Chang-Rae Lee’s 2014 novel On Such a Full Sea uses the genre of speculative fiction to reflect on longstanding healthcare debates in the United States that have recently crystalized around the Affordable Care Act. The novel imagines the political economy of healthcare in a future America devastated by environmental illness. What kind of care is available and to whom? Who provides it? Who pays for it? What about distribution and access? The different healthcare systems governing each of three geo-social zones (...) in Lee's future society represent exaggerated versions of the scenarios participants in the ACA debate claim their opponents’ health policies would produce. The essay argues that Lee’s novel ultimately favors a version of universal government-funded care over a system based on supposed free-market principles, even as the novel also tries to make room for conservative Americans’ fears about the specter of so-called “socialized medicine.” More broadly, the essay contends that the health humanities should devote more attention to literary and artistic engagements with healthcare as a system: a complex set of financial models, public and private institutions, government policies, and actors whose roles range well beyond patient and care provider. (shrink)