As an example of the way economic rights would work, consider the question of the right to health care. One person may require kidney dialysis, another may need a heart bypass operation, another may have to have long-term cancer care, and yet another may need lifelong antiretroviral therapy. In each case, failure to provide this care would probably mean that the person who needs it will die. Surely, therefore, if health care is a right, the state has an obligation to provide such treatment to each of these persons and all others who have similar needs. Moreover, the manner in which such care is provided should meet a high standard. That heart bypass operation, for example, should be conducted by a well-qualified surgeon operating in state-of-the-art facilities.

As should be evident, substantial resources that lie well beyond the reach of most countries are required to provide such care. In my view, a wealthy country such as the United States should, as a matter of good public policy, provide such care to all citizens who need it. Yet to achieve this even in the United States, unless public spending on health care were greatly increased, deep cuts would have to be made in spending on primary health care. If total spending on health care were increased to the degree required for both lifesaving care for the chronically ill as well as primary care for all, there would seem to be two alternative ways to cover the extra costs. One would be to decrease spending on other aspects of government—education, transportation, criminal justice, or national security, for example; the other would be to increase taxes. As a citizen, I espouse the shifts in spending priorities and in tax policy needed to provide comprehensive health care for all.

Where I have difficulty, however, is with the idea that those with different views should have no say in the matter because, as with the Bush administration’s position on free trade, a moral principle, or a right, has been invoked. The intended effect of spelling out civil and political rights in the American Bill of Rights and the French Declaration of Rights was to make it clear that there is no justification for their abridgment. Rights trump all other policy considerations. Those on the left who place matters such as housing, health care, or the environment on the same plane and call them rights proclaim that they can be dealt with in the same way. They cannot be subjected to policy determinations. They, too, should be outside the realm of democratic decision-making, as is made plain by the first five words of the American Bill of Rights concerning civil and political rights: “Congress shall make no law.”

The concept of progressive realization of rights, which is favored by many on the left as a way to deal with the problems in poor countries, makes nonsense out of the idea of rights. In the process of recognizing that these so-called rights are dependent on economic resources, it undermines the principle that rights always take precedence over all other considerations. The implication is that such rights as freedom of speech, freedom of the press, and the right not to be subjected to cruel treatment may also be limited when states lack resources or when they come into conflict with other considerations. Indeed, many repressive governments have caught on, and justify denials of civil and political rights on the grounds that they are developing countries and, therefore, are not able to respect such rights as freedom of expression.

Aryeh Neier is the president emeritus of the Open Society Foundations.