I have argued previously that health care is not a primary right, but a civil right. I want now to engage the argument against health care as a right in more depth, specifically to say that it can only be symptomatic of acute hypocrisy.

The argument, in its typical presentation, is that doctors provide a service, the provision of which they should have exclusive control over; making health care a right denies them that control, therefore health care cannot be a right. Bear in mind that this argument was originally formulated by a non-physician, and is not endorsed by all physicians. That said, the physicians who do endorse this notion are at least being disingenuous - including such docblogs as Kevin, MD and GruntDoc.

There are two ways to approach this - that is, two questions I think relevant.

First, are there other professionals who don’t have exclusive control over the services they provide? There are: soldiers, lawyers, educators, police officers, firefighters - that’s just off the top of my head. This is, of course, a matter of degree - so that lawyers have more discretion over their services than do firefighters. In fact, this may not be the best example, given the antipathy docs have for lawyers.  Still, our judicial system requires anyone accused of a crime to be provided with the services of an attorney; those attorneys may not be well paid, but they are at least available. Anyway, the idea that every person has exclusive control over the skills and services they provide is simply false. There are plenty of professions whose members are constrained so as to ensure their services benefit society more broadly. In most cases, this does not rise to the level of “right” - does someone have a “right” to firefighting? - and yet we still think the service should be available to all, as distinct from ordinary commercial services available to those who can pay.

Now the second question: is there anything within the traditions of medicine itself to suggest that health care is not an ordinary commercial service? There is. I had thought that you could find said traditions in the Hippocratic Oath, but on looking at it discovered a) it’s much weirder than I remembered, and b) it is mostly silent on the doctor’s role in society. But at least two reformulations of the oath do address this last aspect. First, a modern version by Louis Lasagna includes the promise that “I will remember that I remain a member of society, with special obligations to all my fellow human beings.” Similarly, the Declaration of Geneva states, “I solemnly pledge to consecrate my life to the service of humanity.” This is not to say that every doc has taken these oaths; their usage varies, from what I understand. At the same time, these sorts of traditions are not found in the history of, say, dry cleaners or auto mechanics. I suspect medical students learn quite early that their chosen career comes with special obligations - assuming these obligations were not part of what attracted them to the career in the first place. So, as I said, doctors who try to ignore these traditions and obligations are simply being disingenuous.

In exchange for taking on these obligations, doctors are granted tremendous authority and privilege in our society - even over individual lives. For example, if I walk out of a hospital against medical advice - AMA - I am a) putting myself on the hook for a massive bill, and b) affecting my future treatment at said hospital. So I go home only when a doctor “releases” me. If I tried to do this to anyone else, it would be kidnapping and false imprisonment and a felony. This may seem hyperbolic, but wait until you’re trapped in a hospital by a capricious doctor, and tell me it doesn’t feel every bit a violation of your rights. Perhaps a more immediate example is the power doctors have over prescription medicines. I don’t need a prescription to get my clothes dry cleaned or my car fixed - and for the car, nobody has a problem with me buying the parts online.

I agree that it makes sense for doctors to have certain privileges (tho’ obviously, I’m still irked about the AMA thing) - but it only makes sense to grant doctors these privileges if they also have some special obligation to society. Any doctor who denies these obligations while still claiming these privileges for himself is at least technically - and I would argue, fully - a hypocrite.

It is possible, perhaps probable that these docs are not being consciously hypocritical. In fact, it is entirely likely that their hypocrisy is the incidental consequence of not having thought through the implications of their claims. But whether the pathology is deliberate or not, the prescription is the same: recognize your obligation, or surrender your privilege - and either way stop telling sick people they don’t have a right to health care.

Tags: care, docs, pols