America at 250
Should Healthcare Be a Democratic Right?
As our nation prepares to celebrate its 250th birthday this July 4th, we should take time to reflect on what it means to live in a democracy and the responsibilities we share in sustaining it.
The hallmarks of a healthy democracy include:
Free and fair elections
The rule of law
Protection of political rights and civil liberties
Political pluralism
Active citizen participation in civil society
Checks and balances through the separation of powers
The peaceful transfer of power
What is missing from this list?
As a lifelong healthcare professional, I would add access to healthcare. In a nation as wealthy and resource-rich as the United States, access to essential health services should be considered a right of citizenship, not a privilege determined by employment, income, geography, or circumstance.
Perhaps the more important question is this:
How much are we, as a society, willing to invest to achieve universal health coverage?
Many countries with far fewer resources than the United States have succeeded in ensuring that all citizens have access to healthcare. Yet we remain the only high-income nation that relies primarily on a market-based healthcare delivery system. While this approach has fostered remarkable innovation, it has also created barriers to equitable access and limited our ability to fully pursue both individual and community well-being.
Why has progress been so difficult?
The United States possesses the healthcare infrastructure, workforce, and financial resources necessary to provide universal access to essential health services. We already operate large publicly financed programs, including Medicare, Medicaid, and Veterans Health Administration services. The challenge is not whether we can do it—it is whether we have the collective will to do it.
We also know that healthcare alone does not create health. Decades of research have demonstrated that health outcomes are shaped by factors such as housing stability, food security, transportation, education, employment opportunities, environmental conditions, and freedom from discrimination. These social determinants of health often exert a greater influence on well-being than medical care itself.
Too often, we attempt to solve social problems through medical interventions, creating additional layers of bureaucracy for those who are already among our nation's most vulnerable and marginalized citizens. As a result, many individuals must navigate both a fragmented social service system and a market-driven healthcare system simply to obtain the support they need.
For your consideration.
As we enter the second half of 2026, I hope Americans will consider the following:
• Access to essential health services should not depend on employment status.
• Every person should have access to a primary care provider who serves as both an advocate and a trusted partner in creating and sustaining health, preventing disease, and managing illness.
• The root causes of many health problems lie upstream in the social, economic, environmental, and commercial determinants of health.
• A healthcare system should be judged not only by efficiency and innovation, but also by fairness, equity, and justice.
• Access to essential healthcare services should reflect our commitment to human dignity and the common good, rather than political interests or financial gain.
• Integrated primary health care, essential public health functions, and human social services form the foundation of a high-performing health system and should receive the legal recognition and sustainable funding necessary to serve every citizen with dignity, cultural humility, and compassion.
This is not simply a list of policy recommendations. It is a moral imperative.
As America approaches its 250th year, we have an opportunity to reaffirm our commitment to one another and to the ideals that define a democratic society. Ensuring that every person has access to the essential health services needed to achieve health and well-being is not merely a healthcare issue—it is a statement about who we are as a nation and who we aspire to become.
The time for that conversation is now!
