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From the Editor
A letter to a friend.
JASON PONTIN
Dear C, In a recent email, you angrily rejected the notion that health could be a right in the same way that freedom of speech and religion might be rights. You wrote, “Those freedoms are limitations on government, debated by the Founding Fathers, and granted by the U.S. Constitution. They are totally different from an entitlement, such as health care, which is a government spending program.”
I have been thinking a lot about your email, because in this issue of Acumen, we argue that the prices of pharmaceutical drugs should be regulated by the U.S. government as a matter of social justice. Our publisher, Eric Greenberg, proposes in his column that we add another freedom to those guaranteed by the Constitution: the freedom from sickness.
Acumen believes that health care is a right—but why?
You would probably call yourself a political conservative. In common usage you are: American conservatives are understood to be distrustful of government and in love with free markets. But for most of the last three centuries, you would have been called a liberal. It is your old-fashioned liberalism we deplore.
No one has ever described the assumptions of liberalism more happily than Thomas Jefferson in the Declaration of Independence. His idea of inalienable rights, derived from John Locke, supposes a state of nature in which we possess various rights merely by virtue of being human. Liberals thought that governments oppressed these natural rights: the purpose of the rule of law, as a guarantor of freedom, was to limit its scope.
It would have been impossible for the founders to call universal health care a right, because no national health care system exists in the state of nature, and because health care (as you point out) requires government spending—a constraint upon the economic liberty of the free citizen. Modern conservatives would sympathize, although they might use different language.
An alternative view is offered by the British philosopher Thomas Hobbes, who famously described the state of nature as having “No arts; no letters; no society; and which is worst of all, continual fear and danger of violent death; and the life of man, solitary, poor, nasty, brutish, and short.”
To Hobbes, natural rights are a fiction, since there are no rights at all in a state of nature. Such rights as we possess, we possess through the agencies of our civilization, like our government. We pay taxes to fund the legislation and administration of those rights by politicians and bureaucrats. To Hobbes, all rights are wrested from selfish individuals for the good of the community.
But even Hobbes would accept that natural rights are a convenient currency in political exchanges. They are a fiction we consent to believe. When we say we have a right to something, we mean that it is a minimal requirement for a civilized life; that without it, life is scarcely worth living; that we are willing to look to our representative institutions to secure it; and that we are willing to forgo other, often economic, freedoms to enjoy it.
The number of rights is a moveable feast: our rights change according to our historical circumstances, economic resources, and technological powers. In July, the House of Representatives approved a measure that would allow Americans to import cheap drugs. It was a step toward claiming affordable health care as a fundamental right: Americans may be adding another freedom to those they already enjoy.
How this might work without creating gross inefficiencies or discouraging new research is something we begin to discuss in this issue of Acumen.
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