We’ve had a week full of controversies, but one in particular deserves more attention than it got. Of course, I’m talking about the health care right-versus-privilege fight that erupted after a beauty pageant on Sunday, and the way its problematic formulation distorts public policy. (Which one did you think deserved more attention?) Kára McCullough may be one of the most impressive Miss USA contenders in recent memory, but the beauty pageant did her — and themselves — no favor by asking her this question about health-care policy.
McCullough won despite her politically incorrect answer, but she hastily backpedaled after getting an avalanche of criticism on social media. McCullough switched from “privilege” to “right” the next day:
— Good Morning America (@GMA) May 16, 2017
The entire episode was unfortunate and unnecessary for the new Miss USA, who became the victim of a trick question. As I wrote in my column for The Fiscal Times, health care is neither a right nor a privilege. Taken as a whole, the market for health care services and goods is a commodity, and our failure to treat it as such is what’s making it so dysfunctional:
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. …
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.
In our form of self-governance and generally free markets, privilege generally refers to licensed access to certain restricted activities involving public assets. The most common of these is a driver’s license, which confers a privilege to use public roads. One does not need a license to drive exclusively on private roads, as anyone who grew up on a farm or ranch can attest. Doctors and lawyers require licenses to practice their professions, so providing health care can be described as a privilege, but we do not require a government grant to consume health care. Anyone who can provide compensation (directly or through third parties by mutual consent) for care can access it. Some providers — notably those maintained by religious communities, who have recently come under fire — don’t even require compensation for access.
Ironically, it’s pursuit of government intervention on the basis of a “right” to health care that most threatens to turn it into a privilege. As more and more mandates have been applied, consumers have fewer and fewer choices in crafting insurance that actually fits their needs. Permission from government becomes required for even the most basic of exemptions, such as a religious exemption for a mandate to provide free contraception to others. Government-run health care systems ration care, requiring dispensation for surgeries and other services. An overreliance on insurers for all health care costs produces some of these same issues, but at least consumers can rely on competition among insurers for pressure to comply — when government policies don’t chase them out of the marketplaces altogether.
Perhaps the most obvious distortion in public-policy attempts to treat health care as a right is the confusion of health insurance as its equal. In the previous administration’s efforts to guarantee this “right,” they imposed mandates on Americans that forced them to buy insurance — but made access to care even more expensive as a result:
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.
Its 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.
Talking about health care as a right over the last several decades has resulted in huge distortions of both the insurance and care markets. If we want to solve these problems, the first step is to dump the right-versus-privilege paradigm:
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.
Does the AHCA accomplish this? Not really. At best, it might be a first step in that direction, but it still confuses insurance with care, and mostly transfers the destructive and contradictory mandates of ObamaCare to the states.
Congratulations to Miss USA Kára McCullough on her win. In the future, don’t be shy about challenging the assumptions of your interviewers, and you’ll have even more success.