In his confirmation hearing, Robert F. Kennedy Jr told Bernie Sanders that he opposes health care as a human right. His reasoning reveals how libertarian talking points are being used to defend a cruel and irrational health care system.
The most damning moment in Robert F. Kennedy Jr’s confirmation hearing happened when Bernie Sanders asked him a very simple question: “Is health care a human right?”
Two years ago, RFK was running against Joe Biden for the Democratic presidential nomination. Today, after several twists and turns in his political journey, he’s Donald Trump’s nominee for Health and Human Services (HHS) secretary. He’s shifted in many ways over the course of that journey. When he was trying to appeal to disenchanted progressives in the Democratic primary, for example, and later when he was running as an independent candidate, he (correctly) excoriated Trump as a foreign-policy hawk. Later, when he dropped out to endorse Trump, he cited their common “antiwar” stance as part of his rationale. But one constant throughout the whole bizarre saga is that RFK has positioned himself as an “antiestablishment” figure, in large part on the basis of his alleged opposition to “Big Pharma.”
Bernie’s question cut right to the core of that stance. Is the primary problem with “Big Pharma” that the pharmaceutical companies, like the health insurance companies, are rent-seeking middlemen standing between ordinary people and the medicine they need? Or does RFK just object to some of the products themselves (as with the conspiratorial nonsense he’s often promoted about COVID-19 vaccines)? If he truly wanted to slash and burn their profits, instead of letting drug companies negotiate with a multitude of providers, they would face a public “single payer” with unilateral price-setting power. Better yet, this could be combined with Sanders’s long-standing proposal to abolish pharmaceutical patents in favor of one-time cash prizes for breakthroughs.
As simple as Bernie’s question was, Kennedy was reluctant to answer it. And as Sanders continued to press, Kennedy’s answer revealed deep flaws in his worldview:
Kennedy: “In the way free speech is a human right?”
Sanders: “Yeah.”
Kennedy: “I would say it’s different because free speech doesn’t cost anybody anything, but in health care, if you smoke cigarettes for twenty years, and you get cancer, you . . . you are now taking from the pool.”
Before they finally moved on to new topics, Bernie noted the multitude of other countries around the world that “say that health care, whether you’re young or old, poor or rich, is a human right” and that he wasn’t “hearing” the same moral core in Kennedy’s answer. He seemed too disgusted to want to continue to pick at the answer.
It’s worth lingering, though, on the two things that can be very clearly “heard” in RFK’s answer. It was a confused mash-up of two common arguments not just against Medicare for All but against proposals for universal social programs of any kind.
No, Health Care Rights Don’t Require Slavery
Kennedy was a “progressive” as recently as 2023, and he’s a MAGA guy now. But along his winding political journey, he made a stopover as a libertarian, and the label might best describe many of his positions. He took a stab at snagging the Libertarian Party’s presidential nomination at one point last year, and he’s frequently appeared on libertarian podcasts like Dave Smith’s Part of the Problem (where he’s furiously disagreed with Smith about Kennedy’s support for the war in Gaza, but agreed with him on many other subjects). It wouldn’t be surprising if RFK had picked up some libertarian talking points by osmosis, and the point about free speech not “cost[ing] anyone anything” sounded like at least a vague echo of the common libertarian claim that “positive rights” (i.e., rights to have other people do things for you) don’t make sense and the only real rights are “negative rights” (i.e., rights to not have other people do things to you).
The most extreme version of this idea, championed by many of Kennedy’s apologists in online arguments about his clash with Bernie at the confirmation hearing, holds that positive rights can only be deep violations of “real” (negative) rights. Senator Rand Paul, who sometimes calls himself a “constitutional conservative” and sometimes a “libertarian Republican,” once went as far as to say that a right to health care would entail slavery.
With regard to the idea whether or not you have a right to health care, you have to realize what that implies. I am a physician. You have a right to come to my house and conscript me. It means you believe in slavery. You are going to enslave not only me but the janitor at my hospital, the person who cleans my office, the assistants, the nurses. . . . You are basically saying you believe in slavery.
It should probably go without saying that none of the many countries that legally enshrine health care as a basic right actually enslave doctors, nurses, or hospital janitors. That’s not a thing that happens. Similarly, even many conservatives (and some moderate libertarians) believe that the public has a right to police and fire protection, and perhaps even that every child has a right to a public education, but no one thinks that anyone should be forced at gunpoint to become a cop or a firefighter or a teacher. What the socialist left advocates is that, as with all these other services, the state should provide everyone with health care free at the point of service, funded by progressive taxation.
A more common libertarian argument focuses on taxpayers rather than doctors: the real rights violation isn’t forced labor but forced payment. Unlike the slavery argument, this one doesn’t imagine doctors being frog-marched to work with rifles poking in their backs — it just objects to citizens being forced to pay taxes to fund public services. Even this scaled-back version, though, collapses when subjected to any real scrutiny.
There are two problems here. First, even if we accept the premise that there’s some sort of universal negative right against taxation, that would just mean that we had a conflict between two rights, and we had to decide whether the right to health care was more or less morally urgent than the right of rich people to hold on to every penny in their bank accounts. (The rich people’s bank accounts are the ones that are the most relevant here, since even middle-income taxpayers would see a net savings when a slight increase in their tax rate to pay for Medicare for All was balanced against the end of premiums, copays, and deductibles.)
Second, the argument that any redistribution of wealth is objectionable because it’s “theft” or “aggression” doesn’t work. When libertarians say that it’s unacceptable aggression to take away some of Jeff Bezos’s money, for example, what do we mean by saying that it’s “his” money? We can’t mean that it’s legally his, or else no objection to redistribution by the state could arise here. (If we increased his taxes to pay for Medicare for All, the money being redistributed away would be the legal property of the federal government.) But, as I’ve discussed in previous Jacobin articles, if we mean that we can’t take away money that Bezos is morally entitled to, the argument is circular. Whether Bezos has a better or worse moral claim on his tax money than cancer patients is the original issue in dispute.
The Real Question: How Should We Allocate Care?
The second argument RFK Jr. seemed to be gesturing at goes something like this:
Premise One: If health care is a human right, smokers who get lung cancer have a right to be treated.
Premise Two: Smokers who get lung cancer don’t have a right to be treated.
Conclusion: Health care is not a human right.
Why, though, should we believe Premise Two?
Perhaps Kennedy thinks that this would be a waste of scarce resources. If so, it’s hard to overstate the radicalism of his claim. As far as I know, no health system on the planet, public or private, has decided as a matter of policy either that no medical resources will go to lung cancer patients or that none will go to those who got lung cancer from one of that condition’s most common causes.
If RFK truly believes the United States should be the first country in history to systematically exclude lung cancer sufferers from its hospital, he’s talking about crossing a bold new frontier of social cruelty. It’s far more likely that he’s just advocating that we stay at something like the current level of social cruelty, where lung cancer patients with money to burn can get top-notch care and cash-strapped lung cancer patients have far fewer decent options.
It’s true enough that no medical system, public or private, will have unlimited resources. While taking care of lung cancer patients is an incredibly basic function of every normal health system, very much including ones where care is universal and free at the point of service, it’s true enough that even the most lavishly funded system always has to find some way to decide which patients to prioritize when they run up against the limits of their resources. Medical ethics boards and the like face a thankless and often grisly task in making these determinations.
But one of the very worst, most inhuman possible ways of deciding who to prioritize is allocating care by financial status, letting the prosperous bribe their way to the front of the line. And that’s exactly the obscenity RFK is defending.