10/19/2009 05:12 am ET | Updated May 25, 2011

Rights With No Responsibilities?


Is there such a thing as a right without a responsibility? Our most fundamental rights to "life, liberty and the pursuit of happiness" come - of necessity - with the responsibility not to abridge someone else's rights to life liberty, and the pursuit of happiness.

Consider the Bill of Rights. Each right is accompanied by responsibility.
• Right to free speech (First Amendment) means you cannot stop someone else from speaking things out loud that you bitterly oppose.
• Right to bear arms (Second Amendment) comes with an obligation to bear them responsibly and not use them against each other.
• The Fourth Amendment puts the responsibility squarely on the government not to unreasonably search or seize us or our property.
• The right to a fair and speedy trial (Sixth Amendment) again places responsibility squarely with the legal system not to hold us indefinitely without due process.

Apply this concept to health care and see where it leads. [Healthcare - one word - is the system. Health care - two words - is the service.]

We all have a right to life. No one has the right to make us dead. Many people reason that a right to life includes a right to be healthy. Certainly no one has the right to make us unhealthy. But do we have the right to make ourselves unhealthy? I would answer, Yes! That is part of being free.

Does the right to make ourselves unhealthy come with no consequence? Silly question. Being unhealthy carries the consequence of needing health care. Who should pay, whose responsibility is it to pay for the services we choose to consume? Does that responsibility fall on others? Here I would answer a resounding No!

Wait. Wait. Before people start attacking me again over "Should fat people pay more?" we should only be held responsible for those things over which we have control. The majority of obese individuals; the majority of people with cirrhosis of the liver; all people who smoke cigarettes made a choice. They have control.

Andre the Giant (from the movie Princess Bride) and others who are genetically large did not choose their parents (and their genes). For them, weighing 400 pounds could be normal even healthy, but most important, they had no control.

Same thing is true for people who develop breast or prostate cancer. Not so for lung cancer where over 80% were smokers. Yes, Dana Reeve, deceased wife of also deceased actor Christopher Reeve (Superman), and my good friend Sh. were both non-smokers who died from lung cancer. There are exceptions. We must design a system that covers the vast majority and then build in enough flexibility to handle outliers.

When our bodies are unhealthy because of what we do (overeat) or what we do not do (exercise), we should be held responsible and accountable. When our bodies are unhealthy and we could not prevent it, we should not be held responsible.

We can, should, indeed must have a lively extended discussion about all the important elements such as how much to pay, incentives, productivity effects, and healthcare as infrastructure.

What should NOT require any discussion is the acceptance of personal responsibility, which comes of necessity with the freedoms enshrined in our founding principles.

Freedom to fly includes freedom to fall.

If I have rights, certainly if I have freedom, my actions have consequences for which someone will be held responsible. If not me, then who?

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