Rights and the Health Care Debate: Part IV

By Richard Pimentel

“Rights and the Health Care Debate: Part III” focused on John Rawls and this installment will focus on his contemporary, Robert Nozick. Along with Rawls, Nozick is one of the most important political philosophers of the 20th century. Nozick was a young philosophy professor in the early 1970s who published a critical reply to Rawls’s theory of justice. Nozick’s first book, Anarchy, State and Utopia, published in 1974, along with Rawls’s A Theory of Justice were the two most influential books regarding political philosophy in the 20th century. Contrary to Rawls’s defense of modern liberalism and its identity with the welfare state, Nozick’s book promoted libertarianism and a limited role for the state in society.

Rawls’s theory of justice, also known as “justice as fairness”, was built upon his liberty and difference principles. Nozick’s theory of justice is captured in his “entitlement” theory which describes the proper distribution of goods such as money, property, etc. The following are three criteria employed by Nozick to describe a just society:

  • A person who acquires a holding in accordance with the principle of justice in acquisition is entitled to that holding.
  • A person who acquires a holding in accordance with the principle of justice in transfer, from someone else entitled to the holding, is entitled to the holding.
  • No one is entitled to a holding except by (repeated) applications of (a) and (b).

In other words, if individuals have acquired what they possess in accordance with the principles of the entitlement theory, then they have a right to the property. This is also applies to how Nozick sees the distribution of other rights in society. Nozick made the following statement in Anarchy, State and Utopia:

The major objection to speaking of everyone’s having a right to various things such as equality of opportunity, life, and so on, and enforcing this right, is that these “rights” require a substructure of things and materials and actions; and other people may have rights and entitlements over these. No one has a right to something whose realization requires certain uses of things and activities that other people have rights and entitlements over.

For instance, if person X has acquired something in accordance with the entitlement theory, then person Y, who depends on having what person X acquired, has no right to be given what he needs from person X. This is in stark contrast to Rawls’s difference principle that favored the worst off. Nozick disagreed with this principle because he argued that redistributing wealth to poorer people violated the liberty of the rich, particularly those who worked hard for their money. Nozick was not a man who was apathetic towards the poor but he contended, according to the entitlement theory, that justice places a demand upon the government to provide law and order to society and not to be involved in redistributing wealth. Nozick called this the minimal state. It is easy to see the contemporary political camps reflected in the views of these two men: modern liberalism with its emphasis on the welfare state and redistribution has Rawlsian elements while modern conservatism and libertarianism with its emphasis on the limited role of government and tax cuts has Nozickian elements.

These contrasts provide insight into what each man would say in a discussion about the legitimacy of the right to health care. Although Nozick did mention health care in Anarchy, State and Utopia, there seems to be no explicit mention in favor of or against a right to health care. Nonetheless, Nozick provides enough philosophical content to speculate about his view on the right to health care. Nozick’s view of the minimal state offers some answers. The entitlement theory clearly shows that Nozick believes that no one is entitled to another’s holdings or goods that were acquired by that person. He argued that the government should not be in the business of transferring someone’s holdings or goods (e.g. property, wages, etc.) to another who did not acquire the holdings or goods in the first place. From this, it is possible to conclude how he feels about health care that is provided through taxation of citizens. Nozick argued that any taxation imposed by the state in order to provide services or benefits to others is unjust.

There are two reasons why Nozick would say this. First, mandatory taxation that is beyond the needs of a minimal state is unjust. Keep in mind that the definition of a minimal state is one in which its sole purpose is to keep law and order by protecting individuals from force, theft, and the like and by properly administering the courts. Second, mandatory taxation for the purpose of redistribution imposes an unjust burden on citizens who want to spend their earned money in any way that they choose. Nozick called this forced labor because he contended that distributing someone’s wages via taxation to someone else who did not deserve it thus giving the latter an entitlement to the former’s earnings. The former was forced to work for the latter.

Regarding the right to health care, the most significant issue for Nozick is the legitimacy of governmental distribution of wealth. Whereas Rawls argued for its legitimacy, Nozick argues against it to the point of calling it immoral. It is easy to see that Nozick would have problems supporting the right to health care resulting in universal access because of the entitlement principle. Universal access to health care can only come about as a result of the government redistributing wealth through means such as progressive taxation and penalties, something which Nozick opposed. The contrast between Rawls and Nozick is evident in modern American political thought. Although there are people whose views regarding the right to health care contains a hybrid of ideas from Rawls and Nozick, it seems that the two predominant views on the right to health care reflect the philosophies of these two influential political philosophers. Some have made the mistake that Rawls’s views sacrifice individual rights and others have wrongly believed that Nozick’s views were uncaring towards the disadvantaged. Neither is true about these two individuals because they both cared about justice and the role of government in society. The difficulty is that both men viewed the specifics regarding these concepts in different ways and these specifics have greatly influenced rights talk today.