This article will be the third installment in a discussion on health care/insurance reform. In this first entry, I argued that insurance, in its true form, is not a public utility. Insurance businesses can become "too big to fail" and thus proper regulation is necessary. That was followed by a discussion on rights and the role of the state in protecting, preserving and granting rights. My conclusion was that health care rights are positive claim rights, and thus it would be dangerous for the state to legislate a right to health care.
Health care is a very important issue. It is full of emotion. People's lives are at stake. This cannot be ignored when analyzing the role of the state in such an issue. While insurance should not be a public utility nor should the state sanction positive claim rights, that, in my opinion, does not close the issue. The concept of human needs must be explored.
When I first began to think about this from a human needs perspective, I asked myself how one could define human needs. My first inclination was to define these basic needs as food (including water), clothing and shelter. My second inclination was to do some research on the subject. After a quick review of the subject area of needs, I found Maslow's hierarchy of needs to be worth a review.
Maslow published his work in 1943 and this is still widely considered as the seminal work in the field. Maslow proposes a hierarchy of five tiers of needs beginning with physiological needs. These physiological needs must be met for human survival. These needs are breathing, homeostasis, water, sleep, food, sex, clothing and shelter. This seems like a logical list and, with a few possible exceptions, the human cannot survive without them. The the next three tiers round out what he describes as "deficiency needs" beginning with safety and security, then social needs such as love and belonging, and finally esteem and respect. Once the individual has met all of their deficiency needs, they seek self-actualization.
Health care can be viewed primarily as a need of safety and security. This, according to Maslow, is one level above the physiological needs. It should be clear that the state should not impede the individual from pursuing their needs. In this sense, there is an overlap between needs and rights. Your right to pursue health care and security or your right to retain your shelter and food would be classified as negative claim rights. The state should protect these rights by not allowing them to be taken from you by another person (or by the state itself).
But, if an individual has a deficiency in one of their physiological needs, what role should the state play to ensure the provision or attainment of these needs? To force another to provide for those with a deficiency would be a violation of the rights of the one who is forced. However, it is important to understand what happens to the individual who does not have their basic needs met. It is not a stretch to conclude that when humans face a deficiency in their needs (especially physiological needs) that they may be more likely to react violently and/or threaten the security of others.
This issue introduces the concept and the need for a social safety net. A social safety net is a set of structures by which those who have a deficiency in their needs can seek assistance in having those needs fulfilled. There is a definitive economic benefit to those who have to provide to those who have not. Putting aside morality and ethics (which are not universally defined and thus should not be legislated), the provision of services to meet the physiological deficiencies of others helps to serve ones need for safety and security. So, does the state have the obligation to provide a social safety net?
My short answer is yes. However, that is not the end of the discussion. This must be a limited function which should only fill in the gaps where the private sector (mostly via charity) is inadequate. It also must not extend past the point where the cost is burdensome to those who simply seek to maintain their security via the provision of such a social safety net. The role of the state must also be carefully limited to those truly in need of the most basic services. While it is tempting to expand the public social safety net to fulfill higher-level needs, the principles of private funding and protection of negative claim rights must remain.
Does public universal health care reach the standard of necessitating state support in the social safety net? No. However, we should ensure that access to basic and emergency care is available to all. We should also strive to find ways to make this inexpensive, effective, and easily accessible. As we cannot expect a social safety net to provide everyone a 3000 square foot house with a half-acre of land, a personal chef, and a free wardrobe from Macy's refreshed annually; we certainly cannot expect the social safety net to provide "high-quality" or "best-in-class" health care for all.
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