Repeat: America does not have a health CARE system. What we have is a health INSURANCE system. They are not the same thing. The first question we ask anyone who walks in the health system’s door isn’t “How can we fix you?”, it’s “How’re you gonna pay for this?” That’s deplorable. It’s disgusting. We are the only civilized country on earth where that happens. Correction — because that happens here? There is no way we can claim to be “civilized”. Civilized people don’t put profit incentive at the core of their health CARE system

It’s a testament to how thoroughly the insurance companies have bamboozled Americans that most Americans don’t even realize what they’re fighting for when they insist they want to keep the health insurance they have no matter what. Insurance companies don’t provide health care. They provide “GATEKEEPING” services. That’s it. Their job is to stand between us and our health care providers, deciding whether to let us see them or not. A “good health insurance plan” will let us see the health care providers we want — provided they’re “in-network”. A crap plan doesn’t cover anything so why bother figuring out which doctors you like; you aren’t seeing them regardless.

The health insurance companies — like for profit hospitals — are not in the business of curing patients so much as they are in the business of charging them maximum dollars for minimum services. For profit health insurance companies LOSE money every time they have to pay for an insured’s medical expenses. In their ideal world, everyone’s paranoid about their health — paying in — but incredibly healthy — requiring no paying out. Keep in mind, a publicly traded company has a fiduciary responsibility to their shareholders, not to any “patients”. Patients (that cost money) and profits are mutually exclusive propositions.

That’s why Americans have to worry every time they get sick even IF they have decent insurance. The insurance might not cover what they need — and they won’t know about it or know how desperately they need it until it’s already happening. And that’s IF they have insurance. Without the insurance, they’d be completely at the system’s mercy — and our health insurance system has zero mercy.

How the hell did we get into this mess? To a degree, it started during WW Two. In order to direct as much money as possible to the war effort, we made it verboten for big companies to give good employees raises or to raise the salary being paid to new, skilled hires. Big companies still wanted to incentivize their best employees to stay or to motivate new, quality employees to hire on, so they started offering “hospital insurance”. The new hires seemed to like it.

In time, the war ended. So did the moratorium on raises. But, the employer-provided health insurance didn’t end. In fact, it became the “state of the art”. Though the logic behind employers providing their employees health INSURANCE (not the actual care) no longer held, the idea flourished. That was the beginning of our national health care nightmare.

While more big, medium and (now) smaller companies were forced to offer health INSURANCE to their employees, they didn’t have the ability or desire to administer the policies and their implementation. They turned to the newly burgeoning “health insurance business” to do that. The insurance companies, once empowered, were not going to give up that power easily — because that power (to decide what they’d pay for and what they wouldn’t) was the source of their money. The unions — as they should have — took full advantage of their negotiating power to carve out the best health insurance plans with the most coverage for the least out of pocket for their members. Of course they don’t want to lose that!

But even so — what the unions have isn’t the health CARE, it’s the commitment of the insurance company to cover more care. To be a “good gatekeeper” instead of a “mean one”. That is, after all, what insurance companies are: GATEKEEPERS — standing BETWEEN Americans and their actual health CARE. The reason some Americans got angry about Obamacare is because their gatekeepers refused to play along — and deliberately kept Americans from the health care providers they preferred.

I’ve joked here about the kind of health “care” coverage Republicans would create if they were honest about their intentions. I called it “TrumpCare Pick-An-Organ” because the concept was why insure organs that might never go bad on you? Why not gamble a little and save some money. You’ve got two lungs, two kidneys, two kinds of intestines — who needs it all? More to the point, who needs to waste money insuring it all? Why, nobody, of course! It went something like this…

One of the problems Americans have with paying taxes is that we see all that money as wasted — like it was deliberately shoveled down a black hole. Throw waste atop that and the whole idea of paying taxes feels like theft. But, what if every citizen was given an itemized statement every year that showed to the penny where THEIR tax dollars went, what they were spent on and what they bought FOR that taxpayer.

We’d see clearly where our money was being wasted, for sure! But we also could point to things that our tax dollars bought for us — that we wanted — that our tax dollars could provide far more economically than via the private sector? Health CARE, for instance… Every other civilized country on earth does this more cheaply than we do and with far better outcomes.

That’s because socialized medicine is better medicine. Yes, profit incentive creates an environment conducive to innovation. One could get rich. But, in the health care environment, getting rich is counter productive. The need for profits and the need for good patient outcomes are not natural allies. In our insurance-based system, the profits always win out. The people almost always lose.

Or end up with medical bills that, ultimately, will kill them.

Universal single payer is the only answer. Personally, I’m with Bernie Sanders here — to keep the health insurance companies around is to invite abuse and just more stratification of services. Money will attract those more interested in greed than health care. The promise of health care is merely the bait in the “bait and switch”.