Adopting a rhetoric of rights is not going to simplify that. Fundamentally, health care is not a moral question but an economic one. That much can be demonstrated by the fact that even if every American agreed with Senator Sanders about health care as a moral question, we’d still be obliged to approach it as an economic one — the moral consensus, even if it were not mistaken, would solve precisely nothing. Medical care costs something, and we have a social commitment to seeing to it that those costs don’t come down on vulnerable people in an unnecessarily burdensome way, part of what F. A. Hayek described as “providing for those common hazards of life against which few can make adequate provision.” Contra Senator Sanders et al., this is not a project that require socialism in any degree.

What it does require is responsibility — including responsible citizenship — and a clear-eyed understanding of the nature of the problem. What does it mean to be a responsible citizen? In the United States, we have a poor and diminished notion of citizenship, that citizens are only “taxpayers” and “voters.” Good citizens, in the inescapable contemporary formulation, are those who “play by the rules and pay their taxes.” That’s the real individual mandate: Pay and obey. The progressive proposition is that, in exchange for this obedience, childlike citizens are to be provided for by government in loco parentis, and that their role in this is almost entirely passive: submit to taxation, follow the regulations, receive the benefits. Hence the rhetoric of health care as a right.