Healthcare is not a right

I often see the claim that “Healthcare is a right” used as an argument for universal healthcare. In fact, it is included in the Universal Declaration of Human Rights (bold mine):

Article 25.
(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
(2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

Unlike other rights such as freedom of speech, healthcare costs money to provide. There’s no natural healthcare that this right protects access to. To call this a right implies that someone has an obligation to pay for it. Yet those who can and usually do pay for this service through taxation are frequently those who can afford to pay for their own healthcare — and often choose to do so to get a better (perceived) quality of care for themselves.

In a society with no universal healthcare, those who can afford to pay for their own healthcare comfortably can prosper, and be secure in the knowledge that they will be looked after as long as they can afford it. Many will buy health insurance to pool risks with others, increasing their security further. Despite the reduced economies of scale, they are likely individually better off by not subsidising healthcare for those who can’t afford it themselves, at least if we take this narrow view.

It’s no wonder that many people reject “healthcare is a right” as an argument for universal healthcare. Most arguments along these lines elicit sympathy for those who can’t afford their own healthcare, but don’t justify the obligation for others to pay for it. I believe there are better, more compelling arguments for universal healthcare, which appeal to self-interest of those who end up paying for it. Here’s mine:

Those who can’t afford to pay for their own healthcare comfortably will be able to contribute to society and work towards prosperity for as long as they or their dependents don’t need healthcare. However, as they also likely don’t invest in much preventative care, they are more likely to need healthcare than those who can afford to pay for it. And when they do need it, they will find themselves and their families vulnerable. Their condition will worsen, and they will face tradeoffs between healthcare, education, food, or even work. They won’t always choose the best option, even when that option is clear to others.

Their vulnerability inevitably creates more vulnerability. The natural consequence of vulnerability is desperation, and hence, even less rational decision making. Rather than investing rationally in their own future, they fight for their present, perhaps at the cost of their future. Their ability to contribute to society decreases, and at the same time, their discontent increases. Their children lose opportunity to exercise their own talents and contribute to society in future. They and their children become stuck in a poverty cycle.

No matter how society is run, the more people in this situation, the worse it is for all of us. We all lose the benefit of their (and their children’s) lost productivity, we lose a large base potential customers for our own work, and we create a problem — what to do with a growing population of desperate and unproductive people. If we live in a democracy, we also have a growing group of vulnerable voters who are susceptible to the politics of blame, or to vote-buying, yet who are making less rational decisions.

I don’t want to live in that society, and I don’t think most other rational people do either, whatever their political persuasion. Universal healthcare is not just for the people it benefits directly. It’s a mechanism to create prosperity. It enables people who are unlucky or who make mistakes, and their dependents, to recover and become productive again after falling. It enables people who otherwise need to care for a sick dependent to be able to work productively as well, and not be forced to decide between working and caring. It enables people to take a risk, to change career, or start a business. Many of these risks will pay off, and if history is a guide, the returns are likely to outweigh the costs. The end result is a society where more people are more productive, and this benefits everyone.

That doesn’t mean that the wealthy should pay unlimited taxes to fund unlimited healthcare for everyone, nor the end of differentiated service or a user-pays system. It just means we need to find a rational and cost-effective way to provide the right level of healthcare to maximise the productiveness of society, and structure it in such a way that encourages people to make good decisions for their own well-being. The only way to do this is to have the right metrics — we need to measure how many people are taken out of the workforce, or making suboptimal career decisions, because of the healthcare needs for them or their dependents.

When we move away from the “healthcare is a right” claim, the discussion can become data-driven, and hence, rational. It can be framed in terms of self-interest for all, rather than a subsidy from some to others.

Thoughtful readers will also notice that this same set of arguments applies to a number of other social services which are often claimed to be rights. In particular, the other items listed in Article 25 of the UDHR quoted above (eg food, clothing, housing … the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control), as well as education, and various workers’ rights. Claiming that these elements of a social safety net are “rights” is implying an obligation to pay for others without regard to the benefit derived from doing so. In all of these cases, we should be talking about how best to create a productive society for the benefit of all, not how to force people to pay for the realisation of these rights.