Health Care Rights and Wrongs

Michael Cannon’s post about this ridiculous New York Times article nearly made me fall off my chair. The article, entitled “A Poor Nation, With a Health Plan,” favorably compares the health care system in Rwanda with that in the United States. That’s right: because we don’t have state‐​provided universal health care coverage, Americans are worse off than residents of one of the poorest countries in the world. (This is a new article, by the way, not Frank Rich’s column in the Sunday paper.)


Here’s how it begins:

The maternity ward in the Mayange district health center is nothing fancy.

It has no running water, and the delivery room is little more than a pair of padded benches with stirrups. But the blue paint on the walls is fairly fresh, and the labor room beds have mosquito nets.

divInside, three generations of the Yankulije family are relaxing on one bed: Rachel, 53, her daughter Chantal Mujawimana, 22, and Chantal’s baby boy, too recently arrived in this world to have a name yet.


The little prince is the first in his line to be delivered in a clinic rather than on the floor of a mud hut. But he is not the first with health insurance. Both his mother and grandmother have it, which is why he was born here.

In other words, it’s not that the cost of modern medicine has declined in relative terms (thanks to American technological development) and the economy has grown (ours and theirs) such that more people can be medically trained and the tax base can support more public hospitals, but the insurance genie has come and sprinkled fairy dust on misbegotten villagers. (Read the whole thing for some more eye‐​popping lines — Rwanda has less obesity than the United States, for example.)


Now, I’m just a lawyer — about the only thing I know about health policy is that Obamacare is unconstitutional — but it seems to me that there are at least two basic definitional problems with the inferences the article invites the reader to make even beyond the detailed technical analysis Michael provides.


First, there’s a difference between health care and health insurance. Nobody in the United States is denied health care. Between Medicaid and federal law requiring emergency rooms to treat all comers, we simply do not have children dying in the street (like in, say, Rwanda, where, according to the Times, the most common causes of death are “diarrhea, pneumonia, malaria, malnutrition, infected cuts”). As Michael says, “Yes, the poorer nation has a higher levels of health insurance coverage. But the wealthier nation does a better job of providing medical care to everyone, insured and uninsured alike.” That is, you can (and often do) have universal health insurance that provides universally bad care — except for the political elites, who pay extra for proper Western care. Is there any American who would have better health living in Rwanda or any number of countries where the government provides universal health insurance?


Second, and relatedly, health care is not and cannot be a “right” — because rights are things that inhere in human beings by virtue of their being human. As the Declaration of Independence says, we are “endowed by [our] Creator with certain unalienable Rights.” These “natural” rights are things we enjoy without burdening the rights of others: freedom of speech and belief, the right to earn an honest living, freedom of movement, the right to acquire and possess private property, the right to decide what we do every day … all the way down to the right to get out of bed on the left or right side (or to stay in bed all day) — and the right to defend ourselves against those who would take away these rights. Once you start making “rights” out of things that somebody has to provide you — food, shelter, health care, employment — then you’ve violated everyone’s natural rights and reduced their inherent liberty.


And that’s no less true in countries where the constitutions guarantee all sorts of things (e.g., article 24 of the UN Declaration of Human Rights guarantees the right to a paid vacation. Those countries have the added misfortune of having a devalued constitution, whose promises are wholly aspirational at best. Indeed, I’m often amused in foreign travels to be asked why the U.S. Bill of Rights doesn’t include health care (among other things). I mean, if the best constitutions were the grandest ones, I could draw one up that guaranteed the right to immortality, the mandate that all streets be paved in gold, and the provision that everyone have above‐​average intelligence. Also, two chickens in every pot and a flying car in every garage.


There is no magic genie to public health or national development: it takes the rule of law — including restraining political elites from meddling in the economy — and years of entrepreneurship and hard work. Indeed, there are plenty of ways in which the United States can improve its health care system but universal health insurance is beside the point. A cautionary note, though: It wasn’t that long ago, in relative human terms, that America was at Rwanda’s level of development — and it won’t take long to destroy, in the name of “fairness” or “human rights,” all we’ve created.