The most philosophically engaging question of last night’s debate may go unremarked: “Is health care in America a privilege, a right, or a responsibility?”

Here is McCain’s response, in part: “I think it’s a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. And with the plan that—that I have, that will do that.”

Here is Obama’s response, in part: “Well, I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can’t pay their medical bills—for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they're saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that.”

Here, for reference, is The New Dictionary of Cultural Literacy on the first ten amendments to the Constitution, in full: “Among other provisions, they protect the freedoms of speech, religion, assembly, and the press (see First Amendment); restrict governmental rights of search and seizure; and list several rights of persons accused of crimes (see Fifth Amendment).”

What the rights enshrined in these amendments have in common is that they pertain to things that cannot be taken away: speech, press, assembly, arms, protection from quartering of troops, protection from search and seizure, due process, fair trial, protection from cruel and unusual punishment, and states’ rights. Freedom of the press and the right to bear arms, for example, do not entitle you to free printing presses or guns.

Health care is provided by doctors. No one can be forced to practice medicine. No one, having learned to practice medicine, can be forced to treat you. ER physicians are required to treat all comers only in the sense that they can lose their jobs if they don’t. I’ve never heard it convincingly argued that one can have a “right” to a commodity produced by someone else. (Does one, by extension, have a standing “right” to treatments not yet developed?)

McCain said the responsible thing: It would be great if there were “available and affordable health care“ for “every American.” No sane or compassionate person can argue with that. Obama said that it “should be a right.” But rights have nothing to do with “should.” Rights are entitlements contingent on nothing but birth—you might even say they are “God-given.”

A civilized and wealthy country, one that provides roads, schools, and a postal service, ought to be able to provide rudimentary health care for its citizens. But that is a far cry from saying that one has a “right” to it. To say that one has a “right“ to transportation, education, or mailing a letter is to allow that some people, in the service of that “right,” must be compelled to lay asphalt, teach algebra, and deliver mail. I’d like to see anyone make that argument on a national stage. Affordable health care is a worthy goal, but to claim that it’s an entitlement is to wantonly deceive the electorate—and it has to stop.

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