Health Care Rights Language Raises Questions

What is a right? Where do rights come from? On what do they depend? Is there a hierarchy of rights? What obligations do one person’s rights place upon the larger society?

I am asking these questions because of the use of rights language being made in public discourse about health care. To be honest, I find the application of rights language in regard to health care troubling for several reasons, even though I am inclined to think that some kind of basic health care is legitimately thought of as a right.  If I sound conflicted — well, I am.

Here is the problem as I see it. In this country, rights language is enshrined in our foundational documents and serves a very specific purpose: to limit the power of the government.

From the Declaration of Independence:

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.

The point of the mention of rights in this document was specifically to draw a line between what belonged to man as man, given him by his Creator and what belonged to man that was contingent upon some condition, including some form of government. The point of government, according to this, is to secure life, liberty and the pursuit of happiness. This document gives the reason for the existence of our government, while the Constitution outlines the form that a government existing for that reason ought to take. Hence rights language, as it appears in the Constitution, is directed toward limiting the power of the state over the person, and the power of the federal government over the several states.

But the right of others also restrains persons and every right creates concomitant obligations. If others have the right to liberty, then I as a citizen am restrained from unduly restricting their liberty. I become obligated to tolerate actions by my fellow citizens that may displease me because while my fellow citizen has a right to liberty, I do not have a right not to be displeased. If, due to my displeasure, I attempt to restrict the liberty of my fellow citizen, the government acts to secure his right.

In a great many areas of life, this delicate equilibrium between rights and mutual obligations and the role of the state has been tested and retested. Freedom of speech, freedom of religion, right of trial by jury, right of redress — these are all areas in which there is a huge body of case law that spells out the what limits, if any, the state may place upon each right. Extrapolating from these rulings, one can locate one’s obligations as a citizen — we are all mutually obligated to tolerate many things that may not please us in order that our government function so as to secure the rights of all. In order for the government to function at all, of course, it has to have the authority to levy taxes and other authorities all based ultimately on a coercive power that is justifiable only, according to our founders, in order to secure our rights.

Things change though when the “rights” under consideration become, not merely what one has the power to do — such as speak freely, assemble with others, vote, worship as one sees fit — but become rights to have something, such as “affordable housing” or “affordable health care”. Do all people have a right to affordable housing? Does their right to affordable housing trump my right to set a rent price on my property that the market will bear? What if they cannot afford to pay enough to cover the expenses of my ownership of that property? Do all people have the right to affordable health care? Do we mean by that that everyone must have access to the same level of care regardless of ability to pay? What obligations will become incumbent upon us and what limitations on other rights will the rest of us incur once we accept this premise?

It seems apparent that rights language in such contexts — discussing what concrete goods one has a right to, as opposed merely to what one has a right to do — fundamentally alters the role that “rights” historically played in the political thought of our nation. Rather than limiting governmental power, this rights language greatly expands it and seems to change the motivation of the coercive power of the state.

Do we perhaps need some other language to talk about this other than the language of “rights”? And if so, what is it?

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  • Joe DeVet

    The ideas in this essay are a much-needed counter to the tendency to speak of the “right” to health care as if it were an absolute, or an intrinsic right such as life or liberty. Appropriate to bring up this delicate subject in Catholic circles, since Catholic lobbying has tended to speak in a thoroughly unbalanced way about such a “right.”

    Lost in most of the Catholic rhetoric is the fact that health care is an economic good. As such, it can only come about through the provision of land, labor, capital and enterprise. Health care is only available because numerous investors, doctors and other workers, and owners of property direct their private property or their labor toward the provision of that care–in the case of doctors, only after rigorous and very expensive and time-consuming educational preparation.

    A Catholic principle called “justice” requires that those who provide the land, labor, capital and enterprise be justly compensated for their contributions. But how does this principle coordinate with “rights” talk in the case of health care? Unfortunately, the Catholic lobby has utterly failed to negotiate this question. If one fails to take adequate account of the economic realities of health care, then whatever policy solution ensues will be unworkable and will lack key elements of justice.

    Alas, lobbying for health care as a “right” devolves into lobbying, whether explicitly or implicitly, for an abomination called socialized medicine. Thus, the Catholic institutions and lobbying centers send out calls to action supporting Obamacare, blithely remarking that we’ll clean up some inconvenient details like abortion and assisted suicide later on. The Catholic presence in the public square becomes, in this way, a dog which bites its own tail–a thoroughly discredited voice of self-contradiction.

    What Catholic lobbying is missing in all this is that these and other critical life issues will be intrinsic to a government-directed system. The Catholic lobby will perhaps get what it asks for. Once it gets it, though, it will not like what it has, and will probably be powerless to oppose it or correct it.

  • HomeschoolNfpDad

    Catholics have access to a tradition that articulates subsidiarity as a principal that is binding on social institutions, which includes government. The language discussed here about the Constitution and Declaration of Independence, if it referenced the family as well as the citizen, would adequately describe subsidiarity. In short, subsidiarity is this: larger institutions must cede power and control to smaller institutions and ultimately, to the family, if the smaller institution is capable of providing for its needs on its own. The larger institutions may provide assistance to the smaller but cannot subordinate the smaller to the larger, even if such assistance is provided.

    In practice, this would mean that the federal government would avoid acting in any social sphere in which state government were capable. State government and federal government would avoid acting in any social sphere in which private business were capable. Private business would avoid acting in any social sphere in which the family were capable. And the whole edifice would be oriented primarily towards the good of the family. This would not preclude the good of entrepreneurs, employees in private enterprise or civil servants, for each is himself part of a family as well. But large institutions acting under proper subsidiarity would place themselves at the service of smaller institutions.

    The current health care proposals are the exact opposite of this. The federal government is not offering to place its expertise and coercive power at the service of the family. Rather, the federal government is using the family as a pawn in a game that is designed to dramatically increase the size of what has already become a $3+ trillion dollar per year institution. Thereby, those who believe in centralized control seek to increase their own power and prestige in society. Certain elements of the health care bill being considered demonstrate this. Coverage for abortion is the most obvious, but less obvious are certain other stipulations of the bill. For example, members of Congress would be exempt from the coverage under the new bill should it become law. Their existing health care coverage would continue. This is sufficient documentation that the primary purpose of the bill is a power grab: those who exercise the power exempt themselves from being its target.

    Seen through the lens of subsidiarity, the language of abortion included in the bill isn’t even the primary objection because if the bill truly operated within the bounds of subsidiarity, abortion would never be considered. The current bill is a bald-faced attack upon families because it seeks to replace what many families have already accomplished on their own. Because this is the primary context of the bill, including abortion coverage is almost a foregone conclusion: once you have placed the family in your sites and are preparing to pull the trigger, anything goes.

    A proper bill, however, would not necessarily preclude action by the federal government. But a government that acted as a subsidiary of the family would not seek to supplant what already exists nor would it seek to impose things (like abortion) that are bad for families. It would take a close look at the problem and observe that there is a lack of affordable access for certain segments of the population. Then, if the government chose to act, it would act only there.

    As for the Catholic lobby, well, it long ago abandoned subsidiarity. Groups like Catholic Charities will never see another dime of my money in voluntary donation, and not because they support a bill that extends abortion. Rather, it is because they support a bill whose language places families at the service of government instead of the other way around. As I said before, abortion would be anathema in a bill whose primary purpose was to serve families. This one does nothing for families. It seeks instead to replace them.

  • elkabrikir

    Thank you to Mary, Joe, and NFPdad, for your excellent discussion points.

    The concepts of “Right”, “Economic goods”, and “Subsidiarity” must be understood and applied before a health care paradigm shift can be enfleshed. (I don’t concede that a shift is required). Artists never begin a masterpiece by flinging paint onto a canvas or dabbing shades here and there. First they must sketch basic shapes and concepts. Then, over time, the masterpiece reveals itself.

    The supporters of slavery justified it by claiming they didn’t “own” the man, just his labor. It is not a stretch to see how the best and brightest doctors will not allow themselves to be enslaved. An anesthesiologist friend of mine said, “I love what I do, but I’m smart enough to do many things. If it gets to the point where I’m not getting paid what I need to make in the market, I’ll switch professions.” He then went on to tell me that he can’t hire someone to “spread chicken poop on his yard” for what medicaid/medicare re-emburses him. I fear for the day when the most highly qualified medical professionals are driven from healthcare and into some other field. It doesn’t take a genius to eschew enslavement.

    PS Don’t become a slave yourself, to “free” government anything.

  • http://catholichawk.com PrairieHawk

    I would like to inject my two cents as a recipient of state-funded health insurance. I suffer from mental illness. My family does not have the resources to pay my medical bills, and I have tried private insurance and it is either too expensive or I am ineligible because of my medical history. Therefore the State of Minnesota picks up the bill, and it does so very generously, with benefits that the vast majority of people on private insurance do not have, I’d wager. My prescription medications cost me $3 each month, and I get my most expensive meds (which cost almost $400 for a monthly supply on the open market) for free. My psychiatrist and psychologist are completely paid for; if I need to see an internist, it’s free; my bifocals cost $25, and I could go on. I count myself blessed to live in a place that provides such generous benefits.

    I think this is appropriate under the principle of subsidiarity–the State is stepping in where my family and private enterprise cannot. So what is to be done with me? I need these benefits. I’d be wandering the streets in the middle of the night and ending up in the emergency room or the jail if not for my meds (I’m not exaggerating, it has happened before). I like to think, though I doubt this is written down anywhere, that the State sees my value as a human being and has judged that I am better off able to contribute to society according to my capacity and able to live on my own and be at least partially self-sufficient, than I am in jail or an institution. In this way the state’s health insurance policy serves the common good. It is good for everyone that I’m not in jail, because I’m contributing to society.

    Lacking in a discussion of rights is a discussion of the common good, another important Catholic concept. In fact I think the search for what best serves the common good should be driving the health care discussion. I listen to talk radio; I read the papers. I don’t think I’ve heard the common good mentioned once yet. Obama hasn’t mentioned it, and neither has Rush Limbaugh. That’s what I want to hear, is a sober discussion about what is best for the individual, for the family, and for the state, so that everyone who is a citizen of the most prosperous nation in history can benefit from God’s blessing.

  • Mary Kochan

    See, this is where I have the conflict. I agree there has to be a provision for people in PrairieHawk’s position. I also think that access to health care for children cannot depend solely on the parent’s ability to pay. The common good is certainly language we can use to discuss this. Inadequate care for children affects the long-term common good of the society.

    Other language that we might consider comes from the concept of corporal works of mercy. These are our moral obligations to others and one of them is to care for the sick. I think the questions we have to deal with in that context are:

    1. Does the moral obligation we have to care for the sick, create a “right” for the sick person to recieve care?

    2. Should either this obligation or right, if such exists, be enforced by the government?

  • elkabrikir

    Mary:

    Point 1.) Refering to the point that healthcare is an economic good, who would be compelled to provide free goods and services if healthcare is a right? We no longer live in an age of nuns staffing hospitals,etc…

    If there is a “moral obligation” to what extent does it exist? what is the reciprical “moral obligation” to care for oneself out of a duty to that society that cares for you? Who enforces your compliance on either end?

    2.) If this obligation or right exists, does government have the duty to seek out and enforce every moral obligation we owe our brother? (Parents must read to their kids 30 minutes a day and make sure they get 8 hours of sleep; people have transportation to work; college degrees for everyone; contraception for all fertile girls; neutral education….make up your own list)

    Christian Charity fills the gap between a government’s obligations, such as those you mentioned in your article. As government grows, it usurps the province of charity, diminishing its capacity. Charity cannot be compelled either. For this reason, we must work for a more humane and just world, not a better government program.

    Because of the vast resources spent on healthcare and limited resources, rationing decisions will be made. Perhaps babies born under 18 oz will not be saved or, as in the case of Prarie Hawk somebody decides that he is NOT contributing to society, he won’t get his $400 meds for free (they aren’t free in any case. And while I’m at it, NOTHING should be free. Everybody who receives something from the government should be required to give something in return… even if a child draws a picture for an elderly person in a nursing home. Government is NOT charity. What you get for “free” comes by redistributing the wealth.)

    As long as there is Original Sin, ergo until the end of time, people will need healthcare. Some of them will be unable to provide for themselves. Because of the complicated issues involved (like reciprocal duties and rationing) and inherent slippery slope concerns, I do not believe that government has the right to compel participation in or financing of healthcare. Socialized medicine is not the answer. There is no perfect answer outside of love of neighbor.

  • Mary Kochan

    PrairieHawk, how many people make up what you called “my family” and why can’t they pay $400/month for your medication?

  • http://catholichawk.com PrairieHawk

    Mary,

    My mother has given me significant financial help (that is, many thousands of dollars of help) over the years, but in the context of our relationship, which is good, she is unable/unwilling to give more, and I do not think she should be asked to. There is simply nobody else I could ask, even though I do have other relatives who would have the means if I felt I could ask them.

    Elkabrikir, the drug I take is free (to me, I understand that someone is paying for it) because it is an antipsychotic medication and even a minimal $1-$3 copayment is a barrier for some mentally ill people who are not working. So, they have no copayment, they don’t take the drug, and they end up in the emergency room, which costs a lot more. Do you see how the situation of people like me is not one-size-fits-all? The issues are real and complex, and simply to say that the government should get out of the health care business and leave it to the Church or to families is going to impose a very real cost in human and financial terms to society.

    I *don’t* like being on welfare. I *don’t* have an entitlement mentality. I work for pay for as many hours a week as I am able. I know I’m lucky to live in a state with generous benefits, but practically every day I spend 5 minutes thinking, “Okay, can I come up with a new idea for getting off Medicaid/food stamps/rent support”? My life is my responsibility; I’ve always been a very independent person, especially before my illness began, and I hate being dependent. I simply don’t know what else to do. I don’t want to move back into my mother’s basement, and I can’t rely on the Church or other charity because the support isn’t there. I’d love some kind of Catholic health insurance cooperative but it doesn’t exist, for whatever reason. So I’m stuck, at least for now.

    Believe me, I’m open to suggestions.

  • Mary Kochan

    PrairieHawk, I am not picking on you. I just want to illustrate this with your situation.

    Remember that in Catholic thinking, there is no such thing as an “independent person”; we are all interdependent. As Catholics we don’t subscribe to the radical “individualism” that seems so often to be the spirit of this country. So being “independent” is not in and of itself a value. Taking care of one’s own needs to the extent one can has to be seen by us as the way we make ourselves available to serve the common good, rather than as merely an aversion to needing others.

    What really, other than your personal reluctance to ask, would be the rationale for not getting the help you need directly from members of your family? Does you mother have a home? How many rooms are in it? How many people live in it? Why would it be the basement rather than a bedroom? I have a kid in the basement in my house because we don’t have enough bedrooms for the people here; so is that what the situation is? The adult daughter who lives with me and my husband (along with her three kids)is very helpful with many tasks that have to be done. Surely you would be of help to your mother as well and not simply a burden. And finacially, it is usually advantageous to have more people under one roof. (Again, I’m trying to make a broader point here — not picking on you.)

  • elkabrikir

    Prarie Hawk,

    A preface: I use you as an example because you gave yourself up to be one, in charity.

    First, a clarification. I did not say that the government should get out of the healthcare business, althought maybe they should. There are many types of costs in the world.

    Second, you said that you can’t ask your relatives for money. Why should society bear the cost of your broken family? The “clan” system helps minimize this issue worldwide. As NFPdad said, socialized medicine will only serve to distance people even more from their family and from familial duty. (Perhaps we need to reshift the paradigm back to the clan model and away from the government model.) I am aware that any amount of money can be a barrier to some people. My point is this, everybody can do something (if they are of sound mind) that is why I said a child can draw a picture. People, no matter of their age, want to feel like they are part of their own solution. It is part of their dignity.

    Finally, like Mary, I don’t have The Solution. However, we must be able to have open discussions without them being labeled as “fishy disinformation”.

    As an aside, I saw “The Soloist” this weekend. I am inspired to work at a homeless shelter as soon as I can walk/drive again. I know that a simple meal or smile isn’t going to cure schzophrenia or other mental illess. I want the people with whom I come into contact, to know that I am trying to share in, in some small way, their suffering. I need to know that I am a part of their humanity. Blessings to you.

  • http://catholichawk.com PrairieHawk

    Mary and Elkabrikir–

    Thank you for your thoughts and for your charity. It does look like we’ve gotten into a situation where the government is filling the roles that are properly filled by family and church. I know I would feel more a lot more secure if I were relying less on government and more on my family, and on my own abilities to the extent that I am able. I don’t have the answers; I’m very wary of Obamacare, and I wish the Church would step in and take a decisive role instead of simply advocating for “public health insurance that doesn’t fund abortion.” And I will think and pray about what you have said about the role of my family, and my relationship with them. Thank you.

    Anthony

  • tob41

    I am a new person to Catholic Exchange, and I must say this type of dialogue is among the best I’ve seen. Excellent ideas written with charity.

    I’d like to add to the topic if I may. Mary and Elkabrikir and PraireHawk have reached a concensus that I agree with, but I’d like to go further.

    As a father I encourage my children to strive for the ideal which I believe is in line with the Christian model. As a professional however I have to deal with the practical since the ideal is usually unmanageable. I preface in this manner because Mary’s article talked much about the ideal, in fact the idea of rights. Then the replies started to become increasingly practical.

    So being practical, I think at the foundation of the argument of heathcare rights, we shouldn’t talk so much about the role of “government” as a concept. We must focus on the specific United States government. As much as I love my country, I do mistrust my government especially when it comes to trying to help the common good. My mistrust is for practical reasons: this US government does an exceedingly poor job of managing. This is true from social security to education, to healthcare, etc. For this reason I do not agree with our bishops who advocate for universal healthcare. In a different country with effective leaders and burecrats my position would be different. But if we give our government a chance, they will mess it up.

    I wanted to mention that since I understand why Mary originally stated why she was “conflicted”. But I believe that conflict is based on what government should do hypothetically. I believe the answer to be clear, with no conflicts when that premise is put aside and reality of the US government is inserted. At that point the conflict is replaced with certainty that we do better to have the US government out of these matters. And with that I concur with Elkabrikir that the US government shouldn’t usurp our responsibilities as states/cities/clans/families.

  • elkabrikir

    TOB41, thanks for your entry into the discussion!

    I think America’s Founding Father’s agreed with you, therefore, they formed a limited government. Of course, Madison wrote, “If men were angels, there would be no need of government.”

    We also know that as Lord Acton said, “power tends to corrupt, and absolute power corrupts absolutely. Great men are almost always bad men.” I would be scared to death for my immortal soul if I were in a position of power. (The reponsibility of mothering 11 kids is grave enough!)

    The social contract is a delicate balancing act, isn’t it? The Founders errored on the side of limited government for a reason. They must have known what the British Prime Minister said to parliament in 1770 “Unlimited power is apt to corrupt the minds of those who possess it”. (William Pitt the Elder).

    Inherent in the bureaucractic process, are inefficiancies and lack of personalism. What a gift is the Church’s teaching of subsidarity.

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