Health care

Health care is a service produced by doctors, nurses, researchers, and manufacturers. Objectivism holds that there is no right to it, because a right is a freedom to act rather than an entitlement to a good that another person must produce, and that state control of medicine is destructive precisely in proportion to how much a patient depends on a doctor's independent judgment.

“No man can have a right to impose an unchosen obligation, an unrewarded duty or an involuntary servitude on another man. There can be no such thing as "the right to enslave."”
~ Ayn Rand, "Man's Rights", The Virtue of Selfishness

Why it is not a right

The forum's version of this question is a good one and deserves the exact answer rather than a slogan. If the right to life is the source of all rights, and health care is something you need in order to live, why does the right to life not include it?

Because a right is a sanction to act, not a claim on the actions of others. See Rights. The right to life is the right to take the actions a life requires; it is not a guarantee of the results, and it cannot be, because the results have to be produced by somebody. The test Rand applied is to ask who is obliged by the claimed right. A right to speak obliges everyone else only to refrain. A right to medical care obliges a specific doctor to provide it, on terms he did not set, or obliges a taxpayer to buy it for a stranger.

This is why the two kinds of claim cannot coexist as rights of the same type. Rand's point about the mid-century political platforms that listed a right to a home, a job, and adequate medical care was that they never named who was to be compelled to supply them, and that the omission was the whole trick.

The correct formulation of the freedom involved is the one the forum arrives at on its own: you have a right to obtain health care by any means that do not violate anyone else's rights: to buy it, to insure against needing it, to be given it by someone who chooses to give it, to practise medicine yourself. What you do not have is a claim on a doctor's time.

"Rationing"

Objectivists on this forum object to the word being used for both things at once, and the objection is a conceptual one rather than a quibble.

Everything scarce is allocated somehow. In a market, care is allocated by the choices of the people who produce it and the people who pay for it: a price is a piece of information about what others are willing to trade, and no one decides for anyone else. Under a state system, care is allocated by an official rule about who gets treated, in what order, and up to what cost ceiling. Calling both of these "rationing" packages together a process in which people decide for themselves with one in which they are decided about. See Package-Deal.

The substantive claim behind the word is that unpriced care is not free care but delayed care, and that the queue is the price. Threads here about Canadian and British waiting times are arguments over that claim.

What happens to doctors

The distinctively Objectivist emphasis in this area is not on cost curves but on the practitioner. Medicine is a field in which the whole value of the service depends on a professional exercising independent judgment in a particular case, and that is exactly the thing that political control cannot leave intact. As controls accumulate, the doctor's decisions are increasingly made by someone who is not in the room and is not responsible for the outcome. Leonard Peikoff's "Medicine: The Death of a Profession" is the essay-length statement of this argument.

Ayn Rand dramatised it in Atlas Shrugged through Dr. Thomas Hendricks, a brain surgeon who quits when medicine is placed under state control. It is the passage forum members repeatedly go looking for.

“I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it that they expect to depend on, when they lie on an operating table under my hands?”
~ Dr. Thomas Hendricks, Atlas Shrugged

The argument in the novel is not that doctors deserve more money. It is that a mind cannot be conscripted: force can compel a body to be present and cannot compel a judgment to be good. See Initiation of force.

What a free market in medicine would look like

Objectivism does not treat the present American system as the free-market case. Employer-linked insurance created by tax law, licensing restrictions on who may practise and how many may train, prescription and approval regimes, and the mandates that make insurance a prepayment plan rather than insurance are all state interventions, and the pathologies they produce are routinely offered as evidence against markets.

The positive position is that medicine should be a trade like any other: providers free to set terms, patients free to choose and to bear the consequences of choosing, insurance priced to risk and covering catastrophes rather than routine costs, and charity as the voluntary response to people who cannot pay, which is what it was before it was displaced. See Capitalism and Government.

Common misunderstandings

That "no right to health care" means the sick should be left to die. It is a claim about who may be compelled, not a recommendation about whom to help. Voluntary help, including a great deal of it, is consistent with the position. See Egoism and Sacrifice.
That opposing state medicine means defending the current system, the insurance industry, or the American Medical Association. Objectivist writing on this subject attacks all three as creatures of regulation.
That because a doctor is paid, his refusal is somehow different from anyone else's. The principle is the same one that applies to a farmer, a builder, or a programmer; medicine only makes it vivid.
That the argument depends on markets being cheaper. It would hold even if state medicine were cheaper, because the objection is that it is compulsory.
That emergency care is a counter-example. An emergency is a situation in which acting on a value is urgent, not one in which the standard of value changes. See Ethics.

Discussion

References

Rand, Ayn. "Man's Rights". The Virtue of Selfishness. New American Library, 1964. Also in Capitalism: The Unknown Ideal.
Rand, Ayn. Atlas Shrugged. Random House, 1957. Dr. Thomas Hendricks, Part III.
Peikoff, Leonard. "Medicine: The Death of a Profession". The Voice of Reason: Essays in Objectivist Thought. New American Library, 1989.

External links

Individual Rights at the Ayn Rand Lexicon