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If we have the right to health care, why don't we have the right
The Right to HealthCare as been a cornerstone of the Canadian Political
landscape and our society for decades.I present an interesting argument that
would disagree with the idea that there exists a right to healthcare.
Although written from an American perspective, the ideas presented are
applicable to Canada.. and are in line with contemporary libertarian thought.
============================================================================ The
Right to Self-Treatment
by Sheldon Richman, January 1995
_________________________________________________________________
Over the last year or so, much has been said about the right
to health care. The advocates of government management of the
health-care system believe that everyone should be able to obtain the
services of doctors and related practitioners regardless of ability to
pay. That is what has fueled the push by the Clinton Administration
and others for so-called universal coverage.
Truth be told, there is no right to health care as the advocates of
socialized medicine conceive it. In their view, anyone who needs
medical attention ought to be able to count on the government to force
others to provide or pay for it. But no one can have a right to the
services or money of unwilling providers. One has a right to buy
services from willing providers. One has a right to request free
services or financial donations. But one has no right to use the
threat of physical force--directly or indirectly (i.e., through the
state)--to obtain those things. The right to health care in that sense
is a counterfeit right.
There is, however, an authentic right to health care, which was
recognized in the United States until 1914. It is typical of our age
that while nearly everyone embraces the counterfeit right, almost no
one accepts the authentic right. Even worse, few realize they are
denied an important freedom. That authentic right may be called, as
the noted psychiatrist Thomas S. Szasz has called it, the right to
self-medication. It is the right to care for one's own health without
prior permission from the state.
At first glance, many people will believe we already have that right.
They are wrong. For example, one may not seek treatment from a
practitioner who is not licensed by the state. Although one may be
perfectly content with the treatment provided by an unlicensed
practitioner, the state will prohibit that therapeutic relationship;
it will even jail the practitioner if it wishes. True, it will not
jail the patient. It will merely prevent a consenting adult from
engaging in the medical acts of his choice.
Another way that the government interferes with the authentic right to
health care is through the system of prescription medicines. Citizens
of this theoretically free country may not use certain medicines
without the written permission of an officer of the state. Yes,
doctors are officers of the state by virtue of their having been
deputized by the state to grant, or withhold, such permission. That
was not true before 1914. Until then, adult citizens could enter a
pharmacy and buy any drug they wished, from headache powders to opium.
They needed no one's permission. They were, in a phrase,
pharmacologically free.
That freedom was abolished as the paternalist ethic gained currency.
People had to be protected from their own unwise choices. For their
own good, they could not be allowed to prescribe medicines for
themselves. At least, that is what they were told. In fact, we know
otherwise. When Americans were pharmacologically free, they managed
not to kill themselves with overdoses or inappropriate medicines. When
they felt it necessary, they sought advice from physicians or others
who had greater experience than themselves. Americans somehow knew not
to swallow purported medicines without wondering about the
consequences. (We know this because population and life expectancy
grew all during the period.)
Then they lost this right. They were told they were no longer able to
make those kinds of decisions. For some unfathomable reason, they
surrendered their authentic right to health care without a bloody
struggle.
They were lied to, of course. The doctors and the politicians did not
really believe that Americans had suddenly become too benighted to
medicate themselves. No, the doctors and politicians wanted power. The
prescription law was just one piece of a larger conspiracy against the
public. At about this time, the United States got its first laws to
license doctors and accredit medical schools. The same paternalistic
rationalizations were fed to the public. But the minutes of the
medical societies' meetings tell another story. Historian Ronald
Hamowy has documented what was really on the minds of the doctors:
income. They were concerned that free entry, and hence unrestricted
competition, into the medical profession was driving down fees. Only
government regulation could keep the doctors living in the manner to
which they had become accustomed.
That regulation took several forms. Accreditation of medical schools
regulated how many doctors would graduate each year. Licensing
similarly metered the number of practitioners and prohibited
competitors, such as nurses and paramedics, from performing services
they were perfectly capable of performing. Finally, prescription laws
guaranteed that people would have to see a doctor to obtain medicines
they had previously been able to get on their own. The doctors and
politicians succeeded in supporting the medical profession's income;
they also contributed to the infantilization of the American people.
We have never recovered.
The same laws have also subverted the medical profession, since
doctors can be--and have been--prosecuted for prescribing drugs "in
amounts that exceed a legitimate medical purpose." In some states,
doctors must send a copy of prescriptions for certain drugs to a
government bureaucracy. Government thus reserves the power to decide
what is legitimate.
Some will say, things were simpler before 1914. Surely in our complex
age, people cannot be expected to make those decisions for themselves.
This is fallacious. Despite all the purported protection against
self-treatment, the one thing that is supposed to activate the system
for the individual is left entirely to his own discretion: the visit
to the doctor. What protects a person against his decision not to see
a doctor? Even the most extreme proponents of socialized medicine do
not advocate compelling people to see a doctor against their will. The
freedom to do without medical care, at least, is respected. If the
paternalists were truly consistent, they would call for protecting us
from that dangerous freedom by requiring periodic visits to the
doctor. But perhaps that would bare their totalitarian talons a little
too much.
However, if we can be trusted to make such a basic decision, why can't
we be trusted with other decision-making related to health care? The
reason cannot be that people are ignorant in these matters. We are
ignorant in lots of matters in which the consequences of unwise
decisions can be great. Most of us know little about automobiles. An
improperly serviced auto can be dangerous to others. Yet, there is no
law against my servicing my own auto. The law does not stop me from
working on my own furnace, though a mistake could kill me and others.
If I am spiritually distressed, I am free to console myself or seek
comfort from a bartender, friend, or anyone else. If I can work on my
car, my furnace, and my mind, why can't I work on my own body?
But surely no medicine should be allowed on the market before it is
approved by the government, right? Wrong. The right to self-treatment
means just that--the right to choose and administer (or have
administered) any treatment. Each individual should be free to
determine his own level of confidence about a medicine. A desperately
sick person quite reasonably may be willing to seize on a new,
untested drug. He may not survive the years of testing required by the
Food and Drug Administration. (That systemic delay kills thousands of
people each year.) Someone less ill or more risk averse may be more
selective. A third person may only want medicines that have stood the
test of time. The key question is, who should decide one's level of
confidence? Should the government impose one level on everyone? Or
should each decide for himself? In a free society, there can be only
one answer.
It is certainly wise to know what one is doing before treating
oneself. And that is why the free market provides an abundance of
medical information to the layman. It would provide even more in a
free medical marketplace. Sources of information would include
doctors, medical societies, insurance companies, Prevention magazine,
Consumer Reports, newspapers, and more. Competition and the civil
law against fraud and malpractice are the best assurances of quality
in both information and services. But in the end, people must have the
right to enter into any mutually agreed-on contracts for medical
services that they choose. Anything less makes a mockery of the idea
that we are free.
Permission is granted to reprint this article, provided appropriate
credit is given. Please send two copies of the reprint to The Future
of Freedom Foundation
_________________________________________________________________
Sheldon Richman is senior editor at the Cato Institute in Washington,
D.C., and the author of The Future of Freedom Foundation.
=============================================================================
Being intelligent is not a felony
But most societies evaluate it
as being at least a misdemeanour
... A Canadian is an unarmed American with health care.
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