Most Americans today believe the government should guarantee health coverage for all. We can thank Bernie Sanders for putting universal healthcare on the agenda. We can also thank the fact that healthcare is on the rise as a priority among the public. The debate on whether there should be healthcare coverage for everyone centers around whether there is a universal right to healthcare. Those who support it justify their stance on the basis of such a right.
I don’t know if this is the best political strategy. Perhaps it is. But, philosophically, there are better ways to justify universal healthcare. I’m going to argue that even if we don’t have a right to healthcare, the government should still guarantee it for reasons conservatives should endorse.
Supporting universal healthcare by appealing to a universal right to healthcare isn’t a particularly effective argument. Many rejecters of this right seem to think that the only universal rights we have are natural rights — like freedom of speech and freedom of religion — that we associate with the Bill of Rights. Asked to say why this is so, rejecters usually rely on mere intuition or gut feeling. By the same token, those who endorse a universal right to health care also tend to justify their claim on the basis of mere intuition.
Even if we don’t have a right to healthcare, the government should still guarantee it for reasons conservatives should endorse.
The problem is that disagreements become intractable when they bottom out in mere intuition, causing the debate to reach a stalemate. I don’t think it needs to come to this since there should be universal healthcare regardless of whether everyone has a right to it. To move the universal healthcare debate forward, it may be helpful to drop the rights talk.
In his 1984 article “The Right to a Decent Minimum of Health Care,” Allen Buchanan argues that we can justify a guaranteed decent minimum of healthcare through the combined force of three considerations. Furthermore, these considerations don’t appeal to universal rights. Before addressing them, let’s look at the advantages of advancing a decent minimum rather than a maximum level of universal healthcare.
First, a decent minimum would be determined by the resources available to the country. The more affluent the society, the higher the decent minimum could be. Given that the US has the highest GDP in the world, our decent minimum could be relatively high. Second, a decent minimum is open to which aspects of guaranteed health care should take priority. This is politically advantageous because it lends itself to bipartisan support; it leaves room for compromise on what should be covered. Finally, unlike guaranteeing maximum healthcare, advancing a decent minimum is economically feasible.
Now on to the three considerations that justify universal healthcare.
A strong case can be made that many groups have a special right to health care, which is less controversial than a universal right. The right is special in the sense that it only applies to specific groups.
Many groups are entitled to certain rights to rectify institutional injustices that have been committed against them. Native Americans, for example, may be owed healthcare due to the history of unjust treatment by the government. Similarly, many groups are entitled healthcare if they have suffered unjust harm. Employees exposed to toxic chemicals at work may be owed health care to redress the harm suffered.
Many agree that people who have made great sacrifices for our country also have a special right to healthcare, such as military personnel, police officers, and firefighters.
A special right to healthcare would cover many citizens.
The burden of justification is on those who don’t support guaranteed universal health coverage.
The second consideration for universal healthcare appeals to the principle of non-maleficence: The government ought to prevent social harm. Ensuring a safe society is, after all, one of the reasons why we have governments. Public sanitation measures, for example, are justified based on preventing harm to citizens that would result from living together in large groups. Harm prevention also justifies the government providing a police force and military.
These measures lower mortality and morbidity rates and help ensure the health and safety of all citizens. By the same line of reasoning, the government should provide healthcare to all citizens.
The third argument appeals to socio-economic prudence. Just as it’s in the public’s best interest to provide all citizens with an education, it’s advantageous for society and the economy to offer a decent minimum of healthcare to all citizens. This is because a healthier society would create a more productive workforce. Additionally, a healthy and fit citizenry is beneficial for national defense. Finally, universal health care would lower the cost of healthcare for individuals thereby bolstering the spending power of citizens.
There are at least two reasons universal healthcare would lower cost. First, it would make it easier for folks who would not otherwise have healthcare to seek treatment early before their health problems become more severe and costlier. This saves the consumer money, which is good for the economy. It’s also worth noting that healthcare spending per capita in the US is roughly half that of other wealthy countries with universal coverage, even though the US has a higher infant mortality rate.
Universal coverage would also lower the overall cost of healthcare because when individuals who don’t have health insurance get treatment, the cost is picked up by those who have healthcare. This increases premiums, placing a heavier burden than necessary on those who have health insurance. This means that universal healthcare is fairer than the current system since it forces everyone to put into the pot for treatment they would get anyway.
We don’t need to appeal to a universal right to healthcare to show that the government should provide a decent minimum of healthcare for all. The combined force of the three considerations above is enough to justify universal coverage. And these are considerations both progressives and conservatives can get behind. This suggests that the burden of justification is on those who don’t support guaranteed universal healthcare.
It’s a heavy burden.