Betsy Saltonstall is a philanthropic advisor based in Rockport. Her work focuses on civic engagement, equity and the intersections of democracy and economics.

Democracy and capitalism both depend on participation. When citizens stop voting or can no longer afford to participate in the economy, the wheels of both systems grind to a halt. That’s what we’re watching happen now.

The government is shut down, and our health care system is teetering under the weight of costs most people can’t sustain. The two crises mirror each other — both born of political paralysis and public exhaustion.

Democracy is not self-sustaining. It relies on people showing up — to vote, to question, to care. The same is true of capitalism, which depends on people buying in — literally and figuratively.

The power of the vote and the power of the purse are the twin levers of civic life. They are how we say yes or no to the systems that govern and profit from us. When we withdraw from either, we cede control to those who thrive on our apathy.

When people don’t vote, the government falters. When people can’t afford their premiums, the health care system collapses. Both depend on the faith and participation of citizens — and both are losing it.

The current government shutdown isn’t just about spending caps. It’s about health care — the same premium subsidies and coverage programs that millions rely on. But Congress has turned that lifeline into a bargaining chip.

Republicans call health care funding wasteful. Democrats defend it timidly, fearful of alienating the donors who keep them in office. Meanwhile, ordinary Americans are left to wonder whether they’ll still have coverage when the dust settles.

Leadership means standing up for people, not campaign contributors. It means protecting citizens from being dropped from their health care rolls because of a political standoff. These are choices made by the people we elect — and their failures are the price of our disengagement.

The American health care system doesn’t run on compassion. It runs on fear — fear of illness, fear of debt, fear of being uninsured. Every premium payment and paycheck deduction feeds a trillion-dollar machine that converts anxiety into profit.

The five largest insurers made more than $60 billion in profit last year. They also poured hundreds of millions into lobbying Congress, ensuring the system remains just broken enough to be lucrative.

We are told the system is failing. It isn’t. It’s working exactly as designed — for those who profit from everyone else’s insecurity.

Every shutdown exposes the same hypocrisy. Federal paychecks stop, public programs freeze, but health insurance billing never misses a beat. Even as workers lose income, insurers continue to collect premiums.

It’s the perfect snapshot of modern America: a government paralyzed by politics, and a private system that never stops extracting.

We now live in a country where people lose wages before they lose premiums — where the public sector grinds to a halt while the private sector keeps humming, indifferent to the suffering it helps create.

Imagine if citizens couldn’t pay their health care premiums — not as a protest, but because the costs had become unsustainable. Imagine the health care industry grinding to a halt the way our government has now, its wheels locked because the people who keep it running can no longer afford to participate.

That’s not an abstraction; it’s a glimpse of our trajectory. The same forces that have brought Congress to a standstill — greed, polarization, neglect — are eroding our health care system. We are driving ourselves into the same ditch from two directions: political dysfunction on one side, economic exhaustion on the other.

When citizens stop voting, democracy breaks down. When citizens can’t pay for health care, capitalism breaks down. Both are warning signs that the balance between people and power has been lost.

The health care crisis is not separate from the democratic one; it’s a reflection of it. In both arenas, power has shifted away from citizens toward institutions that no longer answer to them. Lobbyists have replaced voters as the audience that matters.

A disengaged electorate becomes a captive market. When people give up on politics, government serves donors. When they give up on reform, health care serves investors. The two systems feed off the same weakness — our collective decision to stop believing that participation matters.

But it does. It always has. The same courage that built labor unions, won civil rights and expanded Social Security can rebuild our democracy and our economy. It starts with showing up — to vote, to question, to demand better.

Health insurance promises peace of mind but delivers anxiety. Americans pay more for health care than any nation on Earth yet face shorter lives, higher debt and relentless insecurity.

We buy insurance because we’re afraid not to, just as we skip elections because we think our vote won’t matter. Both acts of fear sustain systems that depend on our compliance.

The peace we’re promised — financial, political or emotional — will never come from institutions that profit off our fear. It can only come from reclaiming control.

Every other developed democracy has made a different choice. They’ve decided health care is a public good, not a private gamble. They’ve built governments that work for people, not donors. We could, too. We have the doctors, the hospitals, the wealth. What we lack is courage — among leaders and citizens alike.

We need leadership willing to reconnect capitalism and democracy to the people they’re meant to serve — leadership that measures success not by profits or polls, but by how well citizens are protected.

And we need citizens willing to show up — to vote, to speak, to hold their representatives accountable, to refuse to fund systems that exploit them.

Democracy and health care share the same truth: both exist only because we sustain them. Both fall apart when we stop participating.

We built these systems. We can rebuild them. But first, we must remember the simplest truth of all: they only work when we do.