A beauty queen may not be the most authoritative source when it comes to healthcare. Then again, the president of the United States, who is seeking a far-reaching overhaul of the U.S. healthcare system, is a former beauty-pageant owner.
So we probably shouldn't be surprised that the person who has most clearly articulated America's core philosophical belief when it comes to healthcare is our newly crowned Miss USA, Kara McCullough.
She was asked at this week's celebration of swimsuits, evening gowns and womanhood whether she thought "affordable healthcare for all U.S. citizens is a right or a privilege."
"I'm definitely going to say it's a privilege," the 25-year-old answered without hesitation. After getting pounded on social media, she reversed course the next day, telling an interviewer that "I am privileged to have healthcare and I do believe that it should be a right."
Don't laugh. Miss USA initially was voicing a position common to many Americans, mostly conservatives — a stance that has prevented the United States from joining all other developed countries in providing its citizens with universal coverage.
"People who do not want healthcare to be a right often think we would be moving toward socialized medicine, and they're very afraid of that," said Tony Sinay, chair of the Healthcare Administration Department at Cal State Long Beach.
The reality, he said, is that if healthcare is a right, "then it is simply a public good that the government has a responsibility to provide, like streetlights or national defense."
The right-or-privilege question is fundamental to virtually all healthcare policy decisions made by a country.
If healthcare is a right, then the focus is on ensuring that the entire population has access to affordable coverage, which in practice has led other developed countries to adopt variations of a nationwide single-payer insurance system.
If a privilege, then there's substantially more room to accommodate the needs of for-profit companies and to deny healthcare to a significant number of people because they're too costly to cover, such as those with cancer, diabetes or other chronic diseases.
"If you take that position to the extreme," said Joanne Spetz, a professor at UC San Francisco's Institute for Health Policy Studies, "one would have to be comfortable with letting people die on the street."
The Affordable Care Act, signed into law in 2010 by former President Obama, addressed that to some extent by preventing insurers from denying coverage to people with pre-existing medical conditions or charging them higher rates.
Those protections are imperiled by legislation passed this month by the Republican-controlled House of Representatives. It would make it possible for insurers once again to charge prohibitively costly rates for people with pre-existing conditions.
This would be a return to the bad old days for Robert Burns, a Huntington beach resident who was diagnosed with bladder cancer in 1994. His tumor was removed but cancer cells remain in his body in a state of remission.
Burns, 64, told me about how he lost his job — with a health insurer, ironically — a few years after his cancer surgery and found himself in the same boat as millions of other Americans who have experienced severe illnesses.
"I met with a number of insurers, one after another," he said. "They each asked the same questions — have you ever had this, have you ever had that?"
Inevitably, Burns would be asked if he'd ever had cancer.
"When I said yes, every single one said they couldn't cover me," he recalled. "Every single one."
Burns' story doesn't stop there. In 2008, self-employed and still uninsured, he was diagnosed with life-threatening blood clots. He received emergency care at Hoag Memorial Hospital Presbyterian in Newport Beach, running up a bill of close to $250,000.
Unable to get anywhere close to paying such a sum, Burns was grateful to learn that the hospital had reached out to an unknown benefactor, who agreed to cover at least a portion of the amount, presumably as a tax write-off.
While even such self-interested generosity is admirable, what does it say about the U.S. healthcare system that an uninsured patient must depend on the Medici-like kindness of a wealthy patron?
The blood clots returned in 2010, Burns said. This time there was no rich benefactor to cover his $18,000 hospital tab. Burns was forced to file for bankruptcy.
He told me that Obamacare was a lifesaver. It allowed him to purchase insurance from Health Net for a subsidized amount of $82 a month. Next year, he'll be eligible for Medicare.
"Of course healthcare is a right, for God's sake," Burns said, his voice cracking with emotion. "Otherwise we're a society where we don't give a damn about each other."
Or we're a society that equates shared responsibility with socialism, and that rationalizes selfishness as rugged individualism.
"The belief in solidarity, taken for granted in European countries, has never really held sway here," said Tom Rice, a professor at UCLA's Fielding School of Public Health.
He and UC San Francisco's Spetz said the key to universal coverage is making sure everyone participates in the insurance system. In most other developed countries, this is done through payroll taxes, rather than premiums, co-pays and deductibles.
Moreover, universal coverage requires acceptance that healthy people will help pay for sick people, with an understanding that at some point the healthy also will require such assistance.
However, Spetz said, "Americans have very mixed feelings about wealth transfers."
Yet that's precisely how Medicare works, and polls consistently show that most Americans are pleased with the government-run insurance program.
Maybe the question shouldn't be whether healthcare is a right or a privilege.
Maybe the question should be why so many of us don't really seem to understand what we're talking about.