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Health care in a nutshell

Thursday, August 27, 2009 by Dave Winer.

Health care is a lot like a fire department or police department. You never know when it's your house that's going to be on fire, that's why everyone pays equally for protection, and the person whose house burns gets the "benefit" if you can call having your house burn a benefit (or getting very sick). 

The main difference is that very few houses burn, but eventually everyone needs life-saving or end-of-life care. Every responsible person must pay for care, and basically only the truly rich (multi-millionaires) can afford to self-insure.  

If you assume that everyone has to pay for health insurance, then the question is how much do you want to pay. In the US, our current system costs 16% of GDP and we get less care, in some cases much less care than other rich countries that pay as little as 9% of their GDP.  

So we're making poor choices here.  

Obama's plan is less comprehensive than the German, Canadian, French or Japanese plans. In each of these other rich countries, health insurance is a non-profit business. That doesn't mean insurance companies don't make money, they do, but not from health insurance. Obama isn't promoting that (although it's not clear why).  

And for 40 million Americans they might as well live in the third world, for them health care is based on their ability to pay out of pocket. As long as they just get colds, they survive. As soon as they need more care, they either go bankrupt or become disabled, or die. This is their country too, they get a vote in how our system works. You're related to some of these people (unless you have no family). They're the ones who should be standing in anger at the town halls. And they're not all poor, many of them are middle class or upper middle class, they just happen to not be profitable for the insurance industry. These are the people whose houses burn to the ground when they catch fire. 

The people who would vote against universal health insurance are stupidly cocky, because they will all need health care some day and for many of them it will not be there. Sometimes they're people who don't smoke or aren't obese, who don't have any personal bad habits. People get sick for a lot of reasons that no one understands. Maybe just bad luck or bad genes. In the wrong place at the wrong time. 

Bottom-line, we could spend a lot less money on health care and take care of everyone. Instead we're opting on the worst approach, we spend a lot more, and a huge portion of the populace isn't cared for and the rest of us are treated not as patients but as profit centers. If you happen to need health care, you can't get it. This is some kind of way to run a country? Yikes. 

If you want to understand what our options are, I highly recommend listening to the FreshAir interview with T.R. Reid, who has just written a book on health care systems around the world.