If there is one thing modern societies have learned from pandemic years and chronic inequality, it is that health is not a private matter. The spread of illness-biological, social, and moral-exposes how deeply our lives are intertwined. Yet we still talk about healthcare as if it were an optional service, a product to be purchased, rationed, or withheld, rather than what it truly is: the precondition of freedom itself. To see why this matters, we might turn not to a medical economist or a contemporary political theorist, but to a philosopher who wrote at the turn of the nineteenth century-Johann Gottlieb Fichte, one of the founders of German Idealism and a thinker of startling moral precision.
Fichte's Foundations of Natural Right (1796-97) is not, at first glance, a work about health. It is a rigorous attempt to deduce the very concept of rights from the nature of self-consciousness. Yet buried in its dense pages is a simple, radical truth: human freedom is not a solitary state but a social relationship. We are only free, Fichte argues, because we recognize others as free, and because they recognize us in turn. This mutual recognition-what he calls Anerkennung-is not an optional courtesy or a moral luxury; it is the condition of being a self at all.
For Fichte, the famous "I think" of philosophy does not stand alone. It can exist only in dialogue. "No rational being can posit itself as an individual," he writes, "without positing others as individuals outside it." In other words, freedom begins not with independence but with interdependence. Our autonomy, our sense of self-determination, presupposes that others exist who acknowledge us as free beings.
That insight has immense political implications. If every person's freedom depends on the freedom of others, then society's first duty is to create and maintain the external conditions that make freedom possible for all. Fichte calls this realm of external freedom right (Recht), and he insists that the state exists for no other reason than to secure it. The government is not a machine for enforcing laws or collecting taxes-it is, as he beautifully puts it, "the visible body of freedom."
Once you take that premise seriously, healthcare ceases to be a question of policy design or partisan preference. It becomes a matter of justice. Health is not a consumer good or a lifestyle choice; it is one of the essential conditions that allow human beings to act freely in the world. Without a functioning body, without access to medical care, without the assurance that illness will not destroy one's livelihood, the promise of autonomy is hollow. To deny someone healthcare, or to make it contingent on their income, is not simply inefficient or unkind-it is, in the Fichtean sense, irrational. It contradicts the very principle of freedom that gives society its moral legitimacy.
We rarely speak this way in public discourse. Instead, we frame healthcare as a technical problem to be solved-how to balance costs, how to incentivize efficiency, how to manage risk. But behind these managerial debates lies a deeper moral confusion. We treat health as a commodity because we treat persons as consumers rather than as participants in a shared freedom. A Fichtean approach would reverse this logic: healthcare would be understood as the social form through which recognition is realized, the way we enact our mutual acknowledgment that each person's life is of equal worth.
Imagine, for a moment, a society that took this idea seriously. In such a world, hospitals and clinics would not be seen as businesses competing for clients but as civic institutions, as necessary to freedom as the courts or schools. Physicians would not be "providers" and patients "customers"; both would be partners in a moral enterprise whose purpose is to preserve the physical basis of autonomy. The funding of medicine would no longer be justified in terms of national productivity or cost savings but as a direct expression of the state's ethical vocation: to ensure that the conditions of freedom are equally available to all.
Fichte's framework helps us see that universal healthcare is not an act of generosity but of self-recognition. If my freedom depends on your freedom, then my health depends, in part, on yours. A society that leaves people without care endangers not only their bodies but its own moral coherence. It becomes, in effect, a community of mutual disregard-a place where the vulnerable are invisible and the privileged live at the expense of recognition withheld.
Of course, Fichte was an idealist philosopher, not a policy reformer. He wrote in a Europe still ruled by monarchs and aristocrats, long before vaccines or public health existed in any modern sense. Yet his reasoning anticipates what contemporary political philosophers call the social determinants of freedom. Freedom, he reminds us, is not a metaphysical abstraction; it is a lived capacity that depends on real material conditions-on education, on security, and most fundamentally, on health. The task of politics is to guarantee those conditions universally.
In this light, universal healthcare becomes not merely compatible with liberty but necessary for it. Indeed, one might argue that a state which fails to provide for its citizens' health forfeits its claim to be rational or free. Fichte's "visible body of freedom" becomes sick when its members are left without care. The principle of right collapses when life itself is rationed. For a Fichtean, to deny care is to enact a contradiction in thought: to affirm human dignity in the abstract while denying the bodily conditions through which dignity is lived.
This moral insight extends beyond the clinic. Public health measures-clean water, vaccination, environmental protection, and social safety nets-are all, in Fichte's language, conditions of right: they make the external freedom of individuals possible. The pandemic revealed this with brutal clarity. Our interdependence is not a weakness to be managed but the foundation of our shared agency. My safety depends on your access to care; your recovery depends on mine. Freedom, in this view, is not the absence of obligation but its perfection-the recognition that to care for another is to affirm oneself as a rational being.
There is also a political lesson here. When healthcare is treated as a commodity, inequality becomes institutionalized as necessity. Those with means live longer, healthier lives; those without suffer and die prematurely. Fichte would have regarded such a system as a moral absurdity-a world in which the form of right (law, citizenship, contract) survives but its spirit (recognition, equality, autonomy) has perished. His philosophy calls for a transformation in how we understand social order itself: not as a hierarchy of competing interests but as a network of mutual acknowledgment, sustained by institutions that make reciprocity real.