The rights angle.

• Author: Kelley, David

Ideas and their health-care consequences

PRESIDENT CLINTON, WHO RAN FOR OFFICE by attacking the hostile takeovers of the 1980s, is now proposing a hostile takeover of his own, a hostile takeover on a scale far beyond anything that Wall Street capitalists ever dreamed of, a hostile takeover of one-seventh of the nation's economy--the health-care industry.

The Clinton plan in its present form involves a massive increase in government control over physicians, insurers, employers, and--last but certainly not least--the patients who are supposed to be the beneficiaries of the plan. Most people will be forced to obtain their health insurance through purchasing cooperatives: government-backed monopolies that collect payments from consumers and set the terms on which medical providers can offer their services. Everyone will be forced to buy health care through these monopolies, with employers forced to pay the lion's share of the bill. Physicians, hospitals, and HMOs will be prohibited from dealing with patients directly; they will be forced to offer their services through the purchasing cooperatives, subject to highly restrictive rules.

What has brought us to this state of affairs? Socialism has collapsed in the Soviet Union. The nations of Western Europe are trying to trim back their welfare states, desperately looking for ways to privatize. Yet in this country we are on the brink of a massive increase in government subsidies and government controls. Why ?

The full story is a long and complicated one, but the essential cause is simple. It is the assumption that if people have medical needs which are not being met, it is society's responsibility to meet them. In the current debate over health-care reform, universal access has become the unquestioned goal, to which all other considerations may be sacrificed. It is the one point on which the Clintons have declared themselves unwilling to compromise. The assumption is that the needs of recipients take precedence over the rights of producers--the rights of physicians, hospitals, insurers, and drug companies, as well as the rights of the taxpayers who are going to have to pay for it all. In other words, those with the ability to provide health care are obliged to serve, while those with a need for health care are entitled to make demands.

Indeed, it is often said that the need for health care constitutes a right. President Clinton campaigned with the slogan, "Health care should be a right, not a privilege." Opinion polls regularly show that the belief in such a right is widespread, even within the medical profession. If health care is a right, then government is responsible for seeing that everyone has access to it. It is this idea that has driven health-care policy for the past 30 years. A "right" to health care was granted to the poor through the Medicaid program and to the elderly through Medicare. Now the Clinton administration proposes to create a universal entitlement and vastly to expand government control.

But there is no such right. The attempt to implement this alleged right leads in practice to the suspension of the genuine rights of doctors, patients, and the public at large. Indeed, the very concept of such a right is corrupt in theory.

Liberty vs. Welfare Rights

A RIGHT IS A PRINCIPLE specifying something that an individual should be free to have or do. A right is an entitlement, something you possess free and clear, something you can exercise without asking anyone else's permission. Because rights are entitlements, not privileges or favors, we do not owe anyone else any gratitude for their recognition of our rights. When we speak of rights, we invoke a concept that is fundamental to our political system. Our country was founded on the principle that individuals possess the "unalienable rights" to life, liberty, and the pursuit of happiness. Along with the right to property, which the Founding Fathers also regarded as fundamental, these rights are known as liberty rights, because they protect the right to act freely.

The wording of the Declaration of Independence is quite precise in this regard. It attributes to us the right to the pursuit of happiness, not to happiness per se. Society can't guarantee us happiness; that's our own responsibility. All it can guarantee is the freedom to pursue happiness. In the same way, the right to life is the right to act freely for one's self-preservation. It is not a right to be immune from death by natural causes, even an untimely death. And the right to property is the right to act freely in the effort to acquire wealth, the right to buy and sell and keep the fruits of one's labor. It is not a right to any kind of dowry from nature or from the state.

The purpose of liberty rights is to protect individual autonomy. They leave us responsible for our own lives, for meeting our own needs. But they provide us with the social conditions required to carry out that responsibility: the freedom to act on the basis of our own judgment, in pursuit of our own ends, and the right to use and dispose of the material resources we have acquired by our efforts. Liberty rights reflect the assumption that individuals are ends in themselves who may not be used against their will for social purposes.

We should consider what these liberty rights mean in regard to...