Rights, Reasonable Expectations, and Rationing: A Commentary on the Essays of Ruth Mattheis and Baruch Brody

Abstract

Ingredient in the very structure of capitalist democracy is the necessity for so-called “trade-offs,” a term in ever-increasing use these days in the context of the economics of health care. In fact, the very idea of trade-offs in the health care context tends nowadays to plague us all; even the affluent are following the economics of health care and wondering where it will all lead. The furrowed brow is now commonly worn on the heads of physicians and patients alike. The worry is that with respect to medical and health care (for those who draw this distinction) equality and efficiency, democracy and capitalism, humanitarianism and rational spending, even ethical principles and economic propositions are now in conflict; this can also be expressed as a conflict between rights and dollars. There is one way to resolve the conflict: namely, provide a powerful argument to show that there is a right to health care for each and every citizen. After all, it is also a maxim of democratic capitalism that equally distributed (essentially cost-free) rights should not be given a pecuniary value — ought not to be bought and sold for money.

I am expecially grateful for the excellent critical comments provided by my friends and colleagues, Thomas Halper and H. Tristram Engelhardt, Jr.; the remaining inadequacies are clearly the fault of the author.