Tuesday, January 03, 2006

The Argument from Morality in Action: The Right to Health Care

Those who have read my recent series of articles on LewRockwell.com know that I believe that libertarians can achieve great success by using the argument from morality. This argument demands that those who propose moral theories must prove that those theories are both consistent, universal and absolute. Since the only way to know the difference between an opinion (“I like ham!”) and a fact (“Ham comes from pigs”) is through consistent logical analysis, anyone who claims that their moral prescription is a fact must prove their case.

I thought it might be interesting to subject a well-known and contentious topic to the argument from morality, to see how this theory might shake out in practice. I chose health care, since I live in Canada, where our friendly neighbourhood state maintains a rigid grip on medical services. (To my friends in the US, just imagine you are 10-15 years in the future!)

The proposition that is generally believed here in Canada is: everyone has a right to health care. (In the US, generally, it is: the poor have a right to health care.)

Faced with this proposition, libertarians generally point out that government-run health care is inefficient, debt-ridden, coercive, unsustainable, slow and subject to pressure-group influence – and that is all true, but the sad fact is that these arguments don’t work because people just don’t care about efficiency. If the poor have a right to health care, it doesn’t matter if it’s difficult to provide. It’s like telling a couple with a new baby that babies are expensive, exhausting, loud and so on – who cares? They have to take care of their baby. Practical arguments never trump arguments from morality.

To oppose the government, then, we have to take aim against the soft underbelly of the beast, which is the moral absolutes that all government programs feed on.

So – if you find yourself chatting with a man who says that the poor have a right to health care, you can begin by asking him if that is just his opinion, or if it is an objective fact. If it is just his opinion, then you can say sure – that you would also like a Lamborghini and Brad Pitt’s washboard abs, and part as friends, since the law cannot be used to enforce opinions. If, however, he replies that it is an objective fact, then you can begin the rather enjoyable process of getting him to prove his thesis.

If a moral proposition is a fact, than it must be true for all people, and for all time – just as a physics theory must be true for all matter, and for all time. If not – if there is a single exception – then it fails.

Here are some problems with the proposition that everyone has a right to health care.

In the realm of medicine, there are three categories of people. The first is those who are sick, the second is those who are healthy – and the third (a subset of the first two) are those who provide health care. For the sake of brevity, let’s call the sick group Joe Ailing; the healthy Donna Vital and the health care providers Doctor Al Truism.

As long as Joe is healthy, Dr Al owes him nothing. As soon as Joe gets sick, Dr Al now owes him a debt which he is morally obligated to pay off. However, this moral commandment fails the test of universality. Joe is a man, and Dr Al is a man, and yet they are both subject to opposing moral rules at the same time, since Joe is ethically entitled to resources, and Dr Al is ethically required to provide them. When Joe becomes ill, Dr Al suddenly owes him money, time and resources, without reference to any sort of contract. How can that be resolved? How can two men be subjected to both absolute and opposite moral rules at the same time? Have their fundamental natures changed? If not, then the moral absolute that everyone has a right to health care fails, just as a physics theory which posits that, at the same time, one rock falls down, and another falls up, also fails.

Ahhh, if only it were as simple as a single paragraph! Let’s continue. What about the test of time? Theories which claim universal absolutes must also be true without regard for time. Murder cannot be wrong today, but right yesterday. This is clearly not the case with Joe. One day, he has no right to Dr Al’s time and money. However, the next day, he has an absolute right to them. When exactly does this occur? At what point in time does Al become subject to these new and opposite moral rules? How many symptoms does he have to have? What if his illness is imaginary, or psychosomatic, or he is a hypochondriac? How severe does his illness have to be for the complete reversal of this moral right to occur? If he has a cold, can he demand treatment at 2am? Does that right change at 9am? And does Joe even have to be sick? What if he’s just curious about Avian flu? Can he drop in for a nice chat with his doctor about that? And if he does, what about the right to health care of everyone else in Dr Al’s waiting room?

Of course, the argument can come back that Joe must be sick, and that is the substantive difference between Joe and Dr Al, which is why they are subjected to opposite moral rules. Very well – even though illness (except for very rare forms of mental illness) does not change a man’s moral nature – let us take it on faith that there is a substantive moral difference between healthy and sick people.

In this case, the proposition that everyone has a right to health care becomes more problematic, not less! Can the following questions be answered objectively and rationally? What degree of illness is required to change Joe’s moral nature? Does a cold suffice? What about stubbing his toe? There is no objective line that can be drawn. But even if a moral line could be drawn, what about preventative medical care? If Joe has a right to health care, then we can assume that he has the right to regular check ups. Thus if Joe goes to Dr Al for an exam and is pronounced perfectly healthy, Joe is not sick – and so the presence of illness cannot be used to claim any substantive moral difference. How, then, can Joe and Dr Al, as healthy males, be subjected to diametrically opposite moral rules at the same time and in the same room? The question cannot be answered.

And what about Dr Al himself? Doubtless he also has the right to health care, and so can go to Dr Bob for a check up. Thus one day, Dr Al is morally obligated to provide heath care to Joe. The very next day, Dr Al has the moral right to demand health care from Dr Bob – and while he is being examined, is not required to provide health care to anyone else. Thus moral absolutes are constantly changing – and sometimes for the same person overnight – which makes no sense, and invalidates the moral absolute that everyone has the right to health care.

The wonderful thing about false moral premises is that, no matter how they are approached, they always fall apart. So let’s take another tack and see how this nonsense unravels.

Let’s say that all the above problems and contradictions have been magically solved, and we have justified the premise that the sick have the right to health care. In other words, we accept that, when Joe gets sick, Dr Al owes him a debt. So what? That doesn’t mean that the government should take control of anything. We already have a legal system in place to facilitate debt collection – and so we don’t need any additional agencies. Since Dr Al owes Joe a debt, Joe can just use the legal system to collect it! If Dr Al doesn’t ‘pay’ Joe the services he is ‘owed,’ then Joe just takes him to court and all is well.

All right – let’s just see where this little premise takes us. If everyone who is sick is ‘owed’ services by everyone who can provide health care – if it is a universal moral absolute – then everyone with any form of ailment – or who desires any form of check up or preventative care – can take any doctor to court for restitution. Given a world population of 6 billion, we can assume that hundreds of millions of men, women and children are in need of health care at any given time – all of whom have the absolute moral right to sue Dr Al for what he ‘owes’ them (and so the justice system also ‘owes’ them resources as well!). Does that sound like a good idea? Yet that is where the moral theory takes us.

If that doesn’t sound like a good idea, how about this? If someone has stolen my car, I am completely within my rights to go and get it back – using force if necessary. Thus if Dr Al owes his services to anyone who is sick, then hundreds of millions of people have the right to go and extract those services from him – by force if necessary! Sound like a good idea? Yet there it is.

And why would the theory that everyone has the right to health care apply only to services provided by doctors? What if I possess some kind of medical knowledge that might be helpful to anyone out there? What if I’ve gone on a diet and know what works? What if I’m an athlete who’s learned about sports injuries? What if I’m a diabetic who’s learned how to manage my symptoms? Does everyone who can benefit from my medical knowledge have a right to my expertise?

Let’s take another angle. Those who provide health care services ‘owe’ health care to the sick. But who is that exactly? Doctors, sure – but what about nurses? Receptionists? The phone companies who maintain the lines? The petroleum companies that supply the gas that powers the ambulances? The janitors who nightly clean up the offices of the insurance companies? The investors who lend money to pharmaceutical companies? The teacher who instructs the computer programmer who writes a medical billing system? What about the babysitter who looks after the kids of the nurse so she can work a night shift? Does the babysitter also ‘owe’ services to the sick? Can she be sued if she doesn’t show up, and the nurse has to cancel her shift? Where can the line be objectively drawn between those who provide health care services and those who do not? Isn’t the moral theory of a ‘right’ to health care obviously foolish, illogical, subjective and unworkable?

But let’s say that somehow the above problems have all been solved – here’s another problem. When does a woman in the process of becoming a doctor switch from someone with a right to receive health care to someone with an obligation to provide it? In other words, since from one day to the next she becomes subjected to completely opposite moral absolutes, what changes in her nature? Does she somehow become a different species? And at what objective point does it occur? It’s certainly not the first day of her classes – and yet it is also not ten years into her career. Is it at 12:01am on the day before she sees her first patient? Is that when she flips into this alternate and opposite moral universe? Think about how silly this is as a moral theory – 12:00am, she is owed health care – 12:01am, she owes everyone else health care. Madness!

If people have a right to health care, then can Dr Al take a vacation? Can he retire? Is he obligated to answer health questions while on vacation? What if he doesn’t? What if he decides to quit medicine and become an actor? Is he no longer required to provide health care? Why not? What has changed? How can moral rules switch so randomly for the same person? How can this be called any kind of consistent and logical moral theory?

So far we have only been talking about the sick and the doctors – Joe and Dr Al – but usually at this point in the argument, we see the entrance of Donna Vital, the healthy taxpayer. In order to solve the above problems, it turns out that Joe does not have the right to Dr Al’s services, but rather has the right to Donna’s money so that he can pay for Dr Al’s services. This solves some of the problems outlined above – but raises even more substantial silliness!

The transactional sequence of the “taxpayer” solution is that sick people have the right to the money of healthy people – including those who provide health care – as long as that money is used to pay for health care. Thus it doesn’t matter how much money you pay into the system – you are owed health care even if you’re a new immigrant, or a baby. Very well. What are the results of this excellent moral theory?

So Joe gets strep throat, and wants to see Dr Al. On the way, he just has to make a quick stop at Donna’s house to pick up the cash. He can take a gun if he wants, since his right to health care is a moral absolute. Doesn’t that sound like a fabulous idea? What if she’s not home – should Joe go to her neighbour? What if her neighbour doesn’t have the money?

Of course, it’s never presented that way. Cloaked in the magical fog of government force, the problem of individual use of violence is bypassed and buried in sentimental rhetoric. So let’s take that as an axiom, and say that the government has the right to take Sally’s money and give it to Joe to pay Dr Al – or pay Dr Al directly after Joe visits him. What could be wrong with that?

Well, nothing at all – except that the above is a mere description of the uses of violence, and has nothing to do with any moral theory whatsoever. If I say that stealing is wrong for everyone, that’s a moral theory. If I say that stealing is wrong for everyone except for people named ‘Joe’ between the hours of nine to five, I’ve expressed a random and rather silly opinion, not a moral theory. If I say that everyone has a right to health care, that’s a moral theory which can be examined rationally – however, if I say that some people have a right to limited degrees of health care under certain circumstances, and that only certain other people have a right to procure that by the use of force while wearing certain blue-colored clothing, and then only to a certain degree, and that doctors must provide health care, unless they’re on vacation, or it’s after 5pm, and so on and blah de blah – then that’s not any sort of moral theory, but just a bunch of silly and self-contradictory statements that don’t even add up to a coherent subjective opinion, let alone a consistent and objective proposition. It would be like proposing a scientific theory which says that sometimes rocks fall up, and sometimes they fall down – and sometimes they fall up and down (and sideways!) at the same time! A person proposing such a theory invites a prescription for lithium far more than a rational response!

Let’s take one final example. If something is moral, then it must have been moral for as long as men have been rational. Murder cannot be wrong today but right yesterday. Thus the poor have always and everywhere had a right to heath care. Does that mean that any doctor throughout history who ever charged a patient was immoral? Dental care is health care, but here in Canada dentists charge for their services – are they then immoral? My wife charges her patients – is she immoral? Is every American doctor immoral relative to Canadian doctors? If not, why not?

And finally, if the belief that everyone has the right to health care is based on people’s right to goods and services that give them life, then food and water are more critical than health care – and yet no one is advocating that the government take over all the farms and supermarkets? Why not?

Why is this so important? Why bother with all this logical analysis? Well, because the power of the State rests entirely upon supposedly-universal moral theories. Opposing the consequences of government programs has no effect – as we have seen for decades – if people believe that government programs are moral. If someone claims a moral absolute, they must be responsible enough to know what they are talking about. A moral absolute puts guns on the street – it puts people in jail, and sets the whole machinery of state violence in unstoppable motion. If you meet a man who advocates the use of violence to solve social or economic problems, you must insist that he must submit his moral premises to rigorous and relentless logical examination – if he does not, then he is just calling for universal violence to enforce his opinions, which is a very great evil.

Moral beliefs are irresistible universal absolutes, and must be opposed at their source if we are to begin reshaping the fundamental decisions of mankind. Ethics is the hidden physics that shape the world of the mind, and we can only truly oppose the power of the state by attacking the false moral premises that support it.

2 comments:

Anonymous said...

I agree 100%. The absolutist approach can be taken further; most of todays medical procedures did not exist thousands of years ago and therefore they could not possibly be a universal right.

Seth said...

Most of todays medical procedures didn't exist 100 years ago. I would venture that a solid 25% of todays medical procedures and technology didn't exist 20 years ago.