Is health care a service or a right?

John Mackey, co-founder and CEO of Whole Foods, caused quite a stir recently with this post on the Wall Street Journal web site. Sensational exaggerations and knee-jerk boycotts aside, while his statements may seem to make sense, there is a fatal flaw in his reasoning that I've not seen anyone call him on, at least not in a reasoned way. The core of his argument comes down to this:

Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That's because there isn't any. This "right" has never existed in America.

So is health care really a service, not a right? If a bleeding car crash victim staggers into an emergency room, can they be turned away? There is nothing wrong with denying service, right? A restaurant can refuse to serve a shirtless or shoeless person. But even the most hard-line conservative is not going to advocate denying emergency room service to a person in need. I would argue that a service that cannot be denied is a right.

Obviously, we have no trouble denying some medical services to the uninsured, which turns American emergency rooms into their primary source of care. If a problem is not serious enough to drive someone to an emergency room, they do without care. And if the problem becomes more serious, that's exactly where they go, even if it's something that could have been prevented easily with earlier treatment. This is one of the primary reasons American health care is in such trouble. Even aside from the cost in suffering and unnecessary deaths, it would be far cheaper to provide the service of early treatment to the uninsured than to treat them only when they are in serious need.

Another problem with Mackey's point is this: even if health care is a right, that does not mean "equal access to doctors, medicines and hospitals," which sounds like some kind of communist system. Virtually every other developed nation in the world has designed systems based on the idea of health care as a right, and nowhere is there any pretense of "equal access." People who have enough money can always get extra care and have more choices, being able to afford travel to the doctor or hospital they want. The right of freedom of speech does not mean equal access to mass media; the right to keep and bear arms does not mean everyone gets a gun for free; the right to work does not mean we can all do whatever job we choose.

Mackey mentions that there are no rights to food or shelter either. I would like to point him to the International Covenant on Economic, Social and Cultural Rights, which the US has signed but never ratified. Of course, that Covenant also mentions health care as a right, along with other things that many Americans do not consider human rights, but "desirable goals." Which puts the US in the odd position of claiming to be one of the world's foremost proponents of human rights while simultaneously being one of the nations with the narrowest definition of human rights. Our view is that it would be nice if everyone had enough to eat, but there is no intrinsic right to avoid starving to death. So not only is it acceptable to not help starving people, but it is also acceptable to deny people food if they don't meet some standard of merit. After all, this is not a human right, but a service that can be denied.

Am I reducing Mackey's argument to the point of absurdity? Maybe, but I think his argument is at its core flawed and even of questionable morality. He says health is not a right, and I don't know where he draws the line.

He uses the Declaration of Independence and the US Constitution as the only definitions of human rights. Well, a lot has changed in 200 years, and maybe those are not the only documents that should be used. I've mentioned the International Covenant on Economic, Social and Cultural Rights, and there's also the Universal Declaration of Human Rights, widely regarded (outside the US, I suppose) as the Gold Standard of rights documents.

Mackey also goes on to raise the specter of horrendous waiting lists for medical care in Canada and the UK. This is a false argument and misdirection of attention. Which is better, 830,000 Canadians on waiting lists for care, or millions of Americans who get no care at all? But that's really a different topic for another day.