In 2022, a 35-year-old man in Birmingham named Marcus went to the emergency room with chest pain. He sat in the waiting room for six hours, left without being seen because he couldn’t afford to miss another shift, and died of a heart attack three weeks later. He was uninsured. He had been, for most of his adult life.
Marcus is not a statistic. But he became one: one of an estimated 45,000 Americans who die each year due to lack of health insurance — a figure documented in peer-reviewed research published in the American Journal of Public Health, with more recent modeling in The Lancet suggesting the toll may be significantly higher.
Healthcare Is Not a Benefit. It Is a Condition of Existence.
We debate universal healthcare as if it were a policy preference — like choosing between a flat tax and a graduated one. But healthcare is not in that category. Access to medical care is what determines whether a person can participate in everything else we value: work, family, community, contribution. Without it, everything else becomes provisional.
The United States spends more per capita on healthcare than any other developed nation. We spend it on administrative overhead, on billing systems so complex they require entire hospital departments to navigate, on the emergency room visits that happen when preventive care was unavailable. We spend it on the most expensive version of everything because we have designed a system that kicks people out until their problem becomes catastrophic.
The Math of Uninsurance
The argument against universal healthcare almost always comes down to cost. But the cost calculus being used is profoundly incomplete. Consider:
- Uncompensated care — healthcare provided to uninsured patients who cannot pay — costs the system over $40 billion annually
- Preventable hospitalizations cost the US healthcare system over $30 billion per year
- Medical debt is the leading cause of bankruptcy in the United States, affecting over 530,000 families annually
- Each dollar invested in preventive care saves between $3 and $14 in downstream treatment costs
We are paying for universal healthcare already. We are just paying the most expensive, least equitable, most dehumanizing version of it.
What It Means to Be Human
There is a philosophical argument underneath the policy debate that rarely gets stated plainly: a society that allows preventable death and suffering when it has the resources to prevent it has made a choice about whose lives count. That choice has a racial dimension, a class dimension, and a geographic dimension. Rural Americans, Black Americans, and low-income Americans are disproportionately uninsured. That is not coincidence. It is architecture.
Universal healthcare does not mean perfect healthcare. It means that a 35-year-old man in Birmingham doesn’t have to choose between a shift and a chest pain evaluation. It means that the capacity to survive is not income-dependent.
At Hot’s N Cot’s, health equity is part of our advocacy platform because housing stability, economic stability, and health are not separate issues. They are the same issue. A person who cannot get medical care cannot build a stable life. Full stop.
Join us in demanding the world we’re capable of building. Follow our advocacy blog, share these articles, and plug into the Hot’s N Cot’s network at hotsncots.org. The movement needs your voice.