What do we mean when we use the word “rights?”

The following quote has often been attributed to Benjamin Franklin. I am not sure who said it, but it certainly fits with the aim of the founders relative to our rights:

“The U.S. Constitution does not guarantee happiness, only the pursuit of it. You have to catch up with it yourself." --

Lately this word has been thrown around quite a lot. What do we mean by the word “rights?” Who has them? Who is obligated to see that the right is fulfilled and not infringed upon? Many of us first heard the word “right” as it was used in the Declaration of Independence; we have the right to life, liberty, and the pursuit of happiness.  Let us consider this word “right” as we use it in four ways:

Claim right:  A claim right is a right which entails responsibilities, duties, or obligations on other parties regarding the right-holder. If I hold the “mineral rights” to my property, then I must be paid by someone who expects to extract these minerals. 

A liberty right or privilege, in contrast, is simply a freedom or permission for the right-holder to do something, such as freedom of speech, press or assembly. There are no obligations on other parties to do or not do anything. I can show up at “Speaker’s Corner” in London and talk about anything from the demise of the earth according to the Mayan Calendar to monetary policy in the US. 

Natural rights: Natural rights are rights not contingent upon the laws, customs, or beliefs of any particular culture or government, and therefore universal and inalienable; are rights which are "natural" in the sense of "not artificial, not man-made.”[i] They're sometimes called moral rights or inalienable rights.  John Locke (1632–1704) proposed that there are three natural rights[ii]:

• Life: everyone is entitled to live once they are created.
• Liberty: everyone is entitled to do anything they want to so long as it does not conflict with the first right.
• Estate: everyone is entitled to own all they create or gain through gift or trade so long as it does not conflict with the first two rights.

Legal rights, in contrast, are based on a society's customs, laws, statutes or actions by legislatures. Legal rights are sometimes referred to as civil rights; the right to vote, serve on juries, etc. 

Many people in politics and government routinely refer to healthcare as a right. If healthcare is a right, who is obligated to give you healthcare? How did you earn this right? What are you giving in return? In 2009, John D. Lewis, PhD, at Duke University wrote:[iii]

“…the very idea that health care -- or any good provided by others -- is a 'right' is a contradiction. The rights enshrined in the Declaration of Independence were to life, liberty, and the pursuit of happiness. Each of these is a right to act, not a right to things...”

Professor Lewis elaborates further: 

“These two concepts of rights -- rights as the right to liberty, versus rights as the rights to things -- cannot coexist in the same respect at the same time...To reform our health care industry we should challenge the premises that invited government intervention in the first place. The moral premise is that medical care is a right. It is not. There was no 'right' to such care before doctors, hospitals, and pharmaceutical companies produced it. There is no 'right' to anything that others must produce, because no one may claim a 'right' to force others to provide it. Health care is a service, and we all depend upon thinking professionals for it. To place doctors under hamstringing bureaucratic control is to invite poor results."

So if healthcare is not a right in term of rights as defined by the four above, is healthcare a moral obligation on the part of the population who can provide help? Many people would answer “no” and feel that they have given at the office through their taxes. After all, isn’t the government taking care of healthcare now with Medicare and Medicaid? Did we not pass legislation in 1986 that requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay[iv]? So what is the problem? 

Something has happened. My wife’s grandfather was a doctor during the depression. When people could not pay they would bring him a chicken or other food from the farm. Recently, my wife had a two hour stay in the Emergency Department with a kidney infection that resulted in an $18,000 price tag. Of course we were happy that our bill was only $500.00. We will be happy until our insurance goes up once again to pay for a healthcare system that is out of control. Every test known to the medical profession was run. What is worse, this was all predicted to me by a nurse as I was driving to pick my wife up. He told me, “Given the symptoms you have described she probably has an infection. They should call the family doctor for history and give her the required antibiotics.” Instead, he said, “they will run a CAT scan that will add another $3000 to the bill.” So we were more than shocked when the CAT scan test was listed at $8000 as part of the total $18000 bill!

What can we do to bring the patient and healthcare professionals closer together in the service exchange to minimize the influence of structure that is adding cost but not value? Reducing the costs will allow us as a society to better meet our moral obligations to those who cannot pay for care. This will be the focus of our next topic on this blog.

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[i] Natural Rights: http://en.wikipedia.org/wiki/Natural_and_legal_rights

[ii] John Locke on natural rights: http://en.wikipedia.org/wiki/Natural_and_legal_rights

[iii] Aug. 12, 2009 Huffington Post article "Health Care, Why Call It a 'Right'?" by John David Lewis

[iv] Emergency Medical Treatment and Active Labor Act http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act