By Catalina Clarke
On Thursday, Senator Bernie Sanders — in line to chair the Senate health committee when the new Congress is sworn in — said in a video what this desk believes in plain terms: “Healthcare must be considered as a human right, not a privilege.” He called on Democrats to pass Medicare for All, and he named first steps that are, by Washington standards, almost modest: lower the Medicare age from 65 to 55, add dental, vision, and hearing to what Medicare covers, guarantee coverage for every child from birth through age 19, roll back the Medicaid cuts that took nearly a trillion dollars out of the program, and restore the Affordable Care Act’s enhanced subsidies. People would keep their private insurance in the meantime. He put public support at 66 percent of the American people.
The steps matter. But the sentence underneath them matters more, because it names the actual argument: healthcare is a human right, not a commodity. This editorial is our first, and we want to spend it on that sentence — and on the two objections that always arrive with it.
A commodity is a thing allocated by price. Markets are honest machines for many purposes: they are very good at deciding who gets a yacht. But a commodity logic applied to medicine produces a specific, predictable result — care flows toward whoever can pay, and the business in the middle profits most when it pays out least. That is not a corruption of the insurance model. It is the insurance model, working exactly as designed. A company that collects premiums and pays claims earns its margin on the difference, which means every denied claim is, on its own ledger, a small success. We have built a system in which the gatekeeper of a cancer treatment is financially rewarded for saying no, and then we act surprised when the gate stays shut.
Nowhere is the commodity logic uglier than at the pharmacy counter. The same brand-name medicines that sell in Canada, Britain, or Japan for one price sell in the United States for two, three, sometimes four times as much — not because they cost more to make, but because this market allows it. Americans ration insulin, a drug whose discoverers sold the patent for a dollar a century ago because they believed it belonged to the world. People cut pills in half, skip doses, and choose between medicine and rent — in the richest country on earth, for products that already exist in abundance. A commodity is priced at whatever the desperate will bear. A right is not.
No other developed country runs it this way. Every peer nation on earth — Britain, Canada, Germany, France, Japan, Australia, the Nordics — guarantees healthcare to its people as a matter of course, through systems that differ in design but agree on the premise: when you are sick, you get care, and the bill is a public question rather than a private catastrophe. These countries, as a group, spend roughly half of what the United States spends per person, and their people live longer on average. The American system is not the free-market entry in a table of equals. It is the outlier — the most expensive system in the developed world, and the only one that can bankrupt a family for the crime of getting ill.
Now the word that ends most of these conversations before they begin: socialism. It deserves a straight answer. Socialism means public ownership of the means of production — the state running the factories, the farms, the hospitals. Medicare for All proposes nothing of the kind. Doctors remain in private practice. Hospitals remain independent or private, as most are today. What changes is who pays the bill: one public insurer instead of a thicket of private ones. That is the exact structure of Medicare as it exists right now for Americans over 65 — a program so popular that politicians of both parties promise to protect it — and nobody marches against it as a Soviet plot. We already accept the principle every time a fire truck arrives without a credit check, every time a child walks into a public library. Some things a society funds together because they are the floor beneath a dignified life. The only question Medicare for All asks is why a heart attack should be treated as more optional than a house fire.
The honest objections deserve honest treatment, because they exist. A single-payer system would move trillions of dollars onto the federal ledger — though it would simultaneously lift premiums, deductibles, and copays off household and employer ledgers, and the trade has to be counted on both sides. Transition would be disruptive for the people who work in the insurance industry, and a serious plan owes them a serious answer. Other countries’ systems do ration care by queue for some procedures. But let us not pretend the American system does not ration. It rations relentlessly — by price, by network, by prior authorization — and it is the only system in the developed world whose rationing falls heaviest on the people with the least. We have not avoided choosing who gets care. We have chosen, quietly, that it should be those who can pay.
I come from a neighborhood where mutual aid was not a philosophy; it was how a street survived. When someone fell ill, the street carried them — food appeared, children were watched, money was found in envelopes that had no business existing. Nobody asked whether the sick woman had earned her care or chosen the right plan. The idea that a person’s chemotherapy should depend on their employer’s benefits package would not have been argued with. It would have been recognized, immediately, as a failure of civilization.
Senator Sanders will likely hold the gavel of the committee that oversees all of this, and he is proposing to move by reconciliation, fifty-one votes, the same tool that was used to cut Medicaid by nearly a trillion dollars. What gets built with it is a choice. This publication’s position is the one in our headline, and we will hold it as a standard against which we measure every proposal that follows: quality healthcare is a human right — not a privilege, not a perk of employment, and not a commodity.
— Catalina Clarke
Catalina Clarke is Editor-in-Chief of The Library Media.
From The Library — the estate of our family.