I do not, myself, know anyone who doesn’t think that ‘universal healthcare’ is an idea worth aspiring toward. One who does not dream of a world in which everyone is properly covered in medical emergencies is, frankly, either sadistic or unfeeling. This is, perhaps, ad hominem, but I’ll indulge the fallacy for this occasion: If you want people to be without healthcare, something is wrong with you.
I am not, of course, rehashing that repugnant adage, echoed uncritically in the dimmer corners of the blogosphere, that reticence about ‘socialized medicine’ amounts to a quiet genocide. “If you don’t support Obamacare, you want people to die,” one cherished friend posted to his Facebook wall, to no one in particular. “Rationalize all you want. Healthcare is a human right, and repealing/replacing Obamacare is taking it away from millions. They will die, and you pulled the trigger.”
Well. Hastiness is not a virtue, and there is among those like my aforementioned friend a certain disdain for questions of practicality when principles are on the line. No one, by default, has a well developed ideological attention span, and that is not, per se, a vice. But the notion that ‘healthcare is a human right’ has implications, and they are staggering.
For starters – at risk of parroting what has become a cliche – healthcare is a service requiring labor, and a laborer. Until we have fully automated healthcare machines – which is probably inevitable and will certainly be the crux of the modern Luddite controversy – any and all medical treatment will require actual, real human doctors. Now, if healthcare is a human right, then the sick have an inalienable right to the services of doctors who provide it. (I warned you that, early on, I may sound like caged bird amening the usual Rand Paul talking points, but track with me). If we all have a baseline, irreducible right to healthcare, then we all have a baseline, irreducible right to the labor of whoever is able to provide it.
Well, so long as we’re in a place where plenty of folks are studying to become doctors, the sentiment may never bear bad fruit. And yet, if the public has an inalienable right to healthcare but the milieu changes and very few are studying to become doctors, then what? In the absence of an automated system of machinery providing comprehensive healthcare to the sick without requiring the services of a human doctor, how might we maintain a universal healthcare system in a world with a deficit in doctors who could provide it?
Do we institute a ‘Draft’ in which everyone registers at 18, and is liable to be called on by their country to become a doctor ‘for the good of the community’? That’s certainly the most practical solution – and it isn’t without historical precedent, (i.e. the military). If so, how might we gauge the ‘Draft’? Is it random – perhaps by way of a lottery system, as was used during Vietnam. Or do we aptitude test from a young age? Or something else? In any case, we can, potentially, see to it that the supposedly inalienable right to ‘healthcare’ is secured – but only by indenturing some citizens.
This does not, of course, mean that they won’t be paid. We are a civilized country, after all. ‘Indentured’ is not, at least, entirely the same thing as ‘enslaved’ – citizens conscripted into the medical profession would be paid, perhaps generously, for their work. Indeed, it is not simply ‘work’, as such; doctors, like soldiers, would be premier countrymen – American heroes.
This invites us to reconsider, at last, the question of whether ‘forcible indenturing’ is inherently wrong. Is it not, after all, acceptable in the service of some higher good (such as healthcare for all)? Marx himself certainly thought so – he did not, as one might assume, dismiss slavery out of hand as unsalvagably evil; there is, he suggests, a time and place for chattel bondage – and the time is probably nigh that his legacy is retrieved from the distortive grip of the U.S.S.R.
Well. Marx is a remarkable social theorist, and certainly not worthy of the well nigh universal scorn of which he has been the postmortem recipient, but I’m inclined to disagree – it is not, as a matter of fact, morally acceptable to indenture a human being for utilitarian ends, even if those ends are inexhaustibly beneficial. If healthcare is an inviolable human right, then freedom from forcible indenturing is not. And I happen to think that the latter, distant and ethereal as it may sound, is infinitely more important than the former. I would not, frankly, subject anyone to citizenship in a community in which they are owed healthcare by merit of their existence, but are not owed the dignity of freedom from involuntary indentured servitude.
Of course, one certainly might disagree. But in that case we have to reckon with what, exactly, constitutes a ‘human right’? A more direct question, perhaps, would be ‘do people have a right to determine the trajectory of their own lives apart from institutional coercion?’ If not, why? Why does the notion that every human being ought to have healthcare (and food, and water, and sun, and so on) obliterate the notion that human persons should not be institutionally coerced into following a particular path that may grate against their desires? This is not, in fact, a question of ‘individualism’ over against ‘collectivism’, as it is often framed by pundits, so much as it is a question of humanism – with its emphasis on humanity’s innate dignity, and the naturally outflowing right to pursue happiness in the directions that one so desires (provided, of course, that in doing so they do not infringe upon the dignitious rights of another), which has always been, I should point out, the basis for such notions as sexual autonomy, and so forth, – over against a kind of ahumanistic subsistence functionalism – whereby questions of human dignity are co-opted by a threadbare commitment to securing basic subsistence for all by annihilating prospects of social mobility, autonomy, and so on. When pressed on this, I have found, friends enraptured by the functionalism I have outlined above will reply that ‘autonomy’ is, at best, a luxury for the bourgeoisie, unnecessary and, at worst, a kind of stick, carrot and string designed to dull the masses to their more basic needs – such as, again, food, water, and healthcare.
Well, if that’s what you think, then that’s what you think, but that, again, has implications. If, to be painstakingly unsubtle, healthcare is an inalienable human right, and, consequently, the government can indenture individuals to doctorhood (for the good of the community), then, naturally, whom else can they indenture? And, to bring it a little closer to home, what else can the government coerce ‘for the good of the community’?
Studies indicate, for example, that two-parent families are indispensable for the healthy development of children. That is to say, depriving a child of a two-parent household does concrete psychological damage that treatment can only rectify in part. This is not to say that children of single parents are ‘damaged goods’, but simply that, to again be painstakingly obvious, the mechanics of human evolution, and of generations of environmental adaptation have wired us to need certain ‘structural’ constants – one of which is the ‘two-parent’ family – and when these constants are permanently interrupted, our development is wounded, and lifelong emotional shrapnel embeds itself in the psyche of the deprived. In light of this, the question emerges: Are two-parent families a human right? If so, can the government forcibly preserve an unhappy marriage (or assign a replacement parent) to protect the rights of the children? If two-parent families are a human right, and it is not, in itself, wrong for the government to indenture individuals in order to protect the inalienable rights of the community, then it is within the government’s right to ‘indenture’ citizens into permanent ‘spousehood’, or ‘parenthood’ in order to guarantee that no child is deprived their ‘inalienable right’ to a two-parent family.
This is just a thought experiment, to clarify. If ‘healthcare is a human right’, then ‘determining one’s own life’ is not, and, if determining one’s own life is not a human right, then it is not, in itself, wrong for the government to determine your life for you. To be, perhaps, more specific, this would mean that, conceivably, the government could criminalize embodying LGBTTQQIAAP+ identities in public and we wouldn’t have, at least, de facto grounds on which to oppose them. The precedent will have been set, and any future government that could pseudo-philosophize its way into a working theory whereby non-cisgender, non-heterosexual embodiments of of sexual identity could be construed, honestly or not, to ‘harm society’, could justify suppressing whole groups of people and forcibly ‘indenturing’ them into heteronormativity. A conservative regime could, on the basis of some dubious psychological studies, regulate, say, gender presentation ‘for the greater good’ – and more.
The takeaway, then, is that healthcare can only be a ‘right’ in a world where humans are owed basic subsistence and nothing else. Implications matter, because they tend to give birth to themselves over time once the precedent has been set. And a world in which healthcare itself – not ‘access to healthcare’ or ‘opportunity to afford healthcare’ and so on – is an inviolable ‘human right’ is one in which the best progressions of modernity could unravel, what leaps we have made toward liberation for the oppressed could evaporate.
I dream of a world in which healthcare is universally enjoyed – where no one dies in the street because they were turned away at the hospital, where vaccinations are universally accessible, and no one goes bankrupt from hospital bills. To abhor such a future is inhumane. To desire something less is inexplicable. Healthcare is not a luxury. It is a necessity. But as a necessity, it is also privilege. It cannot be owed, at least not within the framework of the humanism that has freed us from the varied feudalisms from which we have come, and will, if we can keep it, carry us further into freedoms we have not yet learned to desire. We trade this humanism for ‘subsistence functionalism’ at our own peril – and not only our own, but that of our progeny, and theirs. Healthcare is a right only if almost nothing else is. This is a bitter trade off, and the consequences are well worth considering.