Bioethics

Americans unclear on what is a “right” and what in an entitlement.

By Chris Rangel MD ⋅ March 4, 2006 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

According to a recent phone survey only one American in 1,000 was able to name all five rights guaranteed by the First Amendment. If you extrapolate this finding to the whole of the country then you find that only 300,000 Americans out of a population of about 3 million know all of their First Amendment rights (I am one of the 300,000, BTW). Incredibly 30% did not know that freedom of speech is one of them despite this concept being one of the cornerstone concepts of our democracy and only a meager 24% could name freedom of religion.

Even though few Americans make the effort to know all 45 words of the First Amendment by heart most have at least a vague sense of their “rights” in the form of freedom from government interference in their lives. So it is very unlikely that our present day Congress would be able to pass such an unconstitutional law as the 1798 Sedition Act. Yet our horribly inexact knowledge of our “rights” helps to explain the wide support for such misguided proposals like the so called Flag Burning Amendment or the sad fact that about half of Americans actually believe that our rights go too far (a common occurrence in time of war).

Digging deeper into the survey we find a significant number of Americans are unclear on the concept of a “right”. About a third believe that education is guaranteed by the first Amendment and one in five believe that there is a “right to drive”. The problem here is that a “right” as defined by the First Amendment simply limits government restrictions on activities such as speech. A “right” is not something that places an obligation on others to provide. Not a single Amendment obligates the government to provide any service (like education) or provision (cars and roads) to the people.

With so few Americans knowing what their rights are and not even understanding what the concept of “right” means, it worries me when I see surveys like this one that found that 77% feel that health care should be a right guaranteed by the government. But health care is not a “right”. Health care is an entitlement in this sense. It worries me that people use “right” and “entitlement” so interchangeably.

Health care is a service that requires others to provide and these providers must be compensated. However this compensation does not come from the government. As Dr. Peikoff (PhD) pointed out, “Government is not a productive organization; it has no source of wealth other than confiscation of the citizens’ wealth, through taxation.” Government simply acts as a collector and distributor. The actual compensation comes from us or rather those of us who pay taxes. Taking something from someone and giving it to someone else does not make it a “right”.

Yet this simple concept has not prevented so many from using the erroneous term “right” when what they really mean is entitlement. They do this because they know that “right” implies getting something for nothing such as freedom of speech and who doesn’t want that? When health care is considered a “right” then the vast majority of Americans support universal health care provided by the government.

But when people realize that health care is not a right but a service requiring them to provide compensation then support for universal health care drops. Only 45% would pay higher taxes or health care premiums in order to have universal coverage. As a service, health care draws on limited resources and unlike a true “right” health care must be proportioned out which means that not everyone will be getting their “fair share”. When people realize this reality then the percentage drops even more to 35-38% if the result would be limited choices and longer waits for non-emergent treatment (the universal ills of universal health care coverage).

Some believe that we have the “right” to get emergency treatment. The 1986 Emergency Medical Treatment & Labor Act (EMTALA) mandated that every US hospital that accepts Medicare/Medicaid must also treat and stabilize every patient in need of emergent treatment without regard to their ability to pay. But this is not a “right”. This is mandated charity (if the treated patient is unable or unwilling to pay afterwards) The uncompensated costs of this unfunded mandate are spread around among paying patients, insurers, and taxpayers. So everyone (including nonresident foreign citizens) has the opportunity to get charity emergent care.

The reason I’m nitpicking on definitions here is that the future debates on universal health care in this country will (as too often are things of this nature) be dominated by political slogans and “buzzwords” in an attempt to simplify a massively complex issue for consumption by an attention span shortened public who know far more about the Simpsons then about their own Constitution. It appears inevitable that one of these slogans will be “Health care is a right” followed by a litany of services that your government should be providing while burying the costs of such a program in the fine print and completely neglecting to mention what unpopular steps will need to be taken in the likely event that costs cannot be contained. Be educated. Be prepared.