When Kara McCullough, the winner of this year’s Miss USA pageant, was asked whether she thought affordable health care for all U.S. citizens is a right or a privilege, she answered, “Privilege” and quickly sparked a heated debate on social media. After a hard look at the arguments on both sides of this issue, I’ve found no clear-cut answers. 

What role does government play in promoting health among its citizens? The Future of Public Health, a report on the issue, was undertaken by the Institute of Medicine and published almost 30 years ago. Today, how to care for the nation’s uninsured and underinsured population remains a dilemma.

During the Industrial Revolution, government officials instituted practices at the federal, state and local levels to safeguard public health. At that time, local governments viewed the health and well-being of communities as their responsibility. The idea of affordable universal health coverage is rooted in this perspective. After all, it is easy to regard health care as an investment in the prosperity of our nation. Healthier citizens make for a stronger, more productive country. Experts believe that if properly implemented, universal health coverage could provide a return on investment that would well justify its costs.

That said, often when the health of a nation’s citizens is undervalued or neglected, it is the poorest and most vulnerable who suffer.

In 2014, officials told the residents of Flint, Michigan, that the water was safe to drink after the city switched its supply source from Lake Huron to the Flint River. The following year, findings showed that the water was contaminated with lead. Toxic levels of the poisonous heavy metal spiked in the bloodstream of the city’s children. The eventual cost to the health of these kids and the financial price to be paid by their parents have yet to be calculated. The vast majority of those affected by this disaster were poor Black people. Who is to be held accountable for the damage to their health? Who will pay for their health care? Should it be those who caused the problems? Why aren’t the politicians who put policies into place at the expense of people’s well-being and lives held accountable?

The crisis in Flint is an example of what happens when government puts the good health of the public last. Is it a privilege for constituents to be protected by those they elect to serve their communities?

In the preamble of the United States Constitution, the founding fathers state that one of the government’s fundamental guiding principles is to “promote the general welfare” of the people. But this phrase means different things to individuals who support universal health care and to those who reject it.

Still, perhaps there’s one thing everyone can agree on: Most Americans need and want affordable, quality medical care in this country.