Andrew Fiala

Do you have a right to health care? Politicians and philosophers wrestle with answer

Do people have a right to health care? Bernie Sanders thinks so. He recently introduced “Medicare for all” legislation that would expand Medicare and provide universal coverage. Other Democratic presidential contenders have jumped on Sander’s single-payer bandwagon.

Sanders recently tweeted, “Health care is not a commodity. It is a human right.” A similar idea was shared on Twitter last year by Pope Francis, who wrote, “Health is not a consumer good, but a universal right.” The senator and the pope think that health is not something to be priced by the market and only available to those who can afford it.

The right to health and medical care is often included in lists of other rights. The United Nation’s Declaration of Human Rights declares, for example, that there is a right to “food, clothing, housing and medical care.”

Andrew Fiala, Fresno Bee columnist JOHN WALKER Fresno Bee file

This idea of rights is different from what we see in the founding documents of the United States. The Declaration of Independence says we have a right to life, liberty, and the pursuit of happiness. The Bill of Rights includes freedom of speech and religion, the right to bear arms, and so on. Nowhere in the Constitution is there a right to food, education, or health care.

The right to pursue happiness only gives us the right to be left alone to compete for work or purchase food. Rights that entitle you to be left alone are called “negative rights.” Negative rights are protections against interference.

The British philosopher John Locke is a source. He said, “no one ought to harm another in his life, health, liberty, or possessions.” Locke includes health here. But he is not talking about a right to health care. Rather, his point is that we ought not damage other people’s health.

Negative rights create limited duties. We only have a duty not to harm others. A different idea of rights, so- called “positive right,” create more extensive duties. A right to education or health care is connected with a duty to provide for those things.

The duty to provide may be limited and local. Parents, for example, have a duty to educate their children. Families may have a duty to care for sick relatives. But most defenders of positive rights go further and declare that society has the duty to provide.

One source of this idea is found in the parable of the Good Samaritan. That story begins in a discussion of the Golden Rule: “Love your neighbor as yourself.” Jesus praises the merciful Samaritan, who extended his love to a stranger. Jesus exhorts, “Go and do likewise.”

Good Samaritanism might merely be understood as requiring private charity. But Jesus’s idea of broad neighborly relation points toward the idea of human interconnection and mutual dependence. As the poet John Donne once put it, around the time that Locke was writing, “no man is an island.” Donne continued, “any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee.”

The idea of involvement with humanity lead to calls for social welfare systems. One important source is Thomas Paine, the philosopher of the American revolution. Paine said that a government “ought to have no other object than the general happiness.” He proposed a system of basic income, support for retirement, and care for widows and children.

Paine’s ideas — like those of Sanders and Francis — might be decried by critics as socialist. Defenders of negative rights do not want to be forced to pay for other people’s well-being. They will be skeptical of taxes that are used to support the poor, educate the young, or care for the sick. They want people to be responsible for themselves and left alone to choose how to spend their money and use their liberty.

But those who maintain that there is a right to health care don’t view negative rights as the end of the story. They judge society in terms of how it cares for those who are ailing and vulnerable. On this view, successful societies care for children and widows, the poor, the aged, and the infirm. And while private charity is nice, the free market is not going to care for everyone for whom the bell has tolled.

Andrew Fiala is a professor of philosophy and director of The Ethics Center at Fresno State: @PhilosophyFiala