Waiting for an event to begin, our group was making small talk. One woman mentioned that recently her niece, while traveling, had broken her ankle. It was set by an unfamiliar orthopedic surgeon in an unfamiliar town. “Six thousand dollars!” the woman exclaimed. “Six thousand dollars to set those bones! Outrageous!” On and on she went about the six thousand dollars.
Finally I asked, “How much should it have cost?”
That put a damper on the conversation.
Does anybody really know how much it is worth to set an ankle? Our health care market has so many distortions, including geographic monopolies, government subsidies in the form of Medicare and Medicaid, insurance companies as middlemen, opaque price lists, licensing restrictions, and the overwhelming human desire to alleviate suffering. It is impossible for the market to settle on a fair price. But surely everyone agrees that the surgeon should receive some compensation for his trouble.
Well, not so fast. An awful lot of people believe health care is a human right. Do people need health care, or do people have a right to health care?
Right, noun: a just claim or title
Need, noun: that which is required or necessary
Did the woman’s niece have a just claim to the surgeon’s skills—or did she require the surgeon’s skills?
People need shelter, too, but do they have a right to shelter? Plenty of people seem to think so. To believe that shelter is a human right is to believe that a person has a just title to housing. What housing? My housing? Your housing? People need food, but is food a right? People are better off with education, but is education a right?
If something tangible is classified as a right, logic dictates that others must supply it. But the supply side of the equation is given short shrift by those who advocate for the right to health care, housing, food, or education. Their constituents are the claimants, not the providers.
If these advocates give any consideration to supply, the usual assumption is that the government will provide. (So don’t worry, Landlord Smith; the right to housing doesn’t mean that people will move into your duplex and not pay rent. Don’t worry, Farmer Brown; the right to food doesn’t mean that people will help themselves to your garden. Don’t worry, Chancellor Jones; the right to education doesn’t mean that students won’t pay their tuition.) This is how the welfare state functions, isn’t it? We are taxed and our tax money is redistributed in the form of Medicaid payments, Section 8 vouchers, SNAP cards and Pell Grants. Aren’t we in agreement on the concept, if not on the details and the scope? Do we really want sick, homeless, hungry, poorly educated people languishing in our communities?
Well, we already have sick, homeless, hungry, poorly educated people languishing in our communities. All that advocacy for the right to health care, the right to housing, the right to food and the right to education hasn’t eliminated these societal ills.
Maybe, just maybe, it’s because rights are demanded, instead of needs met. What if we flipped the script? What if the conversation was about the supply of needs instead of the demand of rights?
Consider housing, for example. When people talk about the lack of affordable housing, they mean housing is too expensive. Why is it too expensive? Because there isn’t enough of it. Things that are scarce cost more. Why is housing scarce? Because there are barriers to building housing: zoning laws, rent control, building codes, high interest rates, permitting rules, lack of labor in the trades, supply chain disruption, land use restrictions. Causes vary from one city to another, but the lack of affordable housing is a self-inflicted ill. Imagine a firefighter kinking the fire hose in two or six or ten places, and then wondering why the water only trickles out. He can stand there all day, demanding his rights to a torrent of water—or he can figure out what’s blocking the flow.
Twenty years ago, I traveled to Cuba for a week with two of my young sons (as one does1). I stuffed our suitcases with aspirin, shampoo, bars of soap, bandages, deodorant, anti-bacterial ointment, toothpaste, and toothbrushes. Forty-plus years after the revolution, band-aids and aspirin were in short supply in Cuba, and a tourist could get mobbed for a bar of soap. When I wasn’t observed by the local police, or when the streets weren’t too crowded, I would hand out these basic medicine-cabinet supplies.
I had also brought a lot of cash, in small bills. I bought trinkets, whether or not I wanted them, and paid for services I didn’t really need, in U.S. dollars. The Cuban peso was nearly worthless, and the Cuban underground economy depended on dollars. However, the safest way for me to get dollars into the community was to tip the staff at our Havana hotel. The concierge, receptionists, maids, waiters, and staff of the business office were all former professionals—including doctors and nurses who didn’t practice medicine anymore.
Healthcare is a human right in the Cuban constitution—free for the taking (the demand side of the equation). Cuban doctors earned about $50 per month—paid by the national government (the supply side of the equation). But what did this healthcare system, to which Cubans have a right, look like? Depending on the source, the healthcare outcomes in Cuba were on par, or slightly better for some metrics, than those in the United States, for far less cost. But the Cuban right to healthcare came with conditions and assumptions and side effects most Americans would not tolerate.
And there was another wrinkle. Doctors and nurses who couldn’t support their families on poverty level wages left the field of medicine and worked in the tourist trade. At our hotel, a doctor could answer the phone in the business office or wait tables in the restaurant, and earn a month’s wage in a couple of days. Such a misallocation of skills and training. Every time someone demands a right to something tangible, I remember those Cuban doctors and nurses who cleaned my hotel room, connected my long-distance phone calls, and served my breakfast.
You may need something, but declaring you have a right to it is meaningless if no one can or will supply it.
__________
1Our trip to Cuba was under the auspices of a short-lived, cultural exchange program—Friendship Through Baseball. My 14-year old son was on the baseball team from Illinois; my 7-year old son came along for the ride.
