Universal Health Care is a very good thing, an idea rooted in fairness and basic human rights, the idea that people should have access to decent medical care no matter their income or social standing. It’s a fundamental measure of a society, how it takes care of its people. Universal health care in the United States would transform society and possibly generate a large fiscal payback in a short time, as people with small problems see a doctor before they become big problems. I’d like to see that.

I also think it’s impossible. The wealthiest nation on earth is also the one least prepared to have the government play a role in health care. It comes down to a fairly simple chain of reasoning.

1. Health care in the United States is far more expensive than anywhere else. Remenber HMO’s? That was an attempt to reduce the overall cost of care, but in the end doctors and patients alike joined in the hate of them.
2. As much as insurance companies suck, they are the ONLY force in the United States with an interest in keeping health care costs down. They are regularly castigated and challenged for saying ‘no’. Lawsuits abound. The general public pushes constantly to limit the power of the insurance companies to say no, even to radical treatments that cost an arm and a leg and have little chance of success. Thus we have the most expensive health care in the world. It is also the best, precicely because there’s not cost/benefit analysis.
3. So if insurance companies are the only force keeping health care costs down, just imagine if the US government were in the insurance business. Even if they could hold the line on costs, there’d be a thousand lawsuits against the government active at any given moment. People who were told ‘no’ for an expensive treatment with little chance of success — but wait! That was the government saying no! Goddammit, no one in Washington is going to tell me I can’t have that buttock transplant!

Alternately, the government can require private insurance companies to insure everyone who asks for it. Still, Uncle Sam will have to pitch in for people who can’t afford a reasonable premium (I am one of those people). Once again it comes down to saying ‘no’, and insurance companies will pass the bill along rather than rack up legal costs.

Another reason universal health care works where I am now: doctors don’t drive fancy cars. They make an honest living and do all right, and they don’t (yet) get kickbacks from the pharmaceutical and medical technology corporations.

Just to be clear: I WANT every US citizen to have access to health care, me included. But it’s not going to happen until the core problem is addressed: health care in the United States costs far too much already. Someone has to learn to say no and mean it before care can be extended to everyone. Alas, the United States government really sucks at no.