Public Health and Government Policy

Question: How does Objectivism view the concept of "public health services"?

I'm aware that, largely, the concept of a "right to health care" is rejected, however there are health issues that are larger than individuals; with epidemics, for example, an individual who chooses to not seek treatment can threaten a population (a "typhoid Mary"). Public health departments have been highly successful in protecting populations in the past century through monitoring and managing health risks. The departments are more cost-effective than individual physicians, preventing illness before it occurs and treating large numbers of people with each policy. This service has historically been governmental, and required a coercive component, such as forcing restaurants to be clean, individuals to vaccinate, etc. I was curious, given that Objectivism values life and detests coercive government, what would be an Objectivist opinon on the necessity (or lack of) governmental public health? To what degree does an individual have a right to be a risk to themselves and others?

Answer: We can answer your question by working backwards from the purpose of government, rights, and morality, and where physical safety threats such as disease work into this equation.?

Ayn Rand said that morality stems from the need to make decisions in order to live. One's life is the standard of value.?Since the free use of one's mind and body is essential to the life of a thinking being, one needs rights to pursue life, free from the initiation of force.?

Knowingly exposing others to one's disease is initiating force against them, and hence in violation of their rights.?Such a person could be punished by the state or in a civil suit.The state would also be justified in preventing the introduction of the disease in the first place, if it had reasonable cause that the person had the disease.?

One might imagine disaster scenarios of Bubonic Plague proportions, where the dangers are of such magnitude that neighborhoods might be quarantined to prevent the spread of disease.But these rare cases would be "lifeboat scenarios" (emergencies), and one properly defines moral behavior for individuals and government based on normal scenarios.?

As for social practices that prevent disease, such as sanitary codes and vaccinations, is there a need for preemptive government measures?

The market provides sanitary goods such as soap and, if unfettered by government, drug companies would sell vaccines.?In fact, because of competition and entrepreneurial motivation, they are more likely to provide quality goods than government. Private schools and companies would likely require them. But the government does need to ensure that immigrants and foreign guests are healthy, since only governments can participate in international affairs without leading to the dangers of anarchism.?

As long as air and water are publicly owned, government plays a role in preventing their contamination,But keep in mind that enlarged governments can be more dangerous than diseases. If one counts the body bags from communism and fascism—both of which emphasized government's commitment to public health—it adds up to over 100 million, more than all cases of AIDS and Bubonic Plague combined.Clearly, a definition of public health and the limits and precise role of government is needed. Ayn Rand wrote:

I most emphatically object to an idea such as the government's right to act in protection ‘of public health and safety’ with no further definition of those terms. What constitutes "public safety"? According to the American Constitution, the duties of the government in respect to public safety are clearly defined and specified. These duties are police protection and military protection—defense against violence from criminals inside the country and against violence from foreign aggressors. But if we begin to believe that the government may take any action it pleases whenever it decides that "the public safety" is threatened, if economic matters begin to be treated as ‘threats to public safety’—then I will remind you that this is the sole slogan through which all the horrors of history have ever been perpetrated.

The guillotine during the French Revolution was being used by a "Committee of Public Safety." The liquidation of political suspects in Russia is done on the ground that their ideas may be a threat to "Public Safety." (Letter to DeWitt Emery, May 8, 1949)

Courts have a role in punishing those who do put others at risk of disease.?This includes adjudicating and enforcing the results of suits?against people and businesses for negligence (e.g., when parents fail to immunize their children and expose other children to disease, or when businesses do not follow precautionary measures and sell contaminated food).?

In summary, good health is in one’s interest, but good health includes a proper enforcement of rights and proper parameters on coercion and government.

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