Do Canadians really have a right to healthcare?

Depends on which side of the negative rights/positive rights divide you stand on

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EDMONTON, AB, Mar 25, 2015/ Troy Media/ – If someone (like me) were to ask you whether you had a right to healthcare, how would you answer?

Though we’ve likely never met, and I know nothing about your race, sexual orientation, health, or economic situation, if you’re Canadian I bet you will answer “yes.” Our single payer healthcare system is one of the institutions most commonly identified with what it means to be Canadian, along with peacekeeping, Tim Horton’s coffee, and hockey. Many would go so far as to say that they and other citizens have a “right” to not just healthcare but high-quality, accessible healthcare at that.

Is it the same as a right to free speech?

But what does that right consist of? Is it the same as a right to free speech, to assemble peacefully with other citizens, to not be persecuted for one’s religion or opinion, to not be arbitrarily imprisoned? Those are negative rights, rights that limit what someone can do to you, and it seems that a right to be free of discriminatory treatment covers a right to medical treatment. It would be a very unethical hospital or doctor that turned away people for being black or female or homosexual. Very well then; we have a right to healthcare.

Do Canadians have a right to free healthcare regardless of the cost to other social priorities or whether it ruins public finances?

But do you have a right to be provided with healthcare? That is, do you have a right to never have to pay for it directly, for it to be delivered to you regardless of what other social priorities have to be sacrificed to do so, regardless of whether it ruins the public finances and drowns the country in debt? That would be a positive right, a right that requires someone else to do something for you, as opposed to refrain from doing something to you.

Positive rights are deeply problematic. They put burdens on other people and the state. Rather than just refraining from a behaviour, a positive right compels it. Consider a right to education – does all education have to be free? Does it have to be provided even to those who do not qualify for it? What if, just for the sake of argument, no one wanted to be a teacher? Would the state then have to enslave some to provide education?

The same argument can be applied to health. Surely health is a very great good, something we rightly prize and strive to maintain, but does providing for it trump every other consideration? If no one wanted to be a doctor would we be right to enslave some and make them provide medical care to the rest of us? We wouldn’t be the first society that had done so – the ancient Romans enslaved Greeks to be their physicians. Positive rights conflict with negative rights, and this is a reason to believe we don’t have any positive rights at all.

I raise the issue of negative versus positive rights not for the entertainment of argument and speculation but because a sense that healthcare is a positive right inhibits every attempt to discuss health sensibly in this country. In Canada, the federal government spends 11 cents of every tax dollar collected on healthcare. The provinces spend an even greater proportion of their budgets on providing health services. The costs are only going to grow as a percentage of revenue as the population ages. Having benefited from it, and knowing many people who have, I have to say the system works well, but could it not be better?

The instant someone suggests modifications to the healthcare system a whole army of opposition is summoned into existence. Reformers are stereotyped as wanting to give us a system similar to America’s, where vast numbers of people go uninsured even with the Affordable Care Act. Those who think healthcare is a positive right can only conceive that this is the only alternative, and so any attempt to modify or improve our system is verboten.

Healthcare is not a positive right

I’m not a public policy expert or a health economist; I’m a philosopher. It’s not my place to advocate for or against any particular means of providing healthcare to Canada’s citizens. I do think it is my place, however, to comment on debates that are prevented from happening because of misguided ideas.

Healthcare, while important, is not a positive right. How to provide it in the best way possible should be an open debate, not one shut down by stereotypes and fear mongering about for-profit conspiracies.

Michael Flood is a marketing writer and communications consultant. He holds an MA in Philosophy from the University of Alberta.

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