Hobbes & Health Care
The health-care debate should begin with one simple lesson: Once we establish that everyone has a right to health care, nobody will have a right to health care.
The reason why such things as "death panels" and rationing are inescapable when government takes over health care is because we will be sacrificing the health of some individuals for the sake of greater social health. This is a utilitarian calculation, and utilitarianism denies that individuals have rights that cannot be violated even if that sacrifice produces a greater good for a greater number.
As former Lieutenant Governor of New York Betsy McCaughey has pointed out, Ezekiel Emanuel, health-care adviser to President Obama, insists that we need to "redefine a physician's duty... that it now includes working for the greater good of society instead of focusing only on a patient's needs."
Intellectuals like Peter Singer, the Princeton "ethicist" who has argued in favor of infanticide, are ready with the calculators and formulas such as "quality-adjusted life-years," which he explained in a recent article entitled "Why We Must Ration Health Care."
This is what happens when we call health care a "right." And the confusion of "rights" and "entitlements" is the chief legacy of New Deal liberalism. For decades now we have been following the path of Thomas Hobbes, who explained that we must surrender all of our natural rights to an all-powerful sovereign, rather than that of John Locke, who argued that the sovereign power of the government was limited to the protection of our individual natural rights.
In a 2001 interview on Chicago public radio, Obama lamented that "the Supreme Court never ventured into the issue of the redistribution of wealth." The problem, he said, was that the court "didn't break free from the essential constraints that were placed by the Founding Fathers in the Constitution... that generally the Constitution is a charter of negative liberty."
In this perhaps unguarded moment, Obama became one of the few liberal politicians candid enough to admit that the Constitution poses a fundamental obstacle to their agenda.
This is a popular theory in academic circles. It is the fundamental argument of Cass Sunstein, a colleague of Obama's at the University of Chicago Law School, now his Czar of Regulation, and the author of The Second Bill of Rights: FDR's Unfinished Revolution and Why We need it More than Ever.
The second bill of rights idea derived from two famous speeches that Franklin Delano Roosevelt gave--one at the San Francisco Commonwealth Club during the 1932 campaign and his 1944 annual message to Congress. In the Commonwealth Club address, he spoke of the advent of "enlightened administration," which would redistribute resources in accordance with an "economic declaration of rights." In his 1944 message to Congress, Roosevelt said that "our rights to life and liberty"--the negative liberty to which Obama referred, had "proved inadequate to assure us equality in the pursuit of happiness." He claimed that "In our day these economic truths have become accepted as self-evident. We have accepted, so to speak, a second Bill of Rights." This bill of rights included the right to a job, the right to food and recreation, the right to adequate farm prices, the right to a decent home, the right to medical care, and the right to a good education.
Of course, these are not "rights" at all--not in the sense that the framers and ratifiers of the Declaration of Independence and Constitution used the term--but entitlements. From the founding until the twentieth century, the American regime assumed that government's purpose was to secure pre-existing natural rights--such life, liberty, property, or association. Everyone can exercise such rights simultaneously; nobody's exercise of his own rights limits anyone else's similar exercise. Your right to life or to work or to vote does not take anything away from anyone else. We can all pursue happiness at once. Entitlements, on the other hand, require someone else to provide me with the substantive good that the exercise of rights pursues. The right to work, for example, is fundamentally different from the right (entitlement) to a job; the right to marry does not entitle me to a spouse; the right to free speech does not entitle me to an audience.
The New Deal is often described as a "constitutional revolution." In fact, it was much more than that. It involved a rejection not just of the structure and principles of the Constitution, but those of the Lockean theory of natural rights in the Declaration of Independence--that, as Jefferson put it, governments are instituted in order to secure our rights. Roosevelt envisioned not a new constitution, but a new idea of what Sunstein calls "a nation's constitutive commitments." Indeed, the Declaration of Independence really was a "bill of rights," which commonly preceded constitutions.
The first bill of rights and the second bill of rights are simply incompatible. The achievement of the second requires the repeal of the first. As to this problem, Sunstein says that "The best response to those who believe that the second bill of rights does not protect rights at all is just this: unembarrassed evasion."
Unfortunately, once government gets into the habit of providing entitlements instead of protecting rights, it's hard to stop. Government is largely responsible for the health-care crisis, by creating the employer-based system of insurance during World War II, then adding Medicare and Medicaid in the 1960s, so that very few Americans realize what they pay for health care, or who pays it.
Government interventions aggravate social problems, and those government-created problems become the basis for further interventions: This is how we descend from Locke's world into Hobbes'.
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Dr. Moreno is Dean of Faculty and the William and Berniece Grewcock Chair in Constitutional History and Associate Professor of History at Hillsdale College in Hillsdale, Michigan.
Dr. Moreno is so right. The effect of making health care universal is that more people will have it, and in the end fewer people will have it.
Right now, illegal aliens go to an emergency room, where they get all the health care they need, including lifetime supplies of medication. Obama wants to deny health care to illegal immigrants. This means, of course, that we will all have to carry our birth certificates with us. This will lead to a national identity card. So everyone will have to carry a national identity care and be unable to get health care because the facilities will be so overcrowded. This will mean a weakened, sickened population of true Americans who will all carry identity cards, making it possible for Obama and his Acorn thugs to take over everything.
The only way to keep true hard-working Americans healthy is to keep the poor and the illegal immigrants out of our health-care facilities.
It has always seemed to me that the basic tenets of Utilitarianism work quite well as a basis for guiding individual, ethical choices; however, they fail miserably as the guiding principles for ethical government decision-making. As an example, consider the classical military dilemma (which actually occurs in every modern war our country has fought): A soldier finds himself in a situation in which a hand grenade has been thrown into the midst of his squad. He is personally in a position that would permit escape; however, his squad mates are not able to do so. The soldier opts to throw himself on the grenade, thereby knowingly sacrificing his own life to save the lives of his squad. Soldiers are neither trained, nor expected, to do this; nevertheless, whenever such an act occurs, we reward it (posthumously) with the highest decorations for valor, and laud the individual for his “conduct above and beyond, the call of duty.” Thus, the sort of altruistic behavior guided by the utilitarian principal of (as Star Trek’s Mr. Spock would say) “the good of the many, outweighs the good of the few,” is clearly seen by the society, as ethically good, even admirable, behavior. Now imagine the same situation, except with the government REQUIRING soldiers to behave in this way, and punishing them (an obvious corollary, necessary to enforce this sort of requirement) for not doing so. This principle is actually in effect in some situations that have exceptionally dire military consequences, such as cowardice in the face of the enemy (i.e., running away in combat). These occasions are extremely rare, and, while the officer in charge is technically authorized to shoot those who run away on the spot (to maintain unit discipline), it is virtually never done, and such cowardice is always seen as a personal moral failing of the individual who ran, rather than primarily as an infraction of government regulations. In the context of healthcare, we tend to see a moral injunction to do things like take a flu shot to help prevent the spread of disease, and the more serious the disease (I remember when EVERYONE got a Smallpox vaccination, despite the risks, and no one complained), the stronger the injunction. The government’s role in all this should be more along the lines of teaching the individual principles by which we would like our citizenry to be guided (through our public school system), alerting citizens to the dangers when they occur (through notices from the CDC, etc.), rather than attempting to coerce what they see as “proper” behavior from the citizens. It is the government’s proper role to publicize the danger of severe head injury when riding a motorcycle without a helmet; however, it is beyond their mandate to coerce (through fines or imprisonment) the use of helmets. When the government is guided by utilitarian principles, the public is actually prevented from engaging in altruistic, morally “good” behavior, because it is being forced upon them, and is then in their self-interest, rather than altruistic in nature. For this reason, it is the proper role of our government to increase the citizen’s personal freedom and liberty wherever possible, in order to permit the exhibition of good moral behavior. To return to the military analogy, the alternative is to create a situation in which soldiers are regularly being court-martialed for their failure to throw themselves on hand grenades, rather than honored for their courageous behavior when they do.