It seems like I keep coming back to the topic of healthcare recently, but when it’s all over the news, I can’t help but continue to make comments. Once again it appears that the Republican congress will not be able to pass anything to repeal the Affordable Care Act. As a liberal, I’m good with this, but it’s not because I want to just see Republican’s not get their way. It’s because I firmly believe we need to reframe this entire debate.

That reframing needs to start with an understanding that healthcare is NOT health insurance. Healthcare is about taking care of medical needs, where as health insurance is… insurance. When we think about the other types of insurance that we deal with it quickly becomes clear that health insurance doesn’t make a lot of sense when it comes to healthcare. If you have car insurance, or house insurance, you expect to use it only in emergencies. Using car insurance is something that we all try to avoid. That means that we pay for general maintenance and repairs of our cars out of pocket. We don’t have a car maintenance plan as a part of our car insurance, and nor do we have it for our houses. It’s expected that these types of insurance will only be used as a last resort, not a first one.

Health care is a different animal. We go to the doctor, not just when we’re in a major accident, but even when we’re trying to take care of ourselves and get check-ups. Because our health is so crucial to our well-being we’re more likely to use it even at the slightest sign of trouble. Unlike our car, which we may let run rough for quite a long time, we want our bodies to work well all the time. This is why the concept of insurance feels like a poor fit for how we care for our physical well-being. But, health insurance is what was decided to continue to be the backbone of the ACA, and that contributes to what I feel is the major crux of the issue.

Do we, as Americans, believe that healthcare is a right?

The question of is healthcare is a right is fundamental to the debate about how we pay for it. Every decision about healthcare flows from that question, “Is healthcare a right?” If, as a society, we feel that healthcare is NOT a right, then the idea of health insurance becomes much more palatable. We can deny people care due to their inability to afford it, because it’s something that we don’t feel everyone has a right to. Just like owning a car or a house is not a right, we could decide that healthcare is also not a right.

However, if we, as a citizenry of these United States, believe that everyone has the right to basic healthcare, the conversation changes. The idea of “insurance” doesn’t make sense for something that is a right as a citizen of this nation. If something is a right, it must be enshrined and guaranteed, so that everyone can have equal access to the same rights as others. Otherwise, it’s not truly a right, and it falls back to being a ‘nice-to-have’, if you can afford it.

I’m sure that you can see where I’m going with this, but (along with other medical cost cutting measures), the only way to truly guarantee healthcare to every citizen, is through some form of single payer system. We enshrine our rights as Americans as things that we can never have taken away from us. If healthcare is truly to become a ‘right’, we need to decide how to enable it for everyone.

This isn’t to say that it would be easy to create a single payer system in America. Every nation that has one has struggles and challenges that they need to overcome. Many of them are not perfect. However, I believe that the country that developed from some small scrappy colonies to the single superpower on the planet, can accomplish what other nations have struggled with. It will be hard, and it will be unique (as America is), but I absolutely think we can get there.

However, we’re never going to get there if we don’t first answer the question about the importance of healthcare to our society. If we truly value healthcare as a right, then we need to find a way to protect it, even for the least in our society. I believe that as a nation we can get there, but we first need to all be in agreement about what we’re fighting for. Maybe, just maybe, someday we can look back at the day when, as a nation, we came together and decided that everyone deserves a chance at a healthy life.