By Jessica Jerome, PhD

Imagine a world where the wealthy separate themselves off from everyone else, living in mansions with perfectly coiffed lawns, enjoying long and healthy lives of sedentary pleasure. Meanwhile the rest of the world lives in teeming, crumbling, violent cities, with few available resources and decrepit services. This is not planet Earth in the year 2013, but rather the setting of the new science-fiction film Elysium, directed by Neill Blomkamp.

In the film, the rich live in an idyllic space habitat called Elysium, while the poor are relegated to an overcrowded and post-apocalyptic Earth. Scenes of Elysium are indistinguishable from Malibu or the Hamptons while scenes on Earth look like the less fortunate areas of any other modern day megalopolis (the film was shot in the slums of Mexico City). Other aspects of the film fall more squarely in the realm of science-fiction. For example, one of the most sought after innovations on the space station, around which multiple plot points turn, is the Med-Bay. Med-Bays look like MRI machines, but can be used to cure any human ailment. In the course of the film we see these bays cure paralysis, reconstruct a man’s face, and save a child from cancer, all in a matter of minutes.

But if you think the idea of a single machine being able to cure all of your ills is far-fetched, what’s even more unbelievable to someone living in the United States is the idea that we would have access to medical treatment simply because we were citizens. In this country health care is not an inherent right of all citizens; instead it is treated as a commodity that is mediated by insurance companies who dole out access to care based on our ability to pay for it through private insurance, our employment with a company that has itself purchased private insurance, our age (in the case of Medicare) or our income and selective medical conditions (in the case of Medicaid). Health care is thus a privilege rather than a right in our society, and the quality of care correlates closely with one’s wealth and status in our society. The United States is a terrible place to be poor and sick. And, as the ongoing debates over the implementation of the Affordable Care Act dramatize, this is unlikely to change anytime soon.

There are many countries around the world that do confer health care on the basis of citizenship. In Brazil, for example, health care is free — by law — and everyone has a right to medical treatment, from organ transplants, to cancer therapy, to HIV medication and treatment. This has been true since 1988 when the Brazilian government included a provision in their new constitution that explicitly recognized health care as the duty of the state, and guaranteed health care to all citizens. Experts agree that universal and equitable coverage remains elusive in Brazil, and recent protests in the country suggest that many residents are still unsatisfied with aspects of the health care system. But, two decades after Brazil’s constitution recognized health as every citizen’s right and a duty of the state the country has vastly expanded health care coverage, improved the population’s health outcomes, and reduced many health inequalities.

The film ends with the heroes reprograming Elysium’s computers to make every person on earth a citizen and thus eligible for full medical treatment. Some of the film’s last images are of throngs of people rushing their desperate, sick and needy onto the planes that will take them up to Elysium’s Med-Bays. It is of course utopian to believe that we can resolve class conflict with a single technological fix (Alyssa Rosenberg has argued this point at length at Think Progress), but the film shows us something else; that the problem of health care is never only one of delivering the most advanced medical technology, but is also a question of how people in power define who has access to it, for it is the access to this care which most crucially determines health outcomes. Defining health care as a right of citizenship would be a start toward grappling with the profound health care inequalities that plague our country.