Healthcare – A Market Good or a Human Right?

Last spring, while serving as a teaching assistant for a health economics course at Washington University in St. Louis , I found myself revisiting a question that had lingered throughout my career: Is health a market commodity or a fundamental human right? Prior to joining the school for my PhD studies in public health sciences, I spent years as a physician, lecturer, healthcare quality advisor, and healthcare administrator in Ethiopia. These diverse roles allowed me to experience the healthcare systems of both Ethiopia and to some extent the United States, offering unique perspectives on how health is perceived, valued, and delivered in different contexts. My encounters in these two very different worlds have fueled my ongoing reflection on this critical question. So, is health something we buy and sell, or is it a right we all deserve?

For ardent advocates of healthcare as a marketable service such as Milton Friedman, healthcare could mean a market-driven service that can be bought, sold, and traded like any other good or service. In this context, individuals or institutions purchase healthcare based on supply and demand, and its value is determined by market forces such as competition, pricing, and quality of services. Access to healthcare is thus shaped by one's ability to pay or access insurance, and the private sector plays a central role in delivering medical goods and services. This view sees healthcare systems operating similarly to other industries, where consumers (patients) choose healthcare providers or services based on costs, availability, and preferences, and providers compete for business by offering the best services at competitive prices.

On the other hand, for proponents of healthcare as a fundamental human right such as Paul Farmer, healthcare holds that every individual, regardless of race, gender, socio-economic status, or nationality, is entitled to the highest attainable standard of health. This includes access to essential healthcare services, clean water, nutritious food, adequate housing, and healthy working conditions. The principle asserts that health should not be based on one's ability to pay or market-driven forces, but rather safeguarded by governments and international institutions as a fundamental right for all people. This perspective is grounded in international human rights law, most notably the Universal Declaration of Human Rights (Article 25) and the International Covenant on Economic, Social and Cultural Rights (Article 12), which emphasize the duty of governments to ensure that all citizens have access to healthcare without discrimination.

Arguments for Healthcare as a Commodity

Treating healthcare as a commodity can drive greater efficiency in resource allocation, primarily through the mechanisms of competition and innovation. In a market-driven system, healthcare providers and pharmaceutical companies are incentivized to compete for patients, leading to improved quality of care and more innovative solutions to health challenges. This competition encourages the development of new medical technologies and treatments, as companies strive to differentiate their offerings and capture market share.

For example, advancements in medical technology, such as robotic surgical systems and minimally invasive surgical techniques, have emerged from a competitive healthcare landscape where companies invest heavily in research and development to gain a competitive edge. The da Vinci Surgical System, widely used for a variety of surgical procedures, exemplifies this trend. Its success can be attributed to the potential for improved patient outcomes and reduced recovery times, driven by both competition among surgical device manufacturers and the demand for advanced treatment options.

Similarly, the pharmaceutical industry thrives in a market environment where companies invest in the discovery of new drugs to treat chronic conditions and emerging diseases. The rapid development of COVID-19 vaccines by companies like Pfizer and Moderna illustrates how a competitive market can lead to unprecedented innovation and speed in healthcare delivery. These companies were able to mobilize resources quickly due to the potential for significant profits and market share, resulting in the development of effective vaccines within months, a feat that would have been challenging in a more regulated, less competitive system.

Arguments for Healthcare as a Right

Health is a fundamental human right, and access to necessary healthcare services should be guaranteed for everyone, regardless of their financial situation. When health is treated purely as a commodity, significant disparities in health outcomes emerge, particularly for marginalized and low-income populations. For instance, in countries with market-driven healthcare systems such as the United States, individuals without sufficient insurance or financial resources may face barriers to essential services, leading to worse health outcomes. This inequity is evident in the higher rates of chronic diseases, preventable illnesses, and mortality among economically disadvantaged groups, underscoring the need for a system that prioritizes health as a right rather than a privilege tied to one’s ability to pay.

Treating health as a right promotes better public health outcomes by emphasizing the importance of preventive care and early intervention. Universal access to healthcare encourages individuals to seek medical attention before conditions worsen, which can reduce the overall burden of disease on the healthcare system. For example, preventive measures such as vaccinations, regular health screenings, and health education initiatives can significantly mitigate the spread of communicable diseases, benefiting society as a whole. Furthermore, by investing in public health infrastructure and ensuring universal access, countries can reduce long-term healthcare costs associated with treating advanced diseases, making the case for health as a right not just morally compelling, but economically sensible as well.

The commodification of health raises profound ethical concerns, as profit motives can overshadow patient care. When healthcare is driven by market dynamics, there is a risk that decisions may prioritize financial gain over the well-being of patients, potentially leading to disparities in treatment and quality of care. This profit-driven approach can undermine the ethical responsibility to care for all individuals, regardless of their socioeconomic status.

Finding a Balance

Hybrid healthcare models that incorporate elements of both commodification and rights-based approaches offer a promising solution to the ongoing debate over healthcare delivery. In such models, a public health system can provide universal access to essential services, while private options can be available for those who desire additional choices and amenities. To support a balanced approach to healthcare, several policy changes can be implemented. Expanding public health insurance options would provide a safety net for those in need, ensuring that essential services are accessible to everyone. Regulation of prices for essential medications can prevent exorbitant costs and improve affordability, particularly for low-income individuals. Additionally, increasing funding for preventive care initiatives can help reduce the incidence of chronic diseases and improve overall public health, ultimately lowering healthcare costs in the long run. Encouraging collaboration between the public and private sectors can also stimulate innovation, allowing for the development of new technologies and treatments while ensuring access for all. By fostering an environment where both approaches coexist, we can create a healthcare system that is efficient, equitable, and responsive to the needs of all individuals.

As we navigate the complexities of the healthcare system, it is essential to recognize that the conversation surrounding healthcare as a commodity versus a human right is not merely academic—it has real-world implications for millions of lives. We must advocate for solutions that strike a balance between fostering innovation and ensuring equitable access for all individuals. By supporting hybrid models that combine the strengths of both public and private systems, endorsing a strategy that prioritizes patient outcomes, and championing policy changes that enhance access and affordability, we can create a healthcare landscape that serves everyone.

In an era marked by rapid advancements in medical technology, shifting demographics, and emerging global health challenges, the importance of continued dialogue and research in the realm of healthcare cannot be overstated. As we seek to balance the competing ideologies of healthcare as a commodity and a human right, ongoing discussions among policymakers, healthcare providers, and communities are essential to adapt to the evolving needs of our populations.

Disclaimer: I do not identify as a health economist or claim to have extensively researched this topic. Rather, these are my personal reflections shaped by my experiences in the field and my subsequent readings.