Is there a right to health care Amos Bailey and Tom Huddle

1. Is there a right to health care?Amos Bailey and Tom Huddle Introduction-Dr. Huddle There is-Dr. Bailey There isn�t-Dr. Huddle

2. Right and Rights Objective: �right� =what is just or what is fair moral law to which we owe obedience ? people ought to be treated rightly Subjective: rights adhering to individuals By virtue of individuality and dignity Origin of rights talk�.Origin of rights talk�.

3. Human Rights Origin: �imago dei� 17th century Grotius 1583-1645 Hobbes 1588-1679 Locke 1632-1704 18th century �Enlightenment� 1776: Declaration of Independence 1789: �Declaration of the rights of man� Freedom of speech Freedom of religion Security of person and property Right to a fair trial, habeas corpus These are what we would now call negative rights�rights not to be interfered with. Argument was that these kinds of rights were �natural rights�; basic foundational entitlements that people should enjoy simply based upon their being human� Its easy to criticize the early approaches to human rights, esp in the American case�Freedom of speech Freedom of religion Security of person and property Right to a fair trial, habeas corpus These are what we would now call negative rights�rights not to be interfered with. Argument was that these kinds of rights were �natural rights�; basic foundational entitlements that people should enjoy simply based upon their being human� Its easy to criticize the early approaches to human rights, esp in the American case�

4. Human Rights Natural rights vs. Civil rights Contractual rights In contrast to natural rights, Many rights that we talk about are products of arrangements that we enter into volountarily or that we hold ourselves and others to based upon our positions in a given society, that are not basic, natural rights�; these rights are stipulated in one way or another� Right to a phone call Right to carry a concealed weapon Right to strike Right to veto a bill These kinds of rights don�t carry the same moral resonance as basic, foundational human entitlements that we refer to when we talk about human rights. In contrast to natural rights, Many rights that we talk about are products of arrangements that we enter into volountarily or that we hold ourselves and others to based upon our positions in a given society, that are not basic, natural rights�; these rights are stipulated in one way or another� Right to a phone call Right to carry a concealed weapon Right to strike Right to veto a bill These kinds of rights don�t carry the same moral resonance as basic, foundational human entitlements that we refer to when we talk about human rights.

5. Natural Human Rights natural �basic� rights are important ? rhetorical power of �rights talk�; : Strong claims (or entitlements) Unconditional Absolute Pre-societal, pre-conventional (not merely stipulated to be so) Foundational And, therefore, morally resonant What we�re debating, is whether heatlh care is a basic human right�whether you think of it as part of an objective moral law or as an implication of human dignity, a basic, foundational, pre-conventional natural entitlement that human beings deserve as their due�.. Which is a notion that has a lot of emotional power, because of its moral resonance. This is what we�re debating�that health care belongs among the basic �natural rights� belonging to all human beings by virtue of human dignity and worth�.or not. What we�re debating, is whether heatlh care is a basic human right�whether you think of it as part of an objective moral law or as an implication of human dignity, a basic, foundational, pre-conventional natural entitlement that human beings deserve as their due�.. Which is a notion that has a lot of emotional power, because of its moral resonance. This is what we�re debating�that health care belongs among the basic �natural rights� belonging to all human beings by virtue of human dignity and worth�.or not.

6. Access to Health Care:Privilege or Right? F. Amos Bailey MD Director, Palliative Care Birmingham VAMC Assistant Professor Geriatrics, Gerontology and Palliative Care

7. Health Care Access is Linked to Insurance It is true that if you present to an ER or hospital you cannot be refused treatment Patients without insurance have difficulty with obtaining medication, outpatient health care, and other aspect of treatment Patients without Health Insurance will have at best spotty and incoherent health care that lacks continuity

8. Cost USA spends more per capital than any other country in the world ~ $7,500 a person per year ~ 40 million uninsured Americans Half of health care costs are covered by governmental programs Current rate of growth in cost of health care is unsustainable, resulting in more people being unable to obtain or afford Health Insurance

9. Value for Our Money USA does not have the best health care outcomes Inadequate vaccination rates Infant and Maternal Morality is higher than most other Developed Countries Life Expectancy is lower than many other countries Rate of disability is higher

10. Value for Our Money It may be that lack of insurance and lack of continuity of care does not explain all of the lower health care �outcomes� Lifestyle, diet and other personal choices may play part of a role in the nation�s �unhealth� However we spend more, have more advanced technology, and other countries have some poor health habits but we have poorer overall outcomes Does this past the smell test?

11. Language of Rights Anglo-American View of Negative Rights These are Rights that relate more to protection from restriction by government Examples could be Right to Free Speech or Freedom of Religion Rights are rarely enumerated as something that you would expect to be provided at some minimal level by society, such a right to work or adequate food, housing or other basic needs

12. Language of Rights Even at times Negative Rights have been in conflict. ex.: Slaves did not have a right to their own life and liberty. Yet, emancipation caused some individuals to have loss of property and wealth, which as odd as it now sounds, was considered an impediment to emancipation. Rights in conflict. . .

13. Language of Rights In the United States a Positive Right that has been asserted and generally accepted is for Primary and Secondary Education for children. Preschool and college are optional, and although there are some programs to assist, there is no right to assistance Alabama as a state recently refused to pass a constitutional amendment because it would have stated a right to education into the state code

14. Communitarian Rights The citizens of a country may choose to share responsibilities for certain services so that the service is available if they should need the service in the future Locally an example could be law enforcement which is provided to protect and serve the community on an equal basis All citizens support these services through taxes but most hope that they will not have need to call on them

15. Communitarian Rights Protection by law enforcement is a positive right that insures other Rights such as property rights, life and liberty. In other words this right to protection by law enforcement is needed to actuate the Negative Rights that are commonly enumerated

16. Communitarian Rights In the realm of law enforcement some individuals with greater means and perhaps fear of threat to property and safety may choose to spend additional funds to live in a gated community or hire a private bodyguard. They are not allowed to deduct this cost from their community support (taxes) that pays for public law enforcement.

17. Communitarian Rights In this relation there has been a long history of inequality in the distribution of these community services such as: Law enforcement Education resources Environmental degradation with toxic industries and disposal of toxic material located in less affluent neighborhoods

18. Communitarian Rights Access to Health Care is a communitarian right that I would assert is need to ensure that all members of society may enjoy the benefits of the Life, Liberty, and Freedom This is analogous to basic education and protection by law enforcement which allows citizens to exercise their other basic rights Citizens may choose to purchase additional services as they do for both education and security

19. Philosophical Argument Duty to our selves and other Justice as fairness Justice and specifically Social Justice in conflict with Autonomy but supporting� Beneficence and avoiding Maleficence

20. Kant�s Categorical Imperative Formula of Humanity �So act that you use humanity, whether in your own person or in the persons of others always at the same time as an end, never merely as a means.� Duty of Humanity is to respect humanity in ourselves and others To fail to respect other�s humanity is to consider them less than human

21. John Rawls � A Theory of Justice� �Justice as Fairness� We all operate behind a �veil of ignorance of our own future� Leads to adopting principles of justice between groups If you are cutting a cake and you don�t know which piece will be yours. . .

22. Ethical Principles Often we have chosen to discuss these as they apply to individual health care providers or patients Will choose to apply these principles to the �Health Care System� Although we have many �systems� in the USA the sum of these health care systems or lack of access to a system will be referred to as �Health Care System�

23. Argument from Principle Justice (Social) Inadequate access to health care on the basis of race, ethnicity, religion, gender or sexual orientation would all be considered anathema Inadequate access to health care on the basis of social economic class is the current de facto situation, resulting in large portions of the population being uninsured and/or underinsured and leaving them and their family impoverished when faced with a serious illness.

24. Argument from Principle Justice (Social) Professional obligation to provide care for our individual patients extended to involvement in restructuring of the �Health Care System�. Patients should be protected from institutional discrimination based on socio-economic class just as they are protected from institutional discrimination on the bases of race, gender etc. It is noted that discrimination still occurs for a number of classes but the only one that is still allowed on an institutional level is economic

25. Argument from Principle Beneficence Deficits in �Health Care System� result in patients not seeking appropriate health care, or seeking it late when less effective, and not being able to be effectively treated due to inability to pay for needed services, such as medication, diagnostic test, or a specific treatment. This could hardly be called beneficent behavior by the �Health Care System� as a whole.

26. Argument from Principle Maleficence It has been well known for decades that the �Health Care System� resulted in disparity in access to basic health care system. All three main teaching hospitals at UAB serve primarily safety net populations with manifest differences in the available technology and sophistication of medical equipment. Individual physicians have worked very hard to maintain parity in quality and outcomes with such different levels of material support. To not advocate for a more equitable �Health Care System� is to be in danger of maleficence

27. Argument from Principle Autonomy Truer autonomy for individual patients would be possible if some basic level of access to health care could be insured More Autonomy, prized by Americans, would be achieved with the application of Rawls� �Justice as Fairness� theory

28. Role of the Individual Physician Primarily has been to be an advocate for individual patients Community Health role such as encouraging influenza vaccination, reporting communicable diseases, encouraging smoking cessation etc. Some physicians see community health role as a major or rather minor part of their professional role

29. National Health Care Plan Should provide basic health care for all citizens There would be ongoing discussion of what the definition of �basic� would be Citizens could choose to purchase additional medical care much like they might choose to engage a bodyguard

30. Universal Access to Health Care Worth working hard for�but not a basic human right Tom Huddle

31. Human Rights 18th century rights��negative� (rights not to be interfered with) Life, liberty Property (security of property) Speech Religion �the pursuit of happiness�

32. Human Rights 20th century; the move to �positive rights� (to goods and services) 1941: FDR�s �freedom from�.� UN Declaration of Human Rights (1948) ..is entitled to realization�of the economic, social and cultural rights indispensable for his dignity and the free development of his personality. Everyone has the right to work Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay. State of the union january 1941 Freedom of speech Freedom of religion Freedom from want Freedom from fear of physical aggression This declaration raises one of the immediate problems with �positive rights�; once you assert a right to goods and services, you have to specify just how much people have a right to; Its tempting to simply expand the entitlement to whatever people think is desirable�but at some point you pass beyond any quantity that could plausibly be a �human right�; State of the union january 1941 Freedom of speech Freedom of religion Freedom from want Freedom from fear of physical aggression This declaration raises one of the immediate problems with �positive rights�; once you assert a right to goods and services, you have to specify just how much people have a right to; Its tempting to simply expand the entitlement to whatever people think is desirable�but at some point you pass beyond any quantity that could plausibly be a �human right�;

33. UN Declaraion of Human Rights Everyone has the right to..food, clothing, housing,..medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age� Everyone has the right to enjoy the arts and to share in scientific advancement.

34. 1966 UN International Covenant on Economic Social and Cultural Rights �..the right of everyone to an adequate standard of living for himself and his family, including adequate food, clothing and housing, and to the continuous improvement of living conditions.

35. �.the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 1966 UN International Covenant on Economic Social and Cultural Rights From negative rights to positive rights as this evolution has happened in our discourse feels like we�ve sprung a leak somewhere�.we�ve moved from clear moral intuitions about what people are due to what might be a utopian vision of an ideal society�.The UN now says people have a right not only to health care but to health!!!! At least they qualified it a little bit� The feeling you�re left with from declarations like this is that the authors are in a dream-world; in the real world of scarcity and sickness and human tendencies to go wrong, health and holidays with pay and continuously improving living standards are things we all want�but in fact they�ve been enjoyed by a small fraction of humanity living in certain places in the last century or so�..and what is gained by labeling them as �human rights�, that is, basic foundational entitlements that some people are presumed to possess and and then presumed to be obligated to grant to others on pain of being �evil� if they fail to? These things might be noble aspirations for the future; they can hardly be �basic human rights� on the same level as your right to a trial by jury or your right to be protected from violence. From negative rights to positive rights as this evolution has happened in our discourse feels like we�ve sprung a leak somewhere�.we�ve moved from clear moral intuitions about what people are due to what might be a utopian vision of an ideal society�.The UN now says people have a right not only to health care but to health!!!! At least they qualified it a little bit� The feeling you�re left with from declarations like this is that the authors are in a dream-world; in the real world of scarcity and sickness and human tendencies to go wrong, health and holidays with pay and continuously improving living standards are things we all want�but in fact they�ve been enjoyed by a small fraction of humanity living in certain places in the last century or so�..and what is gained by labeling them as �human rights�, that is, basic foundational entitlements that some people are presumed to possess and and then presumed to be obligated to grant to others on pain of being �evil� if they fail to? These things might be noble aspirations for the future; they can hardly be �basic human rights� on the same level as your right to a trial by jury or your right to be protected from violence.

36. Structure of Rights Rights involve duties; rights involve: Privilege (liberty); Privilege to f means no duty not to f Claim Claim to receive x means someone has a duty to give you x Immunity Power Focus here is on the claim� Privilege; you�re allowed to do something Claim; you have a right to receive something or not to be interfered with if you do something Rights emphasize recipience and duties emphasize agency/doing; but they�re two sides of the same coin. Focus here is on the claim� Privilege; you�re allowed to do something Claim; you have a right to receive something or not to be interfered with if you do something Rights emphasize recipience and duties emphasize agency/doing; but they�re two sides of the same coin.

37. Rights imply duties; for basic human rights, Negative rights ? positive rights Translates to: Absolute Duty to let people be ? Absolute duty to give people stuff = an absolute duty for some people who have stuff to give it to other people who don�t So in spite of what Amos said about the continuity of negative and positive rights, there seems to be a difference between rights not to be interfered with and rights to be given stuff�.the rights not to be interfered with seem plausibly basic and foundational�the rights to be given stuff run into difficulties when we try to specify them�. Whats behind that? Structure of rights makes it clear that in moving from rights to be allowed do do things your own way; rights to freedom from interference; to, rights to goods and services, we�ve made a leap��.because from asserting an unconditional duty to let people be the way they want to be we�ve moved to assert an unconditional duty to give people stuff. Any such unconditional obligation to give other people stuff that is technically scarce; that is, scarce in the economic sense that it takes time and effort to produce�has the potential to interfere with our unconditional rights not to be interfered with. We have duties to give people stuff in all sorts of situations but its hard to see that we have unconditional duties to give potentially unlimited amounts of our own stuff to unrelated people whose only qualification to get it is their own lack of it. For goods and services to be human rights in the strong sense, our duties to do this must be unconditional and unlimited. So in spite of what Amos said about the continuity of negative and positive rights, there seems to be a difference between rights not to be interfered with and rights to be given stuff�.the rights not to be interfered with seem plausibly basic and foundational�the rights to be given stuff run into difficulties when we try to specify them�. Whats behind that? Structure of rights makes it clear that in moving from rights to be allowed do do things your own way; rights to freedom from interference; to, rights to goods and services, we�ve made a leap��.because from asserting an unconditional duty to let people be the way they want to be we�ve moved to assert an unconditional duty to give people stuff. Any such unconditional obligation to give other people stuff that is technically scarce; that is, scarce in the economic sense that it takes time and effort to produce�has the potential to interfere with our unconditional rights not to be interfered with. We have duties to give people stuff in all sorts of situations but its hard to see that we have unconditional duties to give potentially unlimited amounts of our own stuff to unrelated people whose only qualification to get it is their own lack of it. For goods and services to be human rights in the strong sense, our duties to do this must be unconditional and unlimited.

38. Structure of rights Negative rights In the absence of enabling institutions, universal right is clearly matched with universal obligation Positive rights In the absence of enabling institutions, universal right is matched with: ? Require institutional specification for definition ? �positive rights� do require some to give stuff to others Amos says that there�s no important distinction between negative and positive rights because both have costs and require institutional structures for their support and enforcement. That may be true; but there�s still an important distinction to be drawn. Structure of universal negative rights easily specified�. if I have a right to free speech, everyone else has an obligation not to interfere with my speech� its clear who has the right, who has the corresponding obligation, who�s to blame for infractions of the right; whether one has a police force and justice system to enforce the right or not. This isnt the case with positive rights� if everyone has a right to food or shelter or health care, then what? Who bears the corresponding obligation? its true they can be institutionalized�.but the point is, they MUST be institutionalized before we even know what they mean�.far from being pre-societal or pre-conventional, rights to goods and services start to look like things that societies can agree upon to offer their members and set up institutions to provide; as the US has done in granting its citizens a right to education for grades 1-12�.NOT universal, foundational human rights but special, stipulated rights that are products of societal agreements. Any such right can only be fully specified by answering a host of questions such as: Who is supposed to provide education or health care to whom? Why should those persons or institutions be the providers? What place should the provision of education or health care occupy on the list of social and political priorities? How much of it is to be offered? How is it to be done? Those questions have to be answered; without answering them we don�t even know what the content of the right we�re discussing would be; all we could say about a right to health care would be we�re going to impose an obligation on somebody or other to provide some yet to be specified amount of health care in some yet to be specified way� And in grappling with specifying the who and the how and how much, most of us would say we�re in the realm of prudential judgments that have to be made politically by citizens considering whats best for the society and voting their preferences at the ballot box. They�re not a matter of absolute universal rights or obligations. And most of us would be right about this�Amos says that there�s no important distinction between negative and positive rights because both have costs and require institutional structures for their support and enforcement. That may be true; but there�s still an important distinction to be drawn. Structure of universal negative rights easily specified�. if I have a right to free speech, everyone else has an obligation not to interfere with my speech� its clear who has the right, who has the corresponding obligation, who�s to blame for infractions of the right; whether one has a police force and justice system to enforce the right or not. This isnt the case with positive rights� if everyone has a right to food or shelter or health care, then what? Who bears the corresponding obligation? its true they can be institutionalized�.but the point is, they MUST be institutionalized before we even know what they mean�.far from being pre-societal or pre-conventional, rights to goods and services start to look like things that societies can agree upon to offer their members and set up institutions to provide; as the US has done in granting its citizens a right to education for grades 1-12�.NOT universal, foundational human rights but special, stipulated rights that are products of societal agreements. Any such right can only be fully specified by answering a host of questions such as: Who is supposed to provide education or health care to whom? Why should those persons or institutions be the providers? What place should the provision of education or health care occupy on the list of social and political priorities? How much of it is to be offered? How is it to be done? Those questions have to be answered; without answering them we don�t even know what the content of the right we�re discussing would be; all we could say about a right to health care would be we�re going to impose an obligation on somebody or other to provide some yet to be specified amount of health care in some yet to be specified way� And in grappling with specifying the who and the how and how much, most of us would say we�re in the realm of prudential judgments that have to be made politically by citizens considering whats best for the society and voting their preferences at the ballot box. They�re not a matter of absolute universal rights or obligations. And most of us would be right about this�

39. �Positive Rights� Morality Having produced goods/services, we (some of us) are obliged to give them or to construct institutions to give them to those others that have a right to them until either everyone has all goods and services they have a right to, or we have exhausted our resources. To make the case that goods/services are absolute human rights, Dr Bailey would have to hold to something like this�. now positions like this have been advocated in the ethics literature, but: no people or group of people act like this or have done so�. To quote dr Bailey, does this pass the smell test? To make the case that goods/services are absolute human rights, Dr Bailey would have to hold to something like this�. now positions like this have been advocated in the ethics literature, but: no people or group of people act like this or have done so�. To quote dr Bailey, does this pass the smell test?

40. Traditional Morality We have a moral obligation to help the needy but noone has the right to insist on someone else�s help except: Family People we�re connected to by contracts freely entered into Certain kinds of immediate need confronting us Duty not to harm (without provocation) is absolute What I would wish to defend in opposition to dr Bailey is what everyone in western culture has always believed until people like him started talking about positive rights�.What I would wish to defend in opposition to dr Bailey is what everyone in western culture has always believed until people like him started talking about positive rights�.

41. Duty not to harm is absolute and unlimited (nonmaleficence) Duty to help (beneficence) is not. If we say duty to help is absolute, what becomes of our negative rights? Think about it� compare your obligation to help a street person asking you for money with your obligation not to harm a street person asking you for money. which obligation is greater, even unconditional? consider how much praise you would deserve for helping such a person (some�because you aren�t unconditionally obliged to) compared with not harming him (none; because this is absolutely expected of you)�.Think about it� compare your obligation to help a street person asking you for money with your obligation not to harm a street person asking you for money. which obligation is greater, even unconditional? consider how much praise you would deserve for helping such a person (some�because you aren�t unconditionally obliged to) compared with not harming him (none; because this is absolutely expected of you)�.

42. Summary moral Argument Positive rights ? unconditional obligations for some people to give goods/services to other people Such obligations ? traditional morality Not intuitive, not plausible ? subversion of negative rights that we all agree are important We do have obligations to help the needy; they�re not absolute and unconditional as �positive� basic human rights would suggest

43. Implications for policy We should help those in need Decisions about public provision of goods/services to the needy are moral but also prudential choices Re how much to take from producers so as not to endanger production and protect negative rights Re which/how much goods to provide, given that need will inevitably exceed supply. Such decisions belong in the political process; they cannot be decided by appeal to absolute rights Given our conditions in 21st century America, we ought to guarantee some level of health care to our citizens

44. Fraser Institute�s �economic freedom� index a measure of negative rights Personal choice Volountary exchange coordinated by markets Freedom to enter and compete in markets Protection of persons and their property from aggression by others Finally, beyond the moral argument there�s a practical argument to be had here; if you want more goods and services in the hands of more people, whats the best way to get that? By focusing on positive rights or negative rights? Much of the political argument in the 20th century has been between countries in the west that championed traditional negative rights and countries in the old soviet block and elsewhere who excused their lack of negative rights by focusing on the positive ones� Exploring that dispute fully would be another debate�.im merely going to point out that you can combine various negative rights of freedom from interference and security of property into an index of �economic freedom��Finally, beyond the moral argument there�s a practical argument to be had here; if you want more goods and services in the hands of more people, whats the best way to get that? By focusing on positive rights or negative rights? Much of the political argument in the 20th century has been between countries in the west that championed traditional negative rights and countries in the old soviet block and elsewhere who excused their lack of negative rights by focusing on the positive ones� Exploring that dispute fully would be another debate�.im merely going to point out that you can combine various negative rights of freedom from interference and security of property into an index of �economic freedom��

45. Now if you rank countries by measures that quantify those factors�.Now if you rank countries by measures that quantify those factors�.

46. Countries that have best protected the negative rights turn out to do the best at assuring their citizen�s health�.. Now you may say that correlation doesn�t imply causation; Cf Norton, poverty and property rights cato j 98: suppose the rich countries of the world attained their wealth by economic exploitation of the poor countries or even by luck. Suppose further that the citizens of those richer states prefer well-specified property rights to favor their own well-being over the poorer members of their own countries. In such a case, property rights might be interpreted as the driving force behind the economic gains to the rich countries when in fact they would be only a coincidence. In short, the relationship between property rights and economic performance may be a statistical artifact�.. Countries that have best protected the negative rights turn out to do the best at assuring their citizen�s health�.. Now you may say that correlation doesn�t imply causation; Cf Norton, poverty and property rights cato j 98: suppose the rich countries of the world attained their wealth by economic exploitation of the poor countries or even by luck. Suppose further that the citizens of those richer states prefer well-specified property rights to favor their own well-being over the poorer members of their own countries. In such a case, property rights might be interpreted as the driving force behind the economic gains to the rich countries when in fact they would be only a coincidence. In short, the relationship between property rights and economic performance may be a statistical artifact�..

47. Good development economists: Correlation between protection of negative rights and more/better provision of goods and services is not coincidence. Many good development economists believe that in fact the structures enabling negative rights such as security of property are the road for developing countries out of poverty.. So practically speaking as well as morally, negative rights are prior to the realization and enjoyment of the goods and services desired by advocates for positive rights. Many good development economists believe that in fact the structures enabling negative rights such as security of property are the road for developing countries out of poverty.. So practically speaking as well as morally, negative rights are prior to the realization and enjoyment of the goods and services desired by advocates for positive rights.

48. Point of this quotation is to point out that the postive rights advocates seem to believe that they can start with entitlement and consumption and simply decide how goods and services are to be parceled out�. In the real world, goods and services have to be produced, and production is prior to distribution and consumption; if we want food and health care we have to think about farmers and physicians, how best to encourage them, including respecting their negative rights to produce their services and dispose of them at a given price. If we set up conditions so as to encourage those who produce food and shelter and health care, we�ll have lots of them to decide how to distribute in the political arena. The choice is not between negative rights and positive rights, its really between negative rights and no rights at all. This should not surprise us. If you want goods and services, you�d better protect the rights of those who are going to provide them before you focus on any recipient�s right to get them. But of course, that�s the kind of common sense we�ve learned not to expect from Dr Bailey and his ilk. Point of this quotation is to point out that the postive rights advocates seem to believe that they can start with entitlement and consumption and simply decide how goods and services are to be parceled out�. In the real world, goods and services have to be produced, and production is prior to distribution and consumption; if we want food and health care we have to think about farmers and physicians, how best to encourage them, including respecting their negative rights to produce their services and dispose of them at a given price. If we set up conditions so as to encourage those who produce food and shelter and health care, we�ll have lots of them to decide how to distribute in the political arena. The choice is not between negative rights and positive rights, its really between negative rights and no rights at all. This should not surprise us. If you want goods and services, you�d better protect the rights of those who are going to provide them before you focus on any recipient�s right to get them. But of course, that�s the kind of common sense we�ve learned not to expect from Dr Bailey and his ilk.

49. Conclusion There are no natural, absolute and universal human rights to goods and services, including health care. If we pay attention to real human rights, we can construct a society in which we may (and ought) to choose to provide some good and acceptable level of health care to everybody.