We Don’t Sell Salvation. Why Are We Selling Health?
Avi Penhollow
There’s a phrase you hear tossed around in American policy circles like it’s a statement of fact: healthcare is a service industry. In the same breath, someone might tell you it’s a “business like any other.” But shampooing carpets is a service. Healthcare is not.
To treat the care of human bodies and minds as a line item in a market economy is to misunderstand what it means to be a society at all.
The Moral Bankruptcy of Medical Commodification
Avi Penhollow
The prevailing U.S. model — one that treats medical and dental care as “goods and services” subject to market forces — is morally bankrupt, uncreative, and incompatible with the principles of a just society. We’ve allowed an entire moral vocabulary to be replaced by accounting language. Patients become “consumers.” Doctors become “providers.” Human need becomes “demand.”
It’s not just a semantic shift. It’s a civilizational one.
When a society prioritizes shareholder returns over human well-being, it signals a deeper decay — not of policy, but of imagination. We’ve accepted a system that calculates the worth of human life through the same mechanisms that price a gallon of milk. That is not efficiency. That is moral failure dressed up as pragmatism.
Necessity vs. Commodity
Health is not a consumer choice. It is the foundation upon which every other right and freedom depends. Without health, liberty is an illusion. Without access to care, the social contract is a lie.
And yet, the American system treats healthcare as a tradable commodity — something to be bought, sold, and withheld for profit. The result is predictable: scarcity and exclusion. If you can’t afford the product, you don’t get the service — even if your life depends on it.
There’s a reason other developed nations classify healthcare as a public good. Because they understand that the right to live without preventable suffering is not something you earn by working hard enough. It’s something a humane society guarantees by existing.
The Failure of Market Justifications
Defenders of the for-profit model like to invoke economic dogma — efficiency, innovation, and consumer choice — as though these were sacred virtues. But each of these justifications collapses under the weight of its own contradictions.
Market Justification :Ethical and Societal Failure
“Market Efficiency”
Administrative bloat, endless billing codes, and armies of staff devoted to denial rather than delivery. The U.S. spends more on paperwork than most nations spend on medicine.
“Innovation”
Innovation driven by profit, not need: endless cosmetic enhancements, boutique drugs with microscopic variations, and zero incentive for prevention or public health.
“Choice”
A cruel joke when the only options you can afford are neglect or debt. “Choice” means nothing when the system itself decides who lives comfortably and who dies quietly.
The market is very good at one thing: producing inequality. It is not built to deliver justice.
The Real-World Consequence: Inequality and Exclusion
Consider something as ordinary as a dental visit. My own dentist recently left the insurance network because reimbursement rates were “unsustainable.” Her language wasn’t cruel; it was the language of survival in a system that punishes compassion. But the effect was immediate: patients were divided into two groups — those who could afford to pay out-of-pocket and those who suddenly couldn’t afford care at all.
When a provider exits a network, the cost doesn’t disappear. It shifts. And it always shifts downward — onto patients, onto families, onto people who already carry the burden of illness or disability.
Dental care is the canary in the coal mine of American healthcare. It has long existed outside the core insurance model, revealing the raw logic of the market: those who can pay, get care. Those who can’t, lose teeth — or worse, lose health that ripples through the rest of their body.
This is not an unfortunate side effect of capitalism. It is capitalism, functioning exactly as designed.
Towards a More Ethical System
The United States prides itself on innovation, yet it clings to an unimaginative healthcare model. There is nothing creative about building a system that profits from sickness. There is nothing efficient about turning suffering into revenue.
True creativity — moral creativity — would mean designing a healthcare system grounded in solidarity, not scarcity. It would mean understanding that the health of one is bound to the health of all. That the moral question is not “How can we pay for it?” but “How can we afford not to?”
To reframe healthcare as a covenant, not a commodity, is to reclaim our humanity. It’s to say: we belong to one another. And no one should have to prove their worthiness to receive care.
Because shampooing carpets is a service.
But healing the sick — that’s civilization itself.
The U.S. doesn’t have a healthcare crisis — it has a moral imagination crisis. We’ve mistaken care for commerce, and the result is a system that rewards suffering and punishes compassion.