Editor’s Note: This guest post was authored by two medical students at University College London
In the UK, healthcare is considered a basic human right and there is a social duty to ensure its provision. In the UK, the correlative obligation to provide healthcare is achieved through the National Health Service (NHS). So the question stands: within this paradigm, is it reasonable to expect universal government provision of healthcare? Before examining why all members of society may not truly have a right to healthcare under the current mechanism of provision, let us establish why society believes that it does.
Deconstruction of Rights, Beliefs and the Right to Universal Healthcare
To discern the underlying principles that differentiate a belief from a right it is necessary to define the two. A right is a commonly accepted value that society believes should shape our interactions with individuals and society as a whole. For example, those in a democracy sometimes believe in freedom of speech, often because unrestricted dialogue leads to a more productive democracy, and, consequently it is enshrined as a right. By scrutinizing an undisputed right – such as the right to life, we can crystallise the two distinguishing qualities of a right into two distinct tenets. Firstly, for something to qualify as a right in practice, the provision must be universal. Secondly, the supply must be unqualified.
A belief, on the other hand, is a proposition that an individual holds to be true and thus shapes their interactions with individuals, and society as a whole, but what distinguishes it from an actualized right is that there are no guarantees regarding its provision or supply. And the reason there are no assurances as there are with rights is because, rights are meant to be the indicator for the basic level of dignity a government accords a citizen. A pitfall that must be accepted here is that during a paradigm shift, a belief may become a right and a right may become a belief, by virtue of a transformation in how we think about morals.
What about the right to healthcare specifically? The most important right we all have is the right to life. However, the mechanism by which society “provides” this right is nebulous. There is no exchange of a real object that bestows life, or something akin to that. Fundamentally, the provision or supply of life cannot be controlled. Thus, there is little tangible policy to concretize what is meant by a provision of the right to life. In the modern era, the closest we can get in practice is to provide for a right to maintaining life, through healthcare.
However, if we can use the language of rights to argue that healthcare should be available, that doesn’t necessarily mean universal state provision. The second conclusion brings another moral principle into play, that the government is obligated to make provisions for the citizen, for example, through universal education.
At closer examination though, the rationale that best explains why governments are pre-disposed to protecting these rights is not because they are inherently moral or altruistic, but rather because they are working in their own best interest. Healthcare provision on an individual scale helps improve the wellbeing of that person, but the cumulative effect is that of a net societal benefit, as more people can actively contribute to society for longer. Society has a vested interest in maintaining a base level of health in the population.
The pivotal point in examining rights, is a return to the question of provision; nowhere in the definition of a right is the idea that it must be provided for all by the government. Although this may be a generally accepted idea, it is an extension of the right, not an integral part of it. A different practical arrangement could be both more efficient and remain morally acceptable. If the market can provide healthcare to some, the government only needs to step in for those who can’t afford the premium.
The modern conception of rights is no longer about aspiring to grandiose principles of governance, but rather, an arrangement between the state and the individual as how to best achieve sustainability without foregoing equity. The government should act in the most efficient way possible; that could mean market provision in some cases, and government might only step in and provide to those for whom the market fails to. The societal benefit is still present, but, there is no moral reason that the government have to carry the entire burden of provision.
Provision is not the giant upon whose shoulders we stand, but rather the ladder that ensures we can all stand eye-to-eye
It may be that not everyone has a right to governmental provision of healthcare, as the duty to provide it only exists when an individual cannot purchase the service from the private sector. Rights are not the great equaliser but are merely the basic constructs of society. It is through the targeted provision of these rights, in a society of universal access, that equity is truly achieved.
As a way forward in our moral thinking on healthcare, we argue that the government must be used to make certain that the lowest on the social gradient can be equal to the highest, without incurring any penalty, such as payment for these services. Direct public provision does not have to be universal, merely targeted, and hence, by definition, that it is not a right.
By Hygin Prasad Fernandez and Bilal Mateen