The Logic of Liberty: Whose Responsibility Is Your Health?

I recently had an (imagined) conversation with my friend Julius, who calls himself a socialist. We met for coffee late on Christmas Eve and spoke about the Senate's vote. Remember: it is not too late to contact your Congressperson to limit the worst excesses of the coming health care bill.

Julius: It's a day of celebration!

Me: I thought you hated Christmas.

Julius: Don't be a putz; you know what I'm talking about. The Senate has finally recognized our rights. It's time to party!

M: A right, eh? So what responsibility is induced by that right?

J: Oh, I'm too happy to be bothered by your technical questions. But I'll play along because you have such a sad face. It will be my Christmas present to you. Besides, the answer is easy: The responsibility is clearly the government's.

M: So it's "easy," is it? Aren't you the one who is always deriding others for their "simple" views of "complex" issues? Anyway, it isn't nearly as easy as you think.

J: My, aren't you the sour one. However, I remain cheerful. Our government has finally joined the international community in recognizing the rights of its citizens to health insurance.

M: Who, then, is the government?

J: The president, our wise Senate, and so on. I told you it was easy.

M: So you claim that just the president and members of Congress, and presumably its attached bureaucracy, is the government?

J: Of course.

M: Then the full responsibility for providing health insurance falls to this small group of people?

J: In a manner of speaking.

M: What manner? Surely, you aren't claiming that these few people will pay the health care expenses out of their own pockets.

J: Of course not. They will administer the costs; that's what I meant.

M: I assumed that's what you meant, but I want to know where those funds are coming from. You claim it is the government's responsibility, but then you say the members of the government won't actually be the ones paying. So it appears the actual responsibility lies elsewhere. Where?

J: Come on, don't be so obtuse. You know that the money will come from taxes.

M: And the taxes will be paid by me and you, and other citizens?

J: Yes.

M: So then, what you're saying is that the responsibility is mine, and it is yours.

J: If you want to get technical.

M: I do. It comes to this: we, the citizens, are "the" government, are we not?

J: I guess so.

M: The government is not some abstraction, some far off, beneficent entity, but real people. People like you and me. When you're always crying for "the government" to pay for this or pay for that, what you're really saying, is that I should pay for this, or that I should pay for that. Is that right?

J: Well, yes, I suppose so. But I know you agree with me that since you are a citizen, you have a responsibility to contribute to our society.

M: Unquestionably. I just want to see what the limits of those responsibilities are. Just as I want you to see that when you ask the government for money, you are really asking me for my money.

J: Oh, you can afford it, else you wouldn't be blowing three bucks on this overpriced coffee.

M: Maybe. But let's find out. What new right do you claim that Senate created in their vote?

J: The right to health insurance, naturally.

M: I think you misspeak. Even you would agree that health insurance is not the same as health. Are you sure the "right" you're claiming is health insurance?

J: Everybody knows that health insurance ...

M: Let's not bother with what everybody knows. Let's figure out what we know. You agree, do you not, that having insurance is not equivalent to having health?

J: Not directly.

M: If not "directly," then not at all. Insurance does not bring health, care (from medical specialists and so forth) and certain ways of living do that, am I right?

J: You are. But insurance pays for that care.

M: Once more, you are in a rush to jump to the simple answer. Let's go a little slower. I don't think we have reached an adequate definition of the new right. We need that so that we can figure what responsibilities are induced by that right. We have already agreed that these responsibilities are mine, and yours, so it is well that we understand them.

J: Then the right I mean is health. After all, the Senate was following the Constitution when it said we should promote the "general welfare." Our citizens should be as healthy as possible.

M: I think you should have some more coffee, because you aren't awake yet. You cannot possibly mean what you just said.

J: I do mean it.

M: Then let's discover where the statement "as healthy as possible" leads. To guarantee your optimal health requires that I spare no expense, time, or effort, that I withhold from you no test or treatment, no matter how speculative, that I follow behind you with a safety net, even, lest you fall. Further, since you agreed that each citizen has the same responsibilities, each of us would have to spend the same effort for each other person. We would become a society where all that mattered was health.

J: If I weren't wearing these sunglasses, you'd see me rolling my eyes. You know that the right to optimal health is not what I meant. It was clear that "health" means to be cared for in a manner which is reasonable. If I don't have money, I should be given it so that I can seek care when I need it.

M: It was not clear what you meant; but now we're getting somewhere. However, you left something out, which will be obvious once we decide how much of the responsibility for your health is mine, and how much is yours.

J: I'm not sure I follow you.

M: We already agreed that the responsibility for your health is not solely mine, and that you share some of it. We're just trying to figure your portion. For example, we are as sure as can be that smoking causes a lack of health. Does your right to health require a law mandating you to stop smoking?

J: I could give up smoking. I was going to quit anyway.

M: Good. But how about chips, ice cream, cheap hamburgers, and other artery-clogging foods? These can certainly cause you to lose your health.

J: Dieting is no problem. I'm a little heavy as it is.

M: Drugs -- you know the kind I mean -- are also out. And how about driving a car? That really ups the chances of injury or death.

J: Wait a minute! I clearly have a right to drive!