New Year’s resolution No. 1: Wellness! Everybody makes their resolution to eat better and exercise more. But wellness should be embedded in culture, in societal norms, in the very framework of our infrastructure and design of our communities and how we live and behave.

That’s because society simply cannot afford a just, equitable healthcare system given medical technology’s ability to restore and extend life. If you believe that healthcare is a right, not a privilege, who gets to live and who gets to suffer and wither away?

America’s healthcare system is already grossly dysfunctional, ineffective. We pay the most of any country but have some of the worst health outcomes and life expectancy in the industrialized world – and not for the lack of technology, leading edge medical science or pharmacology. It’s just how care is distributed and made available, costed out.

The Affordable Care Act has been an important first step toward universal care. President Biden reported that with a month to go before enrollment period ends, Jan. 15, Obamacare had a record 11.5 million sign-ups – 1.8 million (18 percent) more than the prior year – and the level of uninsured is down to the lowest level at 8 percent.

Except that figure doesn’t take into account the 60 million Americans who are uninsured or underinsured or that 70,000 die every year because they can’t afford the care they need, according to U.S. Sen. Bernie Sanders, who advocates for universal healthcare.

Another important step is capping the cost of insulin at $35 a month, but Republicans saw to it that it would only would apply to Medicare recipients. Still, perhaps it sets a precedent.

We had a taste of what true universal health would look like in the reaction to COVID. The idea of free tests, free vaccinations, even free masks!

But let’s say Bernie Sanders’ dream of universal health care becomes reality, what then?

Because here’s the conundrum raised by those who think of healthcare as just another capitalist commodity subject to the laws of supply and demand: if everyone is equally able to have an organ transplant, get cancer treatments, kidney dialysis, prosthetic limbs or cloned organs that extend lifespans beyond the century mark, we won’t have enough doctors, nurses, hospital rooms or clinics to supply.

So here’s the solution progressives who believe, yes, healthcare should be universal and equitable advocate for communities and homes and buildings to be set up to maximize opportunities for wellness. That starts with clean air and drinking water – not like Jackson or Flint. Access to affordable, fresh, healthy foods, not food deserts. Free lunch for all public schoolchildren – some version of that is essential to give children equal opportunity to develop into their best selves.

More implementation of Complete Streets, Smart Growth and Climate Smart Communities strategies, such as Gov. Hochul promotes, so our roadways are safer for pedestrians, cyclists as well as cars; communities are designed for sustainability, wellness and happiness with more open spaces, parks, opportunities for exercise and recreation, less pollution, mitigation against climate disasters; agriculture is eco-smart and sustainable agriculture; and we move toward achieving net-zero, clean-renewable energy.

And if anyone is serious about wellness, we as a society must address the epidemic of gun violence with the same fervor and urgency as the deadly coronavirus. Beyond the 45,000 who died in 2022 (over 600 mass shootings), are the hundreds of thousands who are injured, who have ongoing needs for medical and rehabilitative care, who live with pain and trauma. That costs $557 billion a year, a compounding amount.

Now add to this the end of Women’s Reproductive Health – where women are being denied healthcare, even medication, because doctors and hospitals fear being sued for violating abortion bans.

Healthcare should start with wellness and prevention, early detection, diagnosis and treatment. Which means we need more doctors, yes, but also more physicians assistants, nurse practitioners, clinics and telemedicine. Training, education, licensing need to be amended.

Indeed, millions of Americans will face ongoing, perhaps lifelong health issues because of Long COVID – imagine if Republicans repeal Obamacare and “pre-existing conditions” return.

It’s not just health insurance, which is a racket – adding a 20 percent cost inflator to patient care – but the sticker price of care and prescription drugs is a barrier to living a life of wellness. What medical practitioners, including Big Pharma, charge should be subject to the same limits as public utilities like water and electricity – cost plus reasonable profit.

This would also remove the incentive, built into America’s healthcare industry, for people to become sicker, be harder to cure, before they receive diagnosis and treatment.

Wellness can’t be just a New Year’s resolution. It should be a creed.