Yesterday’s FT op-ed on the right to health generated a lot of heat in this blog's comments section. Several commenters disputed an absolute distinction between the “moral approach”—declaring health to be a human right, and the “pragmatic approach”—directing finite public resources to where they can benefit the most people at a given cost. Justin Krauss said:
I too am skeptical about the wisdom of claiming a “right to health” but I don't think that such a right AND a more pragmatic approach to healthcare are necessarily mutually exclusive. I can (although I am not sure that I do) believe that health is a "right" while approaching the problem of how to achieve that right in a pragmatic, most benefit for the most people, manner.
The geckonomist questioned the causal link between calling health a human right on the one hand, and inefficient use of public resources on the other. He argued that the real problem is the way that narrow political interests are able to manipulate public funds, "regardless of the underlying moral reason.”
ryan picked up this same thread, asking whether the rights approach is simply being applied selectively, benefiting some groups more than others:
The primary argument you seem to level is that the 'rights' approach is applied unequally along disease- and class-specific lines, and that the people advocating that healthcare is a human right are the same people that are really just hungry for big headlines and large commitments to a small but visible sector of the actual needs of developing communities….Your real problem is with the execution, not the intellectual framework, of global public health spending.
Others objected to the notion that a human right implies requiring unlimited resources, and suggested various kinds of limits like “basic needs,” “subsistence,” or “basic health care.”
But none of these concepts are precise enough to yield hard upper limits, they will be different in different countries, and the limits themselves will be the objects of political advocacy for obvious reasons.
Nor is there anything about the “limit” process that keeps the sum of basic needs from exceeding the available resources—in fact, it is highly likely that they will do so.
So the problem is back to the issue of how to decide whose basic needs to satisfy and whose to not satisfy. This will be a political debate, and so once again the most politically skilled and connected will win, which will usually not be the neediest. So the rights approach is inherently unequal -- it is not just a matter of execution. And ideas like human rights do matter if they obfuscate the likely outcomes.
It is true the cost-benefit analysis can also be manipulated politically, but it offers at least a chance to lead to a frank and open discussion about effective use of public resources to save as many lives as possible. The ideal that the lives of the poor are worth just as much as the rich is more likely to be realized in the pragmatic approach, ironically, than in the idealism of a human right to health care.