Over the past few weeks, political junkies have been engrossed in the intricacies of healthcare policy. In cafes around D.C. you’re more likely to overhear conversations about essential health benefits and the cadillac tax than weekend plans or last night’s Nats game. However, underlying every debate over the minutiae of the GOP plan to upend Obamacare, there is a fundamental question that begs answering: is healthcare a right? Lawmakers are deeply divided on this issue, as libertarian leaning Senator Rand Paul argues that stabilizing the insurance market is no more important than stabilizing the new car market, while Democratic Senator Cory Booker has plainly stated his belief that that healthcare is a human right. In order to answer a question as contentious and consequential as this, it would be wise to first understand how our country decides what is and is not a right.
The Declaration of Independence states that all men are “endowed by their Creator with certain unalienable Rights.” This is a noble sentiment, and one that carried great weight in a time when monarchs enjoyed near absolute rule over their subjects. However, when one critically examines the Bill of Rights, crafted by some of the very same men who wrote the Declaration, it is clear that the rights they reserved stray far from principles in any religious belief. I don’t recall the Bible verse in which Peter wrote no soldier will be quartered in any house without permission from its owner or the section of the Quran declaring the right to petition, and as far as I can recall, my Torah portion did not disallow cruel and unusual punishment. And when it comes to amendments made after the original ten, I have a hard time believing that God decided it would be best to prohibit alcohol in 1919 only to change his mind in 1933.
What is considered a right is a reflection of the values of our time. As moral standards, social conventions, and technology change, so do our conception of what is and is not a right. In the mid 19th century it was the right of the slave owner to have his “property” returned in the event of an escape, but a century later it was declared that African American children have the right to attend integrated schools. Rights upheld by the political system are products of that same political system, which in this country is ultimately shaped by We the People.
So if rights are created by us, what is the best standard for us to decide what is considered a right? Perhaps the most well known answer to that question is John Rawls’ thought experiment in his work A Theory of Justice. Rawls begins from a simple premise that the most important factor in determining our quality of life is completely out of our control: who we are born as. The parents we are born to, the community we are raised in, the time period in which we are born, our genetic makeup, our race, and so much more are entirely out of our control. Yet, those factors are almost entirely responsible for what kind of life we will lead. While free will may play a role life outcome, the statistics support Rawls’ claim, as a National Bureau of Economic Research study shows that future income is best predicted by your parents’ income, marriage, and locational choices, all of which are out of your control.
Because we don’t choose what conditions we are born under, Rawls argues that to achieve justice we should decide how to structure society from behind the “veil of ignorance.” The “veil of ignorance” is a hypothetical state in which we don’t know who we will be born as. We don’t know our gender, status, parents, or any other factor out of our control. Behind the veil we can make the most objective and rational determination of how to shape society absent of self interest or preconceived beliefs.
So for a moment, let us step behind the veil of ignorance and consider healthcare in the U.S. We don’t know who we will be born as, but we do know a lot about the society we are entering. We know that this nation is the most wealthy to ever have existed, one that spends more money on its military than the next eight countries combined, one in which the Kardashians have a combined net worth over $450 million.
We also know that medical science is making incredible strides, with the ability to restore sight to the blind, attach bionic limbs to amputees, and fight cancer like never before. But we know that prices are astronomically high, as the U.S. spends more on healthcare per capita than any other nation. At the same time, income growth has staggered in recent decades and for the first time the youngest working generation makes less money than their parents. If you were behind the veil of ignorance with all that information at your disposal, would you make healthcare a right?
The great weakness of Rawls’ thought experiment is that we will never know what someone behind the veil of ignorance would choose. Rawls argued that a rational person would support a social safety net because if they were born in unfortunate circumstances than they would desire a least a minimal quality of life. If someone had an equal chance of being in the bottom 1% as the top 1%, then they would probably make life better for the bottom 1% even if it made the top 1%’s life a little bit worse in the form of higher taxes. Undeniably, healthcare is a vital component to well being, and I believe that if most people were behind the veil of ignorance, they would make healthcare a right.
That is not to say that I am necessarily in favor of single payer healthcare. As Antonin Scalia wrote in D.C. v. Heller, rights are not unlimited. Despite the Second Amendment, the government can regulate the purchase of firearms in order to uphold its core duty of protecting the public. Likewise, if universal healthcare were to cost the government so much money that it could no longer perform other duties such as funding public schools, than the right to healthcare could be restricted. I do not proport to be an economist, and this column is making a value argument, not a quantitative one. However, I will just say that nearly every other developed nation in the world other than the U.S. has decided that universal healthcare is best for their population.
Another criticism of healthcare as a right, one leveled by a writer in this publication, is that it will not lead to better health outcomes. “After examining other countries’ universal healthcare systems and comparing mortality rates from preventable diseases, it’s clear to assert that these countries are no better off with a universal healthcare system than publicly funded systems in terms of what actually improves overall health. The evidence demonstrates that healthy diet, nutrition, exercise, and healthy lifestyles are all that’s required, and not how many people are insured under a universal healthcare system,” one Soapbox author writes. While I am all for healthy lifestyles, the personal responsibility mantra is not applicable to the insurance market because not all diseases are preventable. Should we tell the person born with cystic fibrosis that they should just take a few laps around the track? Should we suggest to the person who suffered brain contusions from getting T-boned at an intersection to just eat more fruit? Or perhaps we should tell the nine-year-old with leukemia that he should just count his calories and he’ll be fine? If you get one thing out of Rawls’ thought experiment, let it be that you are lucky to be who are. You could have just as easily been born in a far worse circumstance.
The fate of the American healthcare system is still unknown, but what is clear is that the debate over healthcare’s role in our society will be one of the most impactful issues of our time. Between all the smearing, mudslinging, and grandstanding that will go on the the political realm, I implore you to think about the people who will live or die based on what gets passed, and realize that the only difference between you and them is who you were born as.