Health Care and the Separation of Charity and State

If someone in America needs medical care but cannot afford it, should he rely on charity or should others be forced to pay for it? President Obama and his political allies say that Americans should be forced to pay for it. Forcing some Americans to pay medical bills for other Americans, says Obama, is a “moral imperative”1 and “the right thing to do.”2

Throughout the health-care debate of 2010–11, Obama repeatedly referred to government-run health care as “a core ethical and moral obligation,” arguing that, “No one should die because they cannot afford health care, and no one should go broke because they get sick.”3 In speeches, he repeatedly cited the story of Natoma Canfield, an Ohio cancer patient without health insurance, as a justification for his health-care legislation.4 Many of Obama’s supporters on the political left made similar moral claims. Vanderbilt University professor Bruce Barry wrote in the New York Times that, “Health insurance in a civilized society is a collective moral obligation.”5 T. R. Reid, former foreign correspondent for the Washington Post, called universal health care a “moral imperative.”6 Ezra Klein, another writer for the Washington Post, agreed that it is an “ethical obligation.”7

But all such claims are wrong—morally wrong.

There is no “right” to health care. Rights are not entitlements to goods or services produced by others; rather, they are prerogatives to freedom of action, such as the right to free speech, the right to contract, or the right to use one’s property. Any attempt to enforce a so-called “right” to health care necessarily violates the actual rights of those who are forced to provide or pay for that care.

If a patient needs a $50,000 operation but cannot afford it, he has the right to ask his friends, family, neighbors, or strangers for monetary assistance—and they have the right to offer it (or not). But the patient has no right to take people’s money without their permission; to do so would be to violate their rights. His hardship, genuine as it may be, does not justify theft. Nor would the immoral nature of the act be changed by his taking $100 each from five hundred neighbors; that would merely spread the crime to a larger number of victims. Nor would the essence of the act change by his using the government as his agent to commit such theft on an even wider scale. The only moral way for this patient to receive the assistance he needs is for others to offer it voluntarily. Morally, he must rely on charity.

Fortunately for him, there is no shortage of people willing to offer charity, nor is there a shortage of reasons why one might self-interestedly wish to do so. Americans have always been magnificently generous in helping those in dire straits through no fault of their own. Recall the outpourings of aid that Americans have given to victims of natural and man-made disasters, such as hurricanes or the 9/11 attacks. As a physician, I have gladly provided free or discounted care to worthy patients more times than I can count, as has nearly every other doctor I know. Similarly, every year Americans donate hundreds of millions of dollars to health-related charitable organizations such as St. Jude’s Children’s Hospital, the Dana Farber Cancer Center, the American Cancer Society, and Susan G. Komen for the Cure. Fourteen of the fifty largest American charities are in the health-care sector, and many of these organizations help fund medical treatments for those who cannot afford them.8

Americans donate to charitable causes for various rational, self-interested reasons. Some may want to fund treatments or research to help others fight an illness that affected a family member or friend. Others may take pleasure in knowing that they are helping unfortunate people live better lives than they would otherwise live. Whatever their reasons, many Americans give a lot of money to charity every year, and such giving is an affirmation of their values.

Conversely, some Americans choose not to donate to charities—whether because they have other priorities on which to spend their money, such as saving for their children’s education or starting a business, or because they simply oppose the idea of giving to charity. People’s priorities and policies are personal matters; each individual must determine how best to allocate his resources in light of his own values. The government has no moral right to make such decisions for him. The government’s only proper function is to protect rights—including each individual’s right to decide what to do with his hard-earned wealth.

Morally, the government must maintain a “separation of charity and state,” analogous to and for the same reason that it must maintain a “separation of church and state”—because individuals have a moral right to embrace and act on whatever ideas they regard as true and in their own interest, so long as they do not violate the same right of others.

Separation of church and state means that the government does not dictate whether or how men must practice religion; it leaves them free to engage in any religious practice they wish—or none at all. Similarly, separation of charity and state means the government does not dictate whether and to whom people should provide charity; it leaves them free to do so—or not—according to their own values, interests, and judgment. Just as a proper government does not force citizens to embrace Christianity or Judaism or atheism, so a proper government does not force citizens to work in a soup kitchen or donate to the Red Cross. And just as a proper government does not compel a man to support his neighbor’s church, so a proper government does not compel a man to pay his neighbor’s medical bills.

If Americans want to stop the government takeover of health care, we must stand up for individual rights and demand the separation of charity and state.

About Paul Hsieh

Paul Hsieh, MD, is a practicing diagnostic radiologist in the south Denver metro area. He received his BS in mathematics from the Massachusetts Institute of Technology and his MD from the University of Michigan, and has served on the faculty at the Washington University School of Medicine in St. Louis, MO. Dr. Hsieh is also a founding member of Freedom and Individual Rights in Medicine (FIRM). For more information on FIRM, please visit www.WeStandFIRM.org.

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