For years my aunt Sylvia knew something was wrong. She told doctors she was experiencing pain, but they shrugged it off as age-related. Sylvia sought preventative care in the emergency room, where, like other Medicaid recipients, she knew she would eventually be seen by a doctor. But still, she found herself misdiagnosed and undertreated.

Sylvia joked often with my mom that those on Medicaid were considered disposable in the emergency room. I remember overhearing her say “los ricos don’t have to worry como los pobres.” What could have been avoided during a high-quality check-up grew into something far worse.

In January of 2009, my aunt was diagnosed with stage 4 cervical cancer. She lost her battle with the disease nearly 12 months later at 48 years old. Her experience with the U.S. healthcare system is representative of the country’s inequality—some are seen as deserving, others undeserving.

I still see her struggle around us. In the United States, we don’t have the right to health care—we have the right to pay for health care. People from nearly all levels of income are scared of medically-related bankruptcy, and it’s all too easy to understand why someone might forgo the necessary care or accept undertreatment when faced with the potential of financial ruin.

My aunt never fell into crippling debt, but only because she refused anything that would cost her out of pocket. But for many people, the emergency room becomes punishing thanks to its high and unpredictable costs. Being rich and going to the emergency room is about instant gratification. Being poor and going to the emergency room is a last resort. This creates a tiered system where values are assigned to the people who occupy each rung. Sylvia found herself defined as undeserving.

Government-funded programs like Medicaid aren’t the problem. The issue is a healthcare system as a whole, which acts as a microcosm for the disparities that cut across all lines. At its most absurd, private insurance becomes “wealthcare” — like exclusive medical services that are made known through word of mouth alone. When the richest American men on average live 15 years longer than the poorest ones, something is fundamentally wrong.

I revisited the emotions about my aunt and her passing when I read an article last winter in The Nation about how Black women in Alabama with cervical cancer were twice as likely to die than white women. “This disparity is all the more striking,” reporter Michelle Chen writes, “because cervical cancer is easily preventable and treatable with adequate gynecological care and early screenings, which generally lead to a 93 percent five-year survival rate.”

Alabama currently holds the top spot for cervical cancer death rate in the United States, Human Rights Watch found — a statistic that they connect back to the state’s “patchwork system of social safety net care.” In Alabama, that doesn’t even include the Medicaid expansion offered by the Affordable Care Act.

"The difference between small incremental change and structural reform is the difference between healthcare as a good for sale and healthcare as a human right."