On my previous thread on Republicanism, access to health care was raised a few times as an important right in a modern society. It is hard for any sensitive person to witness the suffering of someone who is sick and suggest nothing should be done. But how far does our moral obligation extend, and what responsibilities lie on the individual? The argument is often framed in the terms that quality of health care provision should be independent of ability to pay. The first thing to point out is that this is unrealistic. Even if private medicine was outlawed, those with enough money would be able to travel elsewhere for better treatment. The only way that it could achieved is if the government spent so much on health care that the marginal impact of any extra spending was effectively nil. But not even rich Western nations have those kind of resources to spend even if they had the will to do so. Even at current growth rates, health care spending may become prohibitive. In the US, it is projected that health care may account for 20% of its economy within the next decade. Every dollar, pound or euro spent on health care is one not spent on other things which may have equal claim or greater utility. The NHS may cost much less than the private system in the US, but it effectively rations care through waiting lists.
So when health care is claimed as a right, how far does it extend? Do we mean that a certain minimum standard of health care should be provided? Some democratically agreed level of provision, or a best effort at matching the best private care? Is the right equal over different types of care acute such as heart surgery, and chronic such as dementia? How do we draw the line, without seemingly uncaring or arbitrary?
The second thing to consider is what responsibilities an individual has, and how it interacts with their other rights. Imagine if a pill was developed that, if taken regularly, could produce large and measurable weight loss. Regardless of expense, there would be an outcry to get it available on the NHS. If a patient then did not take the medicine regularly and had complications as a result, many people would feel that it would be justified to refuse further treatment due to negligence of the patient. But if the doctor proscribed regular exercise and a better diet, and then suggested refusing other treatment if the prescription was not followed correctly, there would likely be a public outcry at an overbearing state (or doctors) invading the rights of the individual to live life as they choose. Should the government have the power of coercion to produce better health outcomes? If not, what can they do?
These are more than just an academic debate. The UK is justifiably proud of the NHS; access to health care remains a hot button issue in the Republic and the US. But attitudes can often be reflexive and unthinking, particularly on the left. How we develop policy depends largely on the answers to these questions. This might have been egalitarian, but did it make sense?