For the past decade, perhaps no other topic has divided the American people more than healthcare. The voluminous debates on the issue have centered upon the wealth-gap, a right to healthcare, and governmental overreach. But something much more principled is at stake: the ideas of the Founding Fathers, mainly, individual liberty and responsibility.

Both are key principles our Constitutional signers believed in, as well as limited government, which is perhaps the central element in our Constitution. Before delving into the notions of how conservatives should view healthcare within the prism of Constitutionalism and limited government, let’s address a fundamental claim that has been unsatisfactorily proffered by well-meaning liberals: Healthcare being a fundamental right.

Since the House and Senate versions of the American Healthcare Act have become public, a quiet assertion has come to light that basic healthcare is a right. Mostly, this has come from the Democrats (see Senator Harris’ statement here) though some assert it is a basic belief of the Republican Party as well. I am not sure this is the conservative approach, however. Most conservatives believe that the opportunity to possess basic healthcare is a right, but that individuals have to work for it; in other words, it is not a basic human right, but a right one earns from hard work and merit.

For something to be a human right, it must emanate from some natural source, something that is by nature given to us by our very existence. It is core and central to our composite make-up. To put in more political-theological words, it is something endowed to us by our Creator. I am unconvinced that the left has successfully demonstrated this point, and as such, fails to convince a majority of Republicans that the federal government is the proper regulator of healthcare. So the question is: assuming that healthcare should be provided in some manner to the American public, what is the proper role for government?


Political philosophy has been debating the role of the government since at least Socrates. The debate looms around the question of liberty on the one hand and security or equality on the other. The problem is that this pendulum is a zero-sum game: the more liberty a people have, the less equality and security they have, and vice versa. Since Machiavelli, the debate has focused on how to balance this equation justly.

In the U.S., the Founders faced this dilemma from both extremes. They had just escaped monarchy and authoritarian rule under the British and were fearful of despotism. However, they also failed miserably under the Articles of Confederation, which gave the states too much liberty and put America at risk of falling into anarchy. The Constitution was an attempt to resolve both problems. The Founders created a limited government, as explicated in Federalist Paper No. 78. This government was only to take action in the direst of circumstances. Making it difficult for legislation to pass, liberty would be protected from government encroachment—simply called tyranny. The Founders were deeply fearful of totalitarianism, whether emanating from government or the people. Limited government was enshrined through a series of philosophical and governmental theories that, when working in tandem, would allow individuals to thrive or fail on their own merit.

This debate also applies to healthcare. President Obama believed that healthcare was a basic right and thus thought that the federal government was the proper mechanism to distribute and manage this right through the Affordable Care Act. But even if considered a right, healthcare should not be managed by the federal government. Anytime citizens agree to turn over an aspect of their individual well-being to the central government, they in effect give a part of their political soul over. They become subjected, or in more severe words, enslaved. As de Tocqueville warns, this is how democratic tyranny and soft despotism starts. Government assumes the role of guardian of the people in every aspect. Slowly, in the name of pure equality, the government takes over all aspects of its citizen’s lives and make them dependent on the government. Pure equality comes at a high cost: the loss of liberty.

The flaws of allowing the federal government to manage healthcare are multifaceted. First, the government assumes and thus self-fulfills the idea that its citizens cannot provide for themselves. For many enlightenment era thinkers such as de Tocqueville and James Madison, being human was dependent upon individual responsibility, virtue, and liberty. To be human meant to determine as much as possible the events of one’s life by one’s own merits. Thus the Declaration of Independence enshrines the right to life, liberty and happiness. Note that we are not promised a good life or happiness, but we are promised the right to find these values on our own. The government cannot purposely prevent us from obtaining them. We are not guaranteed them either.

In fact, the entire structure and flow of the Constitution guards against this by creating a limited government. If the government were responsible for our well-being, it creates what de Tocqueville calls soft-despotism, where we are essentially equal, but no longer free because we depend upon the government for our survival. For enlightenment era liberals and contemporary conservatives, this means that we are prevented from achieving a fully human life because we have not achieved it on our own merit. Many Americans work hard their entire lives to get to a place where they have excellent healthcare benefits. It is a motivator for success. It is not a basic right, but a right that comes with sweat.

This brings us to fairness. The left constantly states that it isn’t fair that so many are left uncovered or underinsured. I am not sure it is unfair, but I can certainly agree that it is tough and deeply sad. However, making those that are successful, especially middle-class individuals, who pay for good healthcare coverage also pay for other people’s healthcare does not strike me as fair either. It is almost a double bill on those who have had more success in their lives. Being unfair to one group of people in the name of another group of people does not make the situation any fairer. In fact, everyone loses.

Assuming the role of healthcare provider, the federal government takes away liberty, creates centralized tyranny, and diminishes the role of individual responsibility. This situation also would either bankrupt the federal government or overtax its citizens to redistribute wealth (a concept entirely opposed by the Founders). The federal government simply cannot afford to constantly assume the role of parent to its citizens, nor should it. On the other hand, true conservatives also believe that the extremely impoverished and those who can’t fend for themselves should be helped as well. Everyone should have protected opportunity and access to some form of affordable healthcare, especially children, and the physically or mentally ill. How do we accomplish providing healthcare but protect individual liberty and merit at the same time?  We let the states decide it.

As the Founders debated, individual liberty is more protected and citizens are freer from centralized tyranny when states are more autonomous, hence the Reserved Powers Amendment. It also, technically, is a better form of democratic governance. Each state and locality is likely to differ on its views concerning healthcare. Certainly citizens in rural Georgia and Texas differ greatly from citizens in larger cities in California and New York. Shouldn’t they be subjected to the same centralized rules or should they be left free to decide for themselves, for the most part, what is best for them?  It seems reasonable that each state should be left to its own in deciding how to handle healthcare. In so doing, if the citizens decide they want to pay higher taxes, create an individual mandate, or even go further by instilling a single-payer system, then the people of that state are free to do so. If voters believe that healthcare is a privilege and one must merit it, the state can implement laws to that effect.

More importantly, having the states handle healthcare still puts most of the impetus on the individual: It is up to you how you want to live your life, what sacrifices you want to make, and what luxuries you want to afford. For those suffering, the states can encourage community organizations, charities, and religious institutions to take up the slack and care for the needy. Isn’t this a better society anyway, where we as citizens care for one another, rather than relying on the government to do it for us? Also, the government can provide tax incentives (rather than punishments) on companies of all sizes to provide healthcare. Further, and most importantly, making this a state issue protects people from allowing the United States to slip into soft-despotism where administrative tyranny reigns supreme and big government dictates the lives of every citizen.

Liberty and individual responsibility have been left out of this debate for too long. It is time for conservatives to remind people that government is not a parental figure; that for the most part, we should live by our own capabilities. Meriting something is much more fulfilling than being given a handout, and it truly allows us to feel human, rising to the challenge of meeting our own expectations.

Craig Douglas Albert, PhD is an associate professor in the Department of Political Science at Augusta University. Follow on Twitter: @polscountrydoc