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A Parable: The Right to Health Care

by John Spritzler
The URL of this article is

[Please also read: "Is Health Care a Right for Free Loaders?"]
[Also please read "Is Anything the Right of ALL?"]

Once upon a time there was a land called Land of the River. It had a great river flowing through it. It flowed from north to south (like our Mississippi river), and it was the only source of water for the land.

Land of the River had two regions, a region in the north called Upriveria and a region in the south called Downriveria. These two regions were culturally very different. 

Upriveria was essentially a feudal society. The rulers were aristocratic nobles who owned all the land and the lion's share of the wealth produced on it. The aristocrats possessed all of the weapons of war and the peasants were defenseless against them. The peasants were required to do all of the labor; the aristocrats did no useful labor whatsoever. The aristocrats (just like our aristocrats in Europe's past and our current ones, such as Alice "$43.7 billion net worth" Walton who does no useful work) believed that useful labor was beneath them, that it was dishonorable. The only honorable activity for an Upriverian aristocrat was military valor. 


The aristocrats enjoyed a pretty good life, compared to the peasants, but in some ways it wasn't so great. One main deficiency was that nobody in Upriveria was a health care provider. This meant that neither the aristocrats nor the peasants enjoyed health care. The aristocrats wanted health care, not only for themselves of course, but also for their peasants (for whom they had the same concern in this regard as a farmer has for the health of his or her livestock.)


Surely, thought the aristocrats, the solution to their problem was Downriveria.
Downriveria was a very different kind of society than Upriveria. Downriveria was an egalitarian society. The people in Downriveria had a thriving and modern economy. It was based on the principle of "From each according to reasonable ability, to each according to need or reasonable desire with scarce things equitably rationed according to need." In Downriveria everybody who was not too young or too old and who was not mentally or physically unable to do any useful work was encouraged to contribute reasonably in some way to the economy, and in return to have the right to take--for free--from the economy what they needed (including health care of course) or reasonably desired and to have an equal status with all others to receive scarce things when they were equitably rationed according to need.
People in Downriveria who were just children or who were now above retirement age after having previously contributed reasonably according to ability were also considered to have contributed reasonably according to ability. People who were mentally or physically unable to contribute were considered to be contributing reasonably according to ability because their ability just happened to be zero. A reasonable contribution included things such as caring for children or elders or going to school too. And people who didn't want to contribute reasonably according to need were free to do as they wished, but they forfeited the right to take things for free from the economy.

In Downriveria, there were lots of people who contributed reasonably to the economy by providing various health care services, from physicians to nurses and orderlies. Also, the people who worked to grow and distribute food, or to build houses or create clothing were considered in Downriveria to be not only contributing reasonably (of course!) but also to be health care providers because nutrition and shelter and clothing are obvious requirements for good health. Similarly, all of the craftsmen and craftswomen who constructed the hospitals and health clinics or built the trucks to deliver food or the factories to make clothing were also regarded quite naturally as health care providers, since without their labor there would be far less health care provided to anybody.


The aristocrats in Upriveria came up with the following plan to solve their problem and get health care for all Upriverians. It was a very simple plan. All they had to do was demand that the Downriverians provide top-notch full-spectrum health care to all the people in Upriveria. 

To implement this plan, the Upriverian aristocrats wrote an Ultimatum and delivered it to the Downriverians.

When the Ultimatum arrived in Downriveria, the Downriverians made copies of it for all of the people in Downriveria, so they could all discuss--in their many Local Assemblies of Egalitarians--how to respond to it. These local assemblies were the highest authority for the people in each local community and they used voluntary federation to reach (or try to reach) mutual agreements about how to act on a larger-than-local-community scale.
All across Downriveria, at each Local Assembly of Egalitarians, the Ultimatum was read out loud to all assembled, and then people discussed how to respond to it. Here is what the Ultimatum said:
"Downriveria must henceforth provide top-notch full spectrum health care (by which we include fully staffed and operational hospitals and health clinics, plus all the food and shelter and clothing required for good health) to all the people in Upriveria. Furthermore, you must ensure that all people in Upriveria who need an organ transplant will have the same chance as those in Downriveria to receive a donated organ even when there are fewer donated organs available than people who need them. You must do this because health care is the right of all and you are thus morally obliged to provide it to us no less than you provide it to Downriverians. The fact that we aristocrats adamantly refuse to produce any products or provide any services for Land of the River society even though we are perfectly capable of doing so is totally irrelevant. If you fail to provide us aristocrats and our peasants with health care, we will proceed to dump toxic material into the river at the border between Upriveria and Downriveria and continue to poison your water until you accede to the demand of this Ultimatum."

There were essentially only two opinions expressed in the Downriverians' Local Assemblies about what to do. And they were as opposite as any two opinions could be!

One group of people (let's call them the "No" group) said:

"This Ultimatum is outrageous! What right do they have to demand that we provide them with health care? Our principle is 'From each according to reasonable ability, to each according to need or reasonable desire' but the Upriverian aristocrats are insisting we go by the very different principle of 'To each according to need or reasonable desire, even outright free loaders.'  We have no moral obligation to accede to the demands of this Ultimatum. We should muster up a militia to forcibly prevent (with violence or its credible threat, as necessary) the Upriverians from dumping poison into our water supply.
"Once we have secured the safety of our water supply, then we should provide health care to the Upriverian peasants since they are in fact contributing to Land of the River society according to reasonable ability.

"As for the Upriverian aristocrats, we have no moral obligation to provide them anything, not health care or anything else, because they are freeloaders who flatly refuse to contribute to Land of the River society reasonably according to ability even though they could easily do so if they wished.
"Still, we should consider providing heath care to the Upriverian aristocrats. Why might we want to provide such health care? 
"Not because we are morally obliged to--i.e., not because they have a right to health care--, but for very different reasons. We might choose to provide the aristocrats health care for various reasons. For some of us the reason might be compassion; for some it might be because it is unhealthy for all of us if there are lots of sick and dying people in the north; for some it might be a desire not to live in a land where there are sick and dying people. As valid as these (and perhaps other) reasons may be, none of these reasons are that we are morally obliged to do it because health care is supposedly the right of all!"
The other group of people (the "Yes" group) said:

"While the Ultimatum does not, unfortunately, have a friendly tone, it nonetheless makes a valid point. Health care is indeed the right of all. This does indeed mean we are morally obliged to provide health care (in the full sense of that phrase as indicated in the Ultimatum) to all of the Upriverians, including the aristocrats. We don't have the choice to refuse, because we are morally obliged to accede to the demand of the Ultimatum.

"It is unfortunate that the Upriverian aristocrats are flat-out free loaders and even proud of it, since they value only military valor as honorable. We hope that these free loaders will one day change their ways. But until then we have no moral choice other than to provide them health care."

The "No" and "Yes" sides debated with each other.

Which side would you be on? The "No" or the "Yes" side?


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