Executive Summary

The United States is often described as a global leader. Last year, we spent $997 billion on defense: more than the next nine countries combined. We lead the world in scientific research, producing more Nobel Prize–winning work than any other country, and with a GDP over $30 trillion, we run the largest economy on Earth. Yet despite all this, 25 million Americans went without health insurance, 41 percent of adults carried medical debt, and roughly two-thirds of bankruptcies were caused by medical bills. The painful reality is that this isn’t a new problem.

The Declaration of Independence lays out that all people are created equal and endowed with unalienable rights, including life, liberty, and the pursuit of happiness. Its use of ‘among’ suggests the Founders didn’t list every basic right, and while they could not have imagined the scale of modern healthcare, it invites us to consider what those rights mean today. The truth is that people in this country do not have a guaranteed right to health. David Bell, an African-American man, died of COVID pneumonia after being refused admission to a hospital three times. No investigation followed.

America’s modern attempt to expand access, the Affordable Care Act, passed in 2010, extended coverage through Medicaid and insurance marketplaces and prohibited discrimination based on preexisting conditions. But coverage alone didn’t guarantee care, and millions of Americans faced uncertainty. Premiums have risen over 60 percent since 2010, and having insurance doesn’t always mean being able to see a provider. Ultimately, the ACA revealed something deeper: legislation can only do so much in a system shaped by structural limits.

Real change requires more than laws. Healthcare must begin before people get sick, focusing on prevention or early intervention. Programs like providing clean syringes for people who inject drugs show that early support can reduce HIV rates by 33 percent without increasing drug use. Care must also be accessible: mobile clinics and community-based services can reach people within 15 minutes instead of leaving them to travel an hour or more. Illness starts long before a hospital visit, shaped by housing, transportation, stress, and social conditions, and society bears responsibility for addressing those factors. Health systems improve when they track outcomes and target critical conditions, from cancer to heart disease to stroke, improving the health of entire communities. Finally, care only works when patients trust the providers. Providers need to meet people where they are, understand their lives, and treat them with genuine concern.

As the United States approaches its 250th anniversary, it is unlikely that a constitutional right to health will appear on paper, but history reminds us that rights are never delivered all at once. A right to health must be realized through action, and the measure of our nation is whether fewer people have to walk through that door of suffering at all.