Is health care a human right? No.

I first wrote this in 2009, but it seems relevant to today as well; I have updated it.

Is health care a human right, as the United Methodist Church says? I don't see how. Human rights, as Americans have always understood them (beginning with Thomas Jefferson and the other Founders) are a fact of nature that cannot be rescinded by human beings. Rights are immutable, indeed, unalienable ("Not to be separated, given away, or taken away" Dictionary.com, as Jefferson wrote in the Declaration of Independence.)  As a precursor to his Declaration theology that unalienable human rights are a endowment by God, Jefferson wrote in his pre-revolution essay, Summary View of the Rights of British America, " The God who gave us life gave us liberty at the same time. The hand of force may disjoin, but cannot destroy them."

Since his day, and certainly preceding it, the historic American understanding of human rights is the exercise of individual freedom, especially in the political realm, for both public and personal good. We have historically never understood our rights as encompassing access to services or commodities.

Rights are inherent in each individual equally, they are not divisible. Take the Declaration's famous insistence that among human rights is "the pursuit of happiness." Note that it is the pursuit of happiness that is a right, not the achievement of it. Nor is one person more entitled to pursue happiness than another, no matter one’s station in life. Besides, happiness (what Jefferson meant was not happiness as we use the word today, but a state of contentment in life and possessions) is not something that can be given us, it is something we have to create.

It does sound all high-minded to say that, like rights, health care should be equal for everybody, which I suppose is why clergy are so susceptible to say so. It's more than obvious that no one in the Congress or the White House believed it in 2009 when Obamacare was enacted. If they had, the act would have required members of Congress and the rest of the federal government to fall under the "public option" along with the rest of us proles. But they’ve protected their turf completely and much better turf is theirs than ours. I’ll believe that equal access and care for everyone is a moral imperative when the people who say it is a moral imperative place themselves under the same imperative.

The presumption that health care is a right, and therefore must be equal for everyone, is founded on two critical errors of understanding. The first is that health care is a resource that is simply available for those who need it, or that can be made equally available through proper legislation and regulation. The second error is that medical care and access to it can be rationed by command more equally, economically and fairly than by demand.

Health care is not a resource to be exploited

Medical facilities and doctors are not phenomena of nature, like water or petroleum are. Hospitals don’t just appear. They are produced. Medical care is not a resource that can be "mined" through more regulation to be more plentiful. Medical care is a service. 

Specifically, it is a contracted service, in much the same way that legal assistance, automotive maintenance or pastoral care are services. Why? Because men and women choose of their own accord to get medical training. Once graduated, doctors, nurses, paramedics and technicians of various kinds reasonably expect that they will be compensated at a rate greater than their costs to enter the profession, greater than their extremely high overhead to run the practice, and enough to make their grueling hours materially worthwhile for themselves and their families.

This fact has very direct consequences under the Medicare and Medicaid systems we have today. The Atlantic's business journalist Meg McArdle explains:

[W]e have a comprehensive national health care plan for seniors. Yet we have a shortage of geriatricians, the one specialty that you would think would be booming. Why? Because Medicare sets a single price for the services of geriatricians, and it is low. Since the field is not particularly enticing (though arguably it really should be, since geriatricians have extremely high job satisfaction compared to many more popular specialties), very few people go into it. It's one of relatively few specialties that consistently has most of its slots and fellowships unfilled.

Moreover, the skills and equipment a doctor or hospital possess are their individual property, not the property, even partially, of the state or public. (There are publicly-owned facilities such as VA hospitals, but in operation there is no difference to the general public between them and private facilities). No one has a natural right to someone else's property. To think we do directly violates the Tenth Commandment. As McArdle says, "People have no obligation to perform labor for others. I may not [justly or legally] force a surgeon to save my mother at gunpoint."

That means that to receive a doctor's services, the doctor and a patient must come to a mutually-agreeable arrangement of what medical care will be provided in exchange for a specified fee. This is a commercial transaction no different in type than hiring a plumber, cab driver or lawyer. That medical services may be life critical does not change the fundamental nature of the contract.

We have access to medical care only as long as a doctor is willing to provide it. No one has to become a doctor or continue in medical practice. If any "reform" of the present health care system reduces the rewards of practicing medicine or complicates the practice, fewer men and women will so choose. Access will then go down for everyone and costs will inevitably rise, no matter what the rate-payment of the public option is, because access or its lack is itself a cost and also drives other costs.

Health care is a service

As Michael Keehn explains, health care is a service but not a community service. Police and fire departments provide community services. That seems obvious enough, but consider: fire departments do not protect your home individually. The fire chief definitely will let it burn to the ground if firefighting needs are greater elsewhere in the town. Just look at what is happening near Los Angeles as of the date of this post. Police and fire protection are in fact rationed to protect the lives and property of the greatest number of people possible with the resources available. But when the resources (manpower, equipment or money) run out, individuals are exposed to greater danger or loss though the community at large may still be protected.

Individual residents of a city do not contract for their community’s police or fire protection. When you call 9-1-1 because someone broke into your home while you were in bed, you don’t have to sign a contract with the police when they arrive, specifying the actions you want them to take and how much you are going to pay.

In contrast, medical care is an individual service. Doctors do not provide their services to the community as a whole, but to individuals. Because of that, each patient enters into a contract with his/her doctor specifying the medical services to be received and how much it will cost. This is mostly mediated through insurance companies, of course, which greatly simplifies the contracting process. The result is that a patient 's health is protected in a way that their safety or homes are not protected by the police or fire departments.

Interestingly, the Roman Catholic Church rejects the idea that health care is a human right. The Most Reverend R. Walker Nickless, bishop of the Diocese of Sioux City, Iowa, explains.

[T]he Catholic Church does not teach that “health care” as such, without distinction, is a natural right.

The “natural right” of health care is the divine bounty of food, water, and air without which all of us quickly die. This bounty comes from God directly. None of us own it, and none of us can morally withhold it from others. The remainder of health care is a political, not a natural, right, because it comes from our human efforts, creativity, and compassion.

Like any human endeavor, health care is finite. It can be properly understood only as such. Any reform that treats medical care as if it can be made infinitely available is a product of cloud-cuckoo land. Medical care, like every other finite thing, must be allocated. The current buzzword for that is "rationed." That’s the foundation of the second critical mistake people are making about health care, that medical care and access to it can be rationed by the government more equally, economically and fairly than by consumers. 

Philip Barlow, Consultant neurosurgeon at Southern General Hospital, Glasgow, explains why "Health care is not a human right." 

Update, March 2020: In 2009. Philip Niles wrote that the real question is not whether health care is a human right, but "How much health care is a human right?" His essay is no no longer online. It is a good question because since medical care is finite. He says, 

With all of the emotional and financial investment in health care, it is important to address the situation with an actionable approach - not an ideologic one.  My suggestion is to quantify just HOW MUCH health care we believe is "right" to provide, recognize that we should cap public health care spending, and focus the moral/fiscal debate on how high that cap should be set.  Let's achieve our ambitions of providing access for the uninsured with the most likely way of succeeding: by haggling about the price.

There is always a price to be paid, one way or another. What politicians seeking votes seem to do is ignore that price (paid by the consumer) and cost (borne by the provider) are not the same. When a political candidate promises free health care for everyone, they conveniently ignore that free care is simply, literally impossible. 

Look at it this way: as I write, we are in the midst of the coronavirus concerns, with a few thousand died from it worldwide and several in the US, where cases are rising. Now imagine you are a government-employee administrator for Medicare For All the next time such a potential pandemic arises -- and most assuredly there will be a next time. 

You have to choose between funding two heart-replacement surgeries plus rehab routines or funding the testing of 50,000 potential virus infectees for the illness. You do not have the funds to do both. 

Which do you choose? Why? And what do you respond when the untreated persons demand it anyway because it is a human right? 

There is always this question: Who pays and in what coin? One candidate this year had either the temerity (or carelessness) to tell his audience the day before the S.C. primary, "Your taxes are going to be raised" to pay for Medicare For All. How much will taxes be raised? He did not say, but presumably they will raised an amount corresponding to the cost of providing the medical care to the population. In other words, everyone will still pay an insurance premium now called taxes, and the tax rate will never go anywhere but up. Why? Because every other nation with "free" health care finds it over-utilized and under-resourced. 

Take Canada, for example, which many politicos say can be a model for us. In reality ...

... Canadians' out-of-pocket health costs are nearly identical to what Americans pay—a difference of roughly $15 per month. In return, Canadians pay up to 50% more in taxes than Americans, with government health costs alone accounting for $9,000 in additional taxes per year. This comes to roughly $50 in additional taxes per dollar saved in out-of-pocket costs.  Keep in mind these are only the beginning of the financial hit from "Medicare for All." 

Canada's public system does not cover many large health costs, from pharmaceuticals to nursing homes to dental and vision. As a result, public health spending in Canada accounts for only 70% of total health spending. In contrast, Medicare for All proposals promise 100% coverage. This suggests the financial burdens on Americans, and distortions to care, would be far greater than what Canadians already suffer. ...  

More serious than the financial burdens is what happens to quality of care in a government-run system. Canada's total health costs are about one-third cheaper than the U.S. as a percent of GDP, but this is achieved by undesirable cost-control practices. For example, care is ruthlessly rationed, with waiting lists running into months or years. The system also cuts corners by using older and cheaper drugs and skimping on modern equipment. Canada today has fewer MRI units per capita than Turkey or Latvia. 

Moreover, underinvestment in facilities and staff has reached the point where Canadians are being treated in hospital hallways. Predictably, Canada's emergency rooms are packed. In the province of Quebec, wait-times average over four hours, leading many patients to just give up, go home and hope for the best.

The piper must always be paid. And so it shall be for us, but both in currency and in other than money. Medical care is always rationed. Always. And the rationing takes place within three areas:

1. Price to the consumer, presently mediated through 
1. insurance premiums and co-pays, and
2. Medicare and co-pays and Medicaid.
3. Under MFA, those will be taxes and HHS.
    
2. Quality of the care provided, mediated through 
1. the training of the physicians, nurses, and other medical staff
2. the quality and availability of medical supplies and equipment.
3. costs of the providers as related to price to the consumers.
    
3. Availability of the care, mediated 
1. always through the number of practitioners and where they work, and that is almost always mediated through compensation,
2. and by what medical specialties they practice, noting that this is heavily related to compensation also (see Megan McArdles' observation above). 
3. by limiting or even eliminating medical for some demographics, say by age, as now-suspended presidential candidate Mike Bloomberg said explicitly.

What we are falling into in this debate is the "Do something!" fallacy: 

1. The status quo is deficient, so something must be done!
2. This is something.
3. Therefore, this must be done. 

Absolutely anything can be justified by that template - and is being justified. But remember: medical care is always rationed, either by price and cost, or by quality, or by availability. When we go to the polls in November, we will not be voting for free health care for everyone. We will be voting only for how we want health care rationed in the coming years, and we will be merely hoping without any evidence anywhere in the world that it will be better than what we have now. 

Here is The New York Times in 2009: "Why We Must Ration Health Care."

Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.

The case for explicit health care rationing in the United States starts with the difficulty of thinking of any other way in which we can continue to provide adequate health care to people on Medicaid and Medicare, let alone extend coverage to those who do not now have it.

This is not where are now except for the VA. Which should tell us something.

Forbes covered the way health care works (well, doesn't work) in Britain: "Britain's Version Of 'Medicare For All' Is Struggling With Long Waits For Care."

Consider how long it takes to get care at the emergency room in Britain. Government data show that hospitals in England only saw 84.2% of patients within four hours in February. That's well below the country's goal of treating 95% of patients within four hours -- a target the NHS hasn't hit since 2015. Now, instead of cutting wait times, the NHS is looking to scrap the goal. ...  

The NHS also routinely denies patients access to treatment. More than half of NHS Clinical Commissioning Groups, which plan and commission health services within their local regions, are rationing cataract surgery. They call it a procedure of "limited clinical value." It's hard to see how a surgery that can prevent blindness is of limited clinical value. Delaying surgery can cause patients' vision to worsen -- and thus put them at risk of falls or being unable to conduct basic daily activities.  

"It's shocking that access to this life-changing surgery is being unnecessarily restricted," said Helen Lee, a health policy manager at the Royal National Institute of Blind People.  

Many Clinical Commissioning Groups are also rationing hip and knee replacements, glucose monitors for diabetes patients, and hernia surgery by placing the same "limited clinical value" label on them. Patients face long wait times and rationing of care in part because the NHS can't attract nearly enough medical professionals to meet demand. At the end of 2018, more than 39,000 nursing spots were unfilled. That's a vacancy rate of more than 10%. Among medical staff, nearly 9,000 posts were unoccupied.

Update, April 2022: Britain's National Health Care "care backlog grows to record high of 6.2 million" (HT: Guy de Boer).

But don't worry. We will be promised that it will different here. But there is zero reason to believe that American politicians and bureaucrats are magically more generous, more compassionate or smarter than Britain's. 

Or for that matter, Canada's, where the government determines medical care, and so uses that power to favor selected constituencies. In Canada, rare but expensive medical treatments go grossly underfunded while the government spends enormous sums on cheap treatments and meds that vast numbers of voters use. Like this:

A girl who died of leukemia was given a final send off after her friends signed her casket with loving messages on January 30.  

[…]Laura might have experienced a few more milestones if a Hamilton, Ontario, Canada, hospital had been able to accommodate a bone marrow transplant for the young woman. Numerous donors were a match with Laura and ready to donate, but Hamilton’s Juravinski Hospital didn’t have enough beds in high-air-pressure rooms for the procedure. Hospital staff told her they had about 30 patients with potential donors, but the means to only do about five transplants a month.  

[…]Dr. Ralph Meyer, Juravinski’s vice-president of oncology and palliative care, told Ontario’s TheStar.com there are plenty of others facing the same situation as Laura in Canada.

Free birth control immediately? Check. Free needles to inject illegal narcotics? Check. Free condoms? Check. Free abortions on demand? Check. Life-saving operation for a single leukemia patient? Not a chance. Leukemia patients are too few to form a voting block, so let 'em die. 

Then there is the Catholic-run hospice in Canada that the government is requiring closure because it refuses to kill its patients. 

A hospice in Canada has lost its funding and is being forced to close after refusing to offer and perform medically assisted suicides. The Irene Thomas Hospice in Delta, British Columbia, will lose $1.5 million in funding and will no longer be permitted to operate as a hospice as of February 25, 2021. 

Fraser Health Authority, one of the six public health care authorities in the province, announced on Tuesday that it would be ending its relationship with the hospice over its refusal to provide medically assisted deaths to its patients.

Anyone who thinks that none of this can happen under Medicare For All is living on a different planet than the rest of us.