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The Logic of Liberty: Whose Responsibility Is Your Health?

M: Aren't you always telling me that cars release pollutants into the air? Those can't be good for health.

J: You know what I meant.

M: I didn't. But I think what you're hinting at is that you should be allowed the possibility of compromising your health in exchange for other benefits, or to enjoy the occasional excess. Driving or flying, for instance. Or having Thanksgiving dinner, a hot dog at the ball game, and so on.

J: It seems reasonable.

M: It isn't. It doesn't follow from your responsibility to maintain your health. If you believe that you have a responsibility, just as you say I have, for your health, then we should make it illegal for you to engage in behaviors that would affect your health adversely. If not, then you are asking to get away with whatever you like, and have society pay the bills to patch you up.

J: OK, I understand. What if I agree to wave my right to health in those cases where my lack of health was directly attributable to my own behavior? But then you'll have to agree to restore me to health when the cause was external.

M: The first part of your bargain is acceptable. I'm not sure about the second. Can you explain it more fully?

J: Suppose I, out of the blue, develop cancer and I can't pay for treatment. That kind of thing.

M: I notice you start with a dread disease, an extreme. Let's start at a lower level where we are less apt to make a mistake. I'll instead suppose you develop a planter's wart, which is certainly a departure from health. Should I be required to pay for its removal?

J: Maybe not.

M: How about we put the wart on your nose. Should I pay to have it cut away and restore your good looks?

J: Well ...

M: Or suppose you developed a hangnail. Or zits. How much should I contribute to your acne wash funds?

J: Nobody is asking you to pay for trivials!

M: Aren't you? OK, suppose you only thought you had cancer and you sought care. But it turned out to be nothing, a false alarm. Should I pay for your hypochondria?

J: It isn't always easy to know when to go to the doctor. Better safe than sorry.

M: Perhaps, but that's an evasion. Should I pay? After all, even if I agree to pay for your care when the cause of your lack of health was external, in this case there was no lack of health. If you insist I pay, then this isn't a right to health you're claiming, but an entirely new right. We can call it a right to "peace of mind."

J: There is mental health, you know.

M: Of course there is. But your mistaken doctor visit cannot possibly weaken your mental health; if anything, it strengthens it.

J: I'm sensitive.

M: Don't I know it. But should I pay? You still haven't answered.

J: I guess not. However, now you must answer: Will you pay for my real cancer?

M: First answer this: Is your cancer treatable of fatal?

J: If it makes any difference, fatal.

M: OK, you have incurable cancer, for which, by definition, there is no treatment. All medical costs are thus solely for your comfort, because you cannot be saved.

J: I suppose so.

M: Then can't you see that you have invented for yourself the "right" to be comfortable?

J: Why should I be in pain?

M: Indeed. But if you are and you're going to die, why should I pay for your comfort? I mean, why should I legally have that responsibility? I might, of course, desire to alleviate your suffering out of compassion.

J: Ha! What do you conservatives know about compassion?

M: I'm surprised that you think such a blatant non-sequitur answers me. Surely you can see how unlimited and ridiculous a 'right' to comfort can be; there would be no end of applications for the lack of it.

J: I suppose you shouldn't be forced to pay. And now I see why you wanted to differentiate between types of cancer. But since I've agreed with you that I should be responsible for small departures from my own health or for my comfort, let's suppose my cancer is treatable. Cancer is clearly different than indigestion, a common cold, and so on, and if left untreated it will kill me. I say that you should pay for my care. And since I'm on to you, I do not mean those costs that are not associated with the treatment of the disease. I'll even beat you to the joke and say that I will pay for my own Jello in the hospital.

M: You're learning, Julius. But tell me this: Do you have the money to pay for the treatment? If you do, then you already know that you have no solid reason for demanding my money. Shall we amend your scenario and say that you haven't the funds to pay?

J: Grudgingly. I don't like the idea of having to pay for the whole thing myself, even if I have the funds. It could turn out that paying bankrupts me.

M: Then why not buy insurance? You could write a contract to indemnify yourself, even against trivials.

J: Aha! You think you have scored a point, but we are back to the beginning. You have talked yourself into a circle! If you agree to pay for my externally caused departures from health, why not just pay for my health insurance, and save yourself some money?

M: Someday I'm going to have to teach you math; then at least you'll be able to calculate a decent tip for our waitress. Look -- pool all the costs of care from each citizen whose lack of health was external. It is cheaper to pay for this care directly and to not add the overhead associated with insurance. After all, the costs of care must still be paid by the insurer, plus we must pay him for administering the fund. If you insist on me funding your insurance, you are creating yet another "right," this one for underwriters to make a profit.

J: That doesn't make any sense, since you just suggested that I buy insurance for myself!

M: Even though you don't celebrate, I'm buying you a calculator for Christmas. Insurance is like buying a lottery ticket that you hope doesn't win: if your ticket comes in, you win a lot of money, but also a lot of sickness. The reason to buy insurance is if you estimate the probability of being paid (that is, of you getting sick) is high. For some people, buying insurance is a bad bet. The way you live makes it a good one.

J: Very funny. However, I'll concede that I don't understand the math, but since I know you, I'll accept it -- for now. I am smart enough to follow an argument, though. You still haven't admitted that you should be responsible to pay for care when I, and others less fortunate than myself, lack the funds.

M: And if I pay, what do you owe me? Do those who accept funds owe a debt to society that they have the responsibility to repay? Should they be required, legally, to honor their debt? Don't answer by invoking a new 'right' to dignity, because then you'd have to explain how my dignity is unaffected by giving away my money for free.

J: Of course people shouldn't have to pay you back!

M: Why?

J: Because you have more money.

M: And that's what makes you a socialist.