When America finds itself mired in complex, expensive, and intractable debates over economic and social policy, it turns for answers to a ready font of wisdom … beauty pageants. Given all the contradictory and destructive rhetoric from all sides on managing health care markets over the last few decades, this might have been one of the last untapped resources for answers. Unfortunately, as Miss USA’s 2017 winner Kara McCullough discovered this week, those answers depend on how the questions are asked.
During the interview portion of the contest, McCullough was asked about the nature of health care and access, a question vexing politicians for years. “Do you think affordable health care for all US citizens is a right or a privilege,” the host asked her, “and why?”
"I'm definitely going to say it's a privilege," McCullough replied – at first, anyway. "As a government employee, I am granted health care. And I see firsthand that for one to have health care, you need to have jobs. So, therefore, we need to continue to cultivate this environment that we're given the opportunities to have health care as well as jobs for all the American citizens worldwide."
It didn’t take long for the outrage to build on social media, even as McCullough won the crown. It didn’t help that McCullough also offered a critique of feminism in the same appearance, saying that it had transformed into a “die-hard” approach that didn’t “care about men.” The passionate pushback focused mostly on McCullough’s choice of health care as a “privilege,” and so the next day McCullough recanted.
"I am privileged to have health care, and I do believe that it should be a right," the pageant winner told ABC’s Good Morning America. "I hope and pray moving forward that health care is a right for all worldwide."
McCullough is certainly no lightweight. The Washington Post’s profile of Miss USA paints an impressive picture – a scientist with a position on the Nuclear Regulatory Committee, born in Italy and raised in Virginia Beach, and a woman who works with children to promote STEM education. Emily Yahr quotes an unnamed pageant producer who describes McCullough as “one of the most intelligent contestants in recent memory.”
The problem for McCullough is that she was asked a trick question. The correct answer was neither “right” nor “privilege,” and not even “world peace.” And it’s this confusion that exists at the heart of the contradictory and damaging policies in place that drive costs out of reach for many Americans.
Health care consists of goods and services produced and delivered by highly specialized providers in exchange for monetary compensation. Overall, it’s a commodity, for which the terms “right” and “privilege” are largely meaningless. In an economic sense, health care is no different than markets for other commodities, such as food, vehicles, fuel, and so on. The ability to purchase goods and services depends on the resources one has for compensation for their delivery in most cases.
Progressives insist that health care is so critical to existence that it must be considered a right, and that government has to guarantee access to it regardless of the ability to pay for it. That, however, doesn’t make it a right, nor is health care the only commodity for which that argument applies. For instance, water is even more critical to existence than health care, but even while most water systems are run by the government, people who don’t pay their bills will get it turned off. Grocery stores are not required to distribute food without proper compensation, and those who take without paying get prosecuted for theft.
Rights, as understood by founders, do not require the transfer of goods and services, but come from the innate nature of each human being. The right to free speech does not confer a right to publication, or to listeners. The right to peaceably assemble does not confer a right to confiscate private property in which to gather or to destroy either. The right to bear arms does not require the government to provide guns or ammunition, and so on. Rights do not require government provision, and the Constitution and especially its Bill of Rights exists to prevent government infringement.
Furthermore, the attempts to force a larger and larger role for government as a guarantor of a “right” to health care has merely made costs grow higher. Over the last decade, US policy has consistently confused health care with health insurance and distorted both to the detriment of consumers. The Affordable Care Act, which ostensibly was framed to ensure universal insurance coverage as a “right,” instead imposed insurance as a mandate with tax penalties for non-compliance.
It’s complicated and contradictory mandates for price controls and coverages provided massive disincentives to healthier and younger consumers for entry into the risk pools, driving up premiums and deductibles for those who remained in them, making access to the benefits nearly impossible short of a catastrophic health event. The net result is to have made it costlier for most Americans to access the health care market, unless – like McCullough – they work for a large employer that takes part of their compensation to cover health insurance. The ACA has distorted the individual-coverage markets so badly that insurers are fleeing them to cut their losses.
The proper way to approach health care is the same as we approach other commodities – shaping oversight to find ways to promote consumption and provision, which will drive costs down. Applying more mandates to these markets will make them worse; we need to find ways to improve price signaling to consumers, and that means recognizing that health insurance is not the same thing as health care.
Rather than mandate one-size-fits-all comprehensive coverage, we should encourage a return of insurance to indemnification against unforeseen events, and have consumers keep more of their resources to spend directly on more routine care. That would reduce overhead for providers, entice more providers into the markets, and produce real competition rather than price fixing so all consumers would have equal access to providers.
Understanding health care as a commodity rather than a right or a privilege would go a long way to taking us to a workable solution for what ails our health care markets. Otherwise, they will continue to be what they are right now – not a right or a privilege, but an absolute mess.