I believe most people who want a universal right to healthcare are motivated by a concern for the wellbeing of the most vulnerable in society. I also believe there's a mistake in this thinking, and that it can have significant unintended consequences. I hope to show here that it's not a right to healthcare that you really want, but something much more valuable.

There’s an underlying assumption that if there is a right to healthcare, everyone (including the poorest) can get medical help. But that’s not true. A right to healthcare, as we know it, actually means something like: Everyone is enrolled in a system that controls the dispensation of healthcare. The system rations out healthcare services on a basis other than patient’s ability to pay money for them.

That’s an important difference. It means that a person can die while waiting for healthcare, under a system in which they have a hypothetical right to healthcare. And it can mean that a person may die because a certain treatment is not available under the local system, despite there being a local right to healthcare.

Thought experiment

Imagine two societies. Society A is very prosperous. There is a competitive healthcare sector. There is an abundance of healthcare practitioners. Medical technology is sophisticated and ubiquitous. Procedures are cheap. The rate of charitable giving is high, and mutual aid fraternities mitigate health expenditure risks for workers in most professions. There is also no right to healthcare.

Society B is very poor compared to A. In the healthcare sector, a government-supported medical cartel artificially restricts the supply of healthcare workers. New treatments are very slow to become available because of an approval system that penalises decision makers for being too lax but not for being overly cautious. In society B though there is a right to healthcare.

In society A again: If a poor person gets ill they usually pay a small amount (perhaps appealing to a charitable organisation for aid or their mutual aid society if necessary) and receive prompt, high quality care.

In society B if a poor person gets ill they interact with the local healthcare system which rations medical care. Usually this means being put on a waiting list. It's a regular occurrence that patients die while on such a list. Eventually, patients who survive will be treated by overworked, distracted doctors who often make mistakes – sometimes with lethal consequences. Others will die because the treatment they need isn’t available under this system. Private care is much more expensive alternative than in society A, well out of reach for a poor person.

Focus on the right target

If this isn't enough already, feel free to imaginatively make conditions in society B even worse. The point is that we can imagine a society in which there's no right to healthcare, but in which the poor are nevertheless better off than under another society in which there is such a right. So it’s not a right to healthcare itself that's important.

What we should be interested in is maximising the degree to which high quality healthcare is actually available to everyone in society. And a right to healthcare has no necessary connection to that outcome, despite sounding like a guarantee of it.

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