. When the Philippines were invaded by Japan during World War II, the country was a commonwealth of the USA. Presumably the US government had a special obligation to protect the Filipinos’ rights to life, liberty, and the pursuit of happiness. In order to secure those rights for the inhabitants of the Philippines, the USA, along with its allies, was forced to raise a vast military using a draft. Countless young men, drafted involuntarily into service, died in World War II, including in the campaign to liberate the Philippines. The sacriﬁce of their right to life was the cost of ensuring freedom for the Philippines and other countries invaded by the Axis powers. These two examples illustrate Shue’s objection to the distinction between positive and negative rights. They show that protecting even the negative rights of life, liberty, and the pursuing of happiness rights can require some positive action on the part of citizens, perhaps by paying taxes or submitting themselves to the draft. Shue put it nicely by saying ‘A demand for physical security is not normally a demand simply to be left alone, but a demand to be protected against harm’.5 When individuals speak of their rights to life, liberty, and the pursuit of happiness, they do so expecting that the government will do something to protect those rights. The clear moral boundary Peikoff draws around negative rights thus disappears as does his basis for claiming that health care cannot be a right… WHAT DOES THIS MEAN FOR HEALTH CARE AS A RIGHT? Even if Peikoff’s dividing line between positive and negative rights actually does not exist, it does not automatically follow that anything can be declared a right. Most people would believe that while hair care would be unreasonable as a right, access to education, food, or shelter might qualify. The difference between hair care and health care, education, food and shelter is that the latter four can be tied to the three rights of life, liberty, and the pursuit of happiness. Any chance for success in life requires that life, liberty, and the pursuit of happiness be protected. The purpose of rights such as access to health care is to ensure some minimum level of opportunity to succeed in society and life. The other problem with Peikoff’s story of hair care rights is that it improperly assumes positive rights are absolutely unlimited. However, even the negative rights are limited. Even if I work hard and manage to buy a huge arsenal of ﬁreworks for my own personal enjoyment, I cannot detonate them in such a way that I am likely to set ﬁre to my neighbours’ property. At best, Peikoff’s analogy might provide the starting point for a debate over the merits of a government monopoly on health care. Otherwise, it simply serves to remind us that rights must be limited to prevent signiﬁcant infringement on others’ rights. In any case, his main objection to government-mandated and supported universal health coverage is not that it is practically unworkable, but that it is unethical for the reasons discussed above… EQUALITY OF OPPORTUNITY ARGUMENTS IN PRACTICE In the current debate about the US healthcare system, the equality of opportunity argument has been put forward in the call for reform. The Ethical Force Program, organised by the Institute of Ethics at the American Medical Association, iden- tiﬁes equality of opportunity as one of three major American values, with the other two being justice and compassion.10 Taking these three values together, the Ethical Force Program has proposed a set of four ethical obligations that it believes should guide healthcare reform. Stated brieﬂy, those four obligations are: (1) universal, equal access to adequate healthcare beneﬁts; (2) implementation of an ethical process for determining the extent and limits of healthcare beneﬁts; (3) sustainability of the system; and (4) clear responsibilities and accountability for the relevant stakeholders. The Committee on Ethics of the American College of Obstetricians and Gynecologists (ACOG) has also issued an opinion on healthcare reform. Like the Ethical Force Program, the ACOG committee identiﬁes values that it believes underlie the need for healthcare reform — the appropriate goals of medicine, the social covenant and justice. The appropriate goals of medicine are essentially ‘to promote health, cure disease, and prevent suffering’. The social covenant reﬂects a sense of community and interdependence among individuals ‘all persons are ultimately dependent on the care of others for their health needs’. Finally, the ACOG committee follows an egalitarian view of justice that emphasises equality of opportunity. Health is viewed as a particularly important ‘background condition’ that is necessary for individuals to utilise other goods that society provides fully. As long as deﬁned subsets of the population face worse health outcomes because factors beyond their control prevent access to health care, it is difﬁcult to say that justice and equality of opportunity are being protected. Notes by Professor on Bradley Bradley Three Projects: Rejects the distinction between positive and negative rights (metaethics) Argues that, because of the special things that it provides and protects, the right to healthcare is necessary for the enjoyment of what are commonly thought of as our basic liberty rights: life, liberty, and the pursuit of happiness. Considers the practical application of his arguments for governments and NGOs. “In this paper, I will examine a libertarian or individualist argument that (1) limits the domain of ‘rights’ to only three: life, liberty, and the pursuit of happiness and (2) rejects the status of health care as a right. I conclude, following Henry Shue’s reasoning, that the argument is flawed and then refute some counterarguments that the individualist or libertarian might apply. Next, I will discuss how life, liberty, and the pursuit of happiness relate to Norman Daniels’ ‘equality of opportunity’ argument for healthcare rights. Finally, I will present cases from the USA. And other countries where the arguments I have discussed have been used in practice.” A Restricted Notion of Rights (Here Bradley examines existing views which claim that the only kind of rights that exist (or at least exist in a governmental setting) are negative rights) Negative Right: impose no obligation on others to give you something or do something for you. Peikoff argues that we can find these rights in the USDI: life, liberty, and pursuit of happiness. Garden analogy Why have a restricted notion of rights? Positive rights restrict the rights of others. If healthcare really were a right, the government would have to ensure that everyone had it, and since the government doesn’t actually generate income, it would have to tax people to pay for it, which actually restricts the rights of the tax payers. That taxation “is an immoral infringement of the right of the taxed to keep the fruits of their labour.” The BoR seems to endorse the negative rights view because it frames rights in terms of restrictions on government. Healthcare might be something that’s good to have, but those who can’t get it for themselves will simply have to rely on charity. Bradley explains Peikoff’s haircare analogy to show P’s point about how a good can quickly become a burden. Critiques of the Limited Notion of Rights One response to P’s negative rights view is to say that the government already provides education and food, so why not healthcare. P would respond by saying that the government shouldn’t pay for that stuff either. (Is/Ought) According to P negative rights are special because they are merely rights that guarantee your ability to act without putting burdens on others. Under this view, the function of government is simply to protect this right and punish transgressions (remember Nozick) Crime fighting and Philippines example BUT: Who pays?!?! This is where Bradley appeals to Henry Shue: protecting negative rights requires positive action on the part of citizens. “ A demand for physical security is not normally a demand simply to be left alone, but a demand to be protected against harm.” Response to Two Possible Objections: Redistribution and Equality of Need The Redistribution Objection P: (the draft is immoral) and taxes to support negative rights are okay because they do not involve a redistribution of wealth. IE: we all benefit equally from taxes for a military, but only poor people benefit from taxes for healthcare (take from the rich, give to the poor.) Response: There’s still a redistribution in taxation to maintain a police force and, more obviously, in the right to a fair trial. How do these explanations work? The Equality of Need Objection P: everybody’s healthcare needs vary, but no one has a greater need than anyone else to life, liberty, and the pursuit of happiness. Response: If LLP is really about being protected from harm, then some people do have a greater need for subsidized protection. IE: Fair trial à some can afford an attorney, but others need one provided for them. What Does this Mean for Health Care as a Right? Whether there is a neg/pos distinction, things like healthcare, education, etc function to ensure that LLP is protected. There is a range of “normal” for life plans and we have to have certain opportunities to pursue those life plans. Since illness makes it difficult (if not impossible) for us to function properly, then we can’t pursue our chosen life plans. The equality of opportunity argument. Neither positive nor negative rights are unlimited (as P seems to assume) Equality of Opportunity Arguments in Practice There are 3 major American values: Opportunity, justice, and compassion The AMA proposed 4 obligations of the medical profession to help guide healthcare reform along the lines of those values 1) Universal, equal access to adequate healthcare 2) Implementation of an ethical process to determine the limits of healthcare 3) Sustainability of the system 4) Clear responsibilities and accountability for the relevant stakeholders. The ACOG also came up with a similar set of values an obligations, designed to promote access to healthcare as a necessary condition that enables people to fully engage in society and in life. Some Perspectives from Outside the USA Norway: we’re all responsible for the health of others Sweden: the people who need healthcare most actually demand it far less than was expected Conclusion Primary point: refute 1) the belief that only negative rights are “true” rights” and 2) the belief that healthcare is therefore not a right. “…the rights to life, liberty, and the pursuit of happiness cited by the libertarian and individualist actually provide a reasonable foundation for establishing a right to healthcare.” Peikoff’s “Healthcare is Not a Right” Health Care Is Not A Right By Leonard Peikoff Delivered under the auspices of Americans for Free Choice in Medicine at a Town Hall Meeting on Health Care in Costa Mesa, California, on December 11, 1993 Updated with permission by Lin Zinser (2007) [http://www.aynrand.org/site/News2?id=13873Links to an external site.] Introductory Note by Lin Zinser: In today’s proposals for sweeping changes in the field of medicine, the term “socialized medicine” is never used. Instead we hear demands for “universal,” “mandatory,” “single-payer,” and/or “comprehensive” systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this “nationalized financing” or “nationalized health insurance.” In a more honest day, it was called socialized medicine. Most people who oppose socialized medicine do so on the grounds that it is moral and well-intentioned, but impractical; i.e., it is a noble idea—which just somehow does not work. I do not agree that socialized medicine is moral and well-intentioned, but impractical. Of course, it is impractical—it does not work— but I hold that it is impractical because it is immoral. This is not a case of noble in theory but a failure in practice; it is a case of vicious in theory and therefore a disaster in practice. I want to focus on the moral issue at stake. So long as people believe that socialized medicine is a noble plan, there is no way to fight it. You cannot stop a noble plan—not if it really is noble. The only way you can defeat it is to unmask it—to show that it is the very opposite of noble. Then at least you have a fighting chance. What is morality in this context? The American concept of it is officially stated in the Declaration of Independence. It upholds man’s unalienable, individual rights. The term “rights,” note, is a moral (not just a political) term; it tells us that a certain course of behavior is right, sanctioned, proper, a prerogative to be respected by others, not interfered with—and that anyone who violates a man’s rights is: wrong, morally wrong, unsanctioned, evil. Now our only rights, the American viewpoint continues, are the rights to life, liberty, property, and the pursuit of happiness. That’s all. According to the Founding Fathers, we are not born with a right to a trip to Disneyland, or a meal at McDonald’s, or a kidney dialysis (nor with the 18th-century equivalent of these things). We have certain specific rights—and only these. Why only these? Observe that all legitimate rights have one thing in common: they are rights to action, not to rewards from other people. The American rights impose no obligations on other people, merely the negative obligation to leave you alone. The system guarantees you the chance to work for what you want— not to be given it without effort by somebody else. The right to life, e.g., does not mean that your neighbors have to feed and clothe you; it means you have the right to earn your food and clothes yourself, if necessary by a hard struggle, and that no one can forcibly stop your struggle for these things or steal them from you if and when you have achieved them. In other words: you have the right to act, and to keep the results of your actions, the products you make, to keep them or to trade them with others, if you wish. But you have no right to the actions or products of others, except on terms to which they voluntarily agree. To take one more example: the right to the pursuit of happiness is precisely that: the right to the pursuit—to a certain type of action on your part and its result—not to any guarantee that other people will make you happy or even try to do so. Otherwise, there would be no liberty in the country: if your mere desire for something, anything, imposes a duty on other people to satisfy you, then they have no choice in their lives, no say in what they do, they have no liberty, they cannot pursue their happiness. Your “right” to happiness at their expense means that they become rightless serfs, i.e., your slaves. Your right to anything at others’ expense means that they become rightless. That is why the U.S. system defines rights as it does, strictly as the rights to action. This was the approach that made the U.S. the first truly free country in all world history—and, soon afterwards, as a result, the greatest country in history, the richest and the most powerful. It became the most powerful because its view of rights made it the most moral. It was the country of individualism and personal independence. Today, however, we are seeing the rise of principled immorality in this country. We are seeing a total abandonment by the intellectuals and the politicians of the moral principles on which the U.S. was founded. We are seeing the complete destruction of the concept of rights. The original American idea has been virtually wiped out, ignored as if it had never existed. The rule now is for politicians to ignore and violate men’s actual rights, while arguing about a whole list of rights never dreamed of in this country’s founding documents—rights which require no earning, no effort, no action at all on the part of the recipient. You are entitled to something, the politicians say, simply because it exists and you want or need it—period. You are entitled to be given it by the government. Where does the government get it from? What does the government have to do to private citizens—to their individual rights—to their real rights—in order to carry out the promise of showering free services on the people? The answers are obvious. The newfangled rights wipe out real rights—and turn the people who actually create the goods and services involved into servants of the state. The Russians tried this exact system for many decades. Unfortunately, we have not learned from their experience. Yet the meaning of socialism is clearly evident in any field at all—you don’t need to think of health care as a special case; it is just as apparent if the government were to proclaim a universal right to food, or to a vacation, or to a haircut. I mean: a right in the new sense: not that you are free to earn these things by your own effort and trade, but that you have a moral claim to be given these things free of charge, with no action on your part, simply as handouts from a benevolent government. How would these alleged new rights be fulfilled? Take the simplest case: you are born with a moral right to hair care, let us say, provided by a loving government free of charge to all who want or need it. What would happen under such a moral theory? Haircuts are free, like the air we breathe, so some people show up every day for an expensive new styling, the government pays out more and more, barbers revel in their huge new incomes, and the profession starts to grow ravenously, bald men start to come in droves for free hair implantations, a school of fancy, specialized eyebrow pluckers develops—it’s all free, the government pays. The dishonest barbers are having a field day, of course—but so are the honest ones; they are working and spending like mad, trying to give every customer his heart’s desire, which is a millionaire’s worth of special hair care and services—the government starts to scream, the budget is out of control. Suddenly directives erupt: we must limit the number of barbers, we must limit the time spent on haircuts, we must limit the permissible type of hair styles; bureaucrats begin to split hairs about how many hairs a barber should be allowed to split. A new computerized office of records filled with inspectors and red tape shoots up; some barbers, it seems, are still getting too rich, they must be getting more than their fair share of the national hair, so barbers have to start applying for Certificates of Need in order to buy razors, while peer review boards are established to assess every stylist’s work, both the dishonest and the overly honest alike, to make sure that no one is too bad or too good or too busy or too unbusy. Etc. In the end, there are lines of wretched customers waiting for their chance to be routinely scalped by bored, hog-tied haircutters, some of whom remember dreamily the old days when somehow everything was so much better. Do you think the situation would be improved by having hair-care cooperatives organized by the government?—having them engage in managed competition, managed by the government, in order to buy haircut insurance from companies controlled by the government? If this is what would happen under government-managed hair care, what else can possibly happen—it is already starting to happen—under the idea of health care as a right? Health care in the modern world is a complex, scientific, technological service. How can anybody be born with a right to such a thing? Under the American system you have a right to health care if you can pay for it, i.e., if you can earn it by your own action and effort. But nobody has the right to the services of any professional individual or group simply because he wants them and desperately needs them. The very fact that he needs these services so desperately is the proof that he had better respect the freedom, the integrity, and the rights of the people who provide them. You have a right to work, not to rob others of the fruits of their work, not to turn others into sacrificial, rightless animals laboring to fulfill your needs. Some of you may ask here: But can people afford health care on their own? Even leaving aside the present government-inflated medical prices, the answer is: Certainly people can afford it. Where do you think the money is coming from right now to pay for it all—where does the government get its fabled unlimited money? Government is not a productive organization; it has no source of wealth other than confiscation of the citizens’ wealth, through taxation, deficit financing or the like. But, you may say, isn’t it the “rich” who are really paying the costs of medical care now—the rich, not the broad bulk of the people? As has been proved time and again, there are not enough rich anywhere to make a dent in the government’s costs; it is the vast middle class in the U.S. that is the only source of the kind of money that national programs like government health care require. A simple example of this is the fact that all of these new programs rest squarely on the backs not of Big Business, but of small businessmen who are struggling in today’s economy merely to stay alive and in existence. Under any socialized regime, it is the “little people” who do most of the paying for it—under the senseless pretext that “the people” can’t afford such and such, so the government must take over. If the people of a country truly couldn’t afford a certain service—as e.g. in Somalia—neither, for that very reason, could any government in that country afford it, either. Some people can’t afford medical care in the U.S. But they are necessarily a small minority in a free or even semi-free country. If they were the majority, the country would be an utter bankrupt and could not even think of a national medical program. As to this small minority, in a free country they have to rely solely on private, voluntary charity. Yes, charity, the kindness of the doctors or of the better off—charity, not right, i.e. not their right to the lives or work of others. And such charity, I may say, was always forthcoming in the past in America. The advocates of Medicaid and Medicare under LBJ did not claim that the poor or old in the ’60’s got bad care; they claimed that it was an affront for anyone to have to depend on charity. But the fact is: You don’t abolish charity by calling it something else. If a person is getting health care for nothing, simply because he is breathing, he is still getting charity, whether or not any politician, lobbyist or activist calls it a “right.” To call it a Right when the recipient did not earn it is merely to compound the evil. It is charity still—though now extorted by criminal tactics of force, while hiding under a dishonest name. As with any good or service that is provided by some specific group of men, if you try to make its possession by all a right, you thereby enslave the providers of the service, wreck the service, and end up depriving the very consumers you are supposed to be helping. To call “medical care” a right will merely enslave the doctors and thus destroy the quality of medical care in this country, as socialized medicine has done around the world, wherever it has been tried, including Canada (I was born in Canada and I know a bit about that system first hand). I would like to clarify the point about socialized medicine enslaving the doctors. Let me quote here from an article I wrote a few years ago: “Medicine: The Death of a Profession.” “In medicine, above all, the mind must be left free. Medical treatment involves countless variables and options that must be taken into account, weighed, and summed up by the doctor’s mind and subconscious. Your life depends on the private, inner essence of the doctor’s function: it depends on the input that enters his brain, and on the processing such input receives from him. What is being thrust now into the equation? It is not only objective medical facts any longer. Today, in one form or another, the following also has to enter that brain: ‘The DRG administrator [in effect, the hospital or HMO man trying to control costs] will raise hell if I operate, but the malpractice attorney will have a field day if I don’t— and my rival down the street, who heads the local PRO [Peer Review Organization], favors a CAT scan in these cases, I can’t afford to antagonize him, but the CON boys disagree and they won’t authorize a CAT scanner for our hospital—and besides the FDA prohibits the drug I should be prescribing, even though it is widely used in Europe, and the IRS might not allow the patient a tax deduction for it, anyhow, and I can’t get a specialist’s advice because the latest Medicare rules prohibit a consultation with this diagnosis, and maybe I shouldn’t even take this patient, he’s so sick—after all, some doctors are manipulating their slate of patients, they accept only the healthiest ones, so their average costs are coming in lower than mine, and it looks bad for my staff privileges.’ Would you like your case to be treated this way—by a doctor who takes into account your objective medical needs and the contradictory, unintelligible demands of some ninety different state and Federal government agencies? If you were a doctor could you comply with all of it? Could you plan or work around or deal with the unknowable? But how could you not? Those agencies are real and they are rapidly gaining total power over you and your mind and your patients. In this kind of nightmare world, if and when it takes hold fully, thought is helpless; no one can decide by rational means what to do. A doctor either obeys the loudest authority—or he tries to sneak by unnoticed, bootlegging some good health care occasionally or, as so many are doing now, he simply gives up and quits the field.” (The Voice of Reason: Essays in Objectivist Thought, NAL Books, 1988, pp. 306-307) Any mandatory and comprehensive plan will finish off quality medicine in this country—because it will finish off the medical profession. It will deliver doctors bound hands and feet to the mercies of the bureaucracy. The only hope—for the doctors, for their patients, for all of us—is for the doctors to assert a moral principle. I mean: to assert their own personal individual rights—their real rights in this issue—their right to their lives, their liberty, their property, their pursuit of happiness. The Declaration of Independence applies to the medical profession too. We must reject the idea that doctors are slaves destined to serve others at the behest of the state. Doctors, Ayn Rand wrote, are not servants of their patients. They are “traders, like everyone else in a free society, and they should bear that title proudly, considering the crucial importance of the services they offer.” The battle against socialized medicine depends on the doctors speaking out against it—not only on practical grounds, but, first of all, on moral grounds. The doctors must defend themselves and their own interests as a matter of solemn justice, upholding a moral principle, the first moral principle: self-preservation. Concluding Note by Lin Zinser: In addition, we must join the doctors in their defense and in our own. Hospital administrators, nurses, physical therapists, health insurance companies, and patients must speak out against these plans, on moral grounds, as a matter of justice. If the doctors become slaves, so will we all. Notes on Peikoff by Professor Peikoff Healthcare is not a right (at least not in the positive sense) and the reason healthcare will never work in practice is because it is immoral Definition: Morality and Rights We only have a very limited set of rights, namely those to life, liberty, property, and the pursuit of happiness The reason we only have these rights is because they are negative rights, not positive rights Do you remember the difference? P looks at the right to life and the right to the pursuit of happiness as an example. “Your right to anything at another’s expense means that they become rightless.” This view of rights is what made America so great, but now we are undermining that greatness with increasing immorality with respect to rights. “The newfangled rights wipe out real rights — and turn the people who actually create the goods and services involved into servants of the state. The Russians tried this exact system for many decades. Unfortunately, we have not learned from their experience. Yet the meaning of socialism (this is the right name for Clinton’s medical plan) is clearly evident in any field at all — you don’t need to think of health care as a special case; it is just as apparent if the government were to proclaim a universal right to food, or to a vacation, or to a haircut. I mean: a right in the new sense: not that you are free to earn these things by your own effort and trade, but that you have a moral claim to be given these things free of charge, with no action on your part, simply as handouts from a benevolent government.” Hair Care Analogy The fact that you want or need healthcare (or haircuts) is not a reason why you are or ought to be entitled to them, and it certainly doesn’t make it a right. What if you can’t afford healthcare? “But can people afford health care on their own? Even leaving aside the present government-inflated medical prices, the answer is: Certainly people can afford it. Where do you think the money is coming from right now to pay for it all — where does the government get its fabled unlimited money? Government is not a productive organization; it has no source of wealth other than confiscation of the citizens’ wealth, through taxation, deficit financing or the like.” He concedes that there may be some people who legitimately can’t afford healthcare; however, there could be medical charity (or any other kind of charity) But, again, merely needing it (depeserately) and getting it for free do not make it a right, it’s still charity. Immorality and Doctors The idea of a right to healthcare effectively enslaves doctors and threatens to destroy the medical profession “As with any good or service that is provided by some specific group of men, if you try to make its possession by all a right, you thereby enslave the providers of the service, wreck the service, and end up depriving the very consumers you are supposed to be helping. To call “medical care” a right will merely enslave the doctors and thus destroy the quality of medical care in this country, as socialized medicine has done around the world, wherever it has been tried, including Canada (I was born in Canada and I know a bit about that system first hand).” Finally: I’d like to conclude with a sentence from Ayn Rand. Doctors, she wrote, are not servants of their patients. They are “traders, like everyone else in a free society, and they should bear that title proudly, considering the crucial importance of the services they offer.”