While it seems that using government to control costs (!) is a major excuse to enact comprehensive health care reform these days, a more long-lasting rationale has been to declare that "health care is a right," and then back that up with government action.

Andrew E. Busch takes on this argument in an essay published by the Claremont Review of Books.

First up, he argues that a right to health care is not consistent with traditional, historic understandings of what a "right" is:

"health care is not a natural right as the founders or John Locke would have understood it. In their view, natural rights exist prior to the formation of government. Since there is no government in the pre-political state of nature, there cannot be a right to government-supplied health care in the state of nature."

Americans, Busch says, have rejected other appeals to establish a positive right, including a right to welfare or a right to obtain an abortion and get public funding to do so. (At least one state, Minnesota, actually has deemed a right to have taxpayers fund for one's abortion.)

The one example of a "positive" right to taxpayer support--to obtain legal defense in a criminal trial--is uniquely related to the state's power to deprive a person liberty, a situation not at all similar to medical concerns.

Busch also mentions two possible justifications for government-paid health care--utilitarianism and the "veil of ignorance" of John Rawls--and found them wanting.

If a positive right to health care existed, further, it would trump political rights. "Accepting a positive government obligation to fund social services claimed as a matter of right would lead inexorably to government without limits."

He closes with an appeal to the value of letting civil society find a solution to the problems of health care access.