This past weekend, Pope Francis addressed 9,000 members of Doctors with Africa, a group that works to bring quality healthcare to African populations.  During his remarks, the Holy Father said that healthcare is “not a consumer good, but rather a universal right, and therefore access to healthcare services cannot be a privilege.”  The Pope is not alone in setting up the dichotomy between healthcare as a right and as a commodity.  Many people think it must be one or the other.  However, upon a closer examination we find that both are true.  Healthcare is a natural right, yet because supply can never possibly meet demand it must be treated as a commodity as well.  It is in this light, especially with the current debate surrounding a comprehensive health care bill, that it is instructive to examine what a synthesis of these two sides would consist of.

Much of the confusion that arises in the discussion of this particular issue stems from the fact that there is a profound misunderstanding what is meant by the word ‘right.’  While many people invoke their rights, they have very little understanding of what rights actually are and where they come from.  Compounding this problem is that within most legal systems, rights are synonymous with individual freedom.  Rights are considered real provided that they do not infringe upon the rights of others.  As Cardinal George once pointed out, “[T]his philosophy of rights is agnostic about all human values except freedom, since the safeguarding of individual freedom is sufficient to assure the preservation of all other values.”  Properly understood though rights involve true human goods and the When rights are viewed through the lens of individual freedom rather than in terms of human goods and obligations, this leads to the wide-spread tendency for people to encounter “great difficulty in taking responsibility for their own and other people’s integral development” (Pope Benedict, Caritas in Veritatis, 43).

Two further distinctions are helpful as well.  The first is the distinction between what are commonly referred to as natural rights and positive rights.  Natural rights, which are synonymous with human rights, stem from a common human nature.  These rights are always attached to those things that lead to true human flourishing and thus are predicated to all men.  On the other hand, there are positive rights which are granted by someone in authority and are obtained by contract or convention.

Secondly, there is a necessary (although virtual) distinction between what John Finnis has called two-term and three-term rights.  Most rights are spoken of in two terms as the moral relationship between a person and the good that is being pursued.  However a proper understanding of rights involves a third term that refers to the holder of the corresponding duty to ensure that the right is exercised.  Most rights are usually only spoken of in two terms.  This is adequate insofar as it emphasizes the two most important terms but the idea of the positive intervention of a second person to help the person obtain the good that is needed is often lost.

Pope Francis in saying that healthcare is a universal right was merely reaffirming the teachings of the Church.  It was John XIII that first used the term “human rights” in Pacem in Terris.  The Pope lists among these “human” or natural rights, the right to healthcare. He says, “(M)an has the right to live. He has the right to bodily integrity and to the means necessary for the proper development of life, particularly food, clothing, shelter, medical care, rest, and, finally, the necessary social services. In consequence, he has the right to be looked after in the event of ill-health…”(Pacem in Terris, 28).

However we cannot overlook the astute observation of Pope Benedict in his recent Encyclical, Caritas in Veritate that duties “reinforce rights and call for their defense and promotion as a task to be undertaken in the service of the common good” (CV, 43).  If healthcare is a universal right, then we must ask who holds the duty to provide it.  Certainly the duty falls to the State as the custodian of the common good to protect the right to healthcare as a natural right. But because healthcare represents an example of the difficulty of attributing the corresponding duty to provide for the right (the “third-term” spoken of above), it is often thought that the state should assume the task directly.  But protecting the right to healthcare is not the same thing as providing it or even making it “affordable.”  The problem with this of course is that it contradicts the principle of subsidiarity which says those who are closest to the problem should act to help those in need.

Violating the principle of subsidiarity is not the only danger and maybe not even the greatest.  By acknowledging the fact that healthcare is a basic human good, it is important also to acknowledge that it is a limited resource.  This is where the notion of healthcare as a commodity must also be recognized.  In fact it is the nature of healthcare as a commodity that leads to innovation.  There has to be a free market of sorts within healthcare.  The best way to relieve scarcity of a man-made (or at least man-discovered in this case) resource is to subject it to the forces of a just free market.  It is the only way to make affordable healthcare available to the widest scope of people.  This is why health insurance (and universal healthcare coverage) will always lead to lower quality healthcare for all.  Who is more qualified to determine what medical interventions one needs: the doctor who is taking care of you or an insurance company that constrains his options in treating you?  This stymies innovation and drives costs up by adding another layer of oversight.

While specific policies need to be left to those who are qualified (not Popes, Bishops, and Priests for example whose charism does not grant them economic knowledge), there are several principles that need to be observed because it is both a natural right and a scarce resource. First, it is important to recall that because healthcare is protective of the basic good of health and thus a natural right, everyone must have access to adequate healthcare.  Once this minimum is met then the resource can be made available for purchase for those who can afford it.    This does not mean that every single desirable service should be available to all.  However in respect of the principles of the common good and solidarity, everyone must recognize its scarcity.  The waste of medical resources, regardless of who pays for them must be avoided.  All must serve as responsible stewards of the healthcare system.

Secondly, the limits of what can be accomplished by healthcare need to be recognized and respected.  The purpose of healthcare is to cure illness and provide relief from suffering.  However there are limits to what healthcare can do and to what ought to be done.

Finally, there needs to be a hierarchy of sorts in recognition of how the scarce resource is allocated.  This means all must be sensitive to the needs of others and those who have a real need should be given priority over those whose need is not as great.

In conclusion, while many argue that healthcare is either a right or a commodity, the truth is that it should be treated as both.  It is a natural right that adequate healthcare be provided for everyone, but this must always be tempered by the fact that it is a scarce resource and thus also needs to be treated as a commodity.