The debate between liberals and conservatives over healthcare is based on a difference in philosophy, and we Americans need to decide on our philosophy before we can fix healthcare. Is healthcare, like education, something Americans should be entitled to regardless of their financial situation, or is healthcare more like yacht ownership - something those who have money can avail themselves of, and those who don’t should do without?

The debate between liberals and conservatives over healthcare is based on a difference in philosophy, and we Americans need to decide on our philosophy before we can fix healthcare.  Is healthcare, like education, something Americans should be entitled to regardless of their financial situation, or is healthcare more like yacht ownership - something those who have money can avail themselves of, and those who don’t should do without?  
What confounds most people about healthcare is its high (and perpetually rising) cost.  If we, as a society, embrace the yacht analogy, the best way to keep costs down would be to repeal the Emergency Medical and Treatment Labor Act (EMTLA) of 1986.  This law requires public hospitals (those funded with public money) to treat all patients regardless of their ability to pay, and private hospitals that accept medicare to treat emergencies regardless of ability to pay.  Patients must at least be stabilized before being turned out onto the street.  Since hospitals have trouble collecting from indigent patients, those costs are borne by the rest of us through higher hospital bills.
If we, as a society, decide to embrace the education analogy, then our cobbled together system with some getting healthcare through medicare, some through medicaid, some through the V.A., some through their employment, some through privately purchased insurance and some through emergency room treatment only is very inefficient.
Since the end of World War II, 32 countries have instituted a single payer (government) healthcare system.  We are constantly told such systems are horrible with long waiting lines and poor quality care, but how many of those countries, after trying a single payer system, have repealed it and gone back to a system like we have?  None, Zero, Zip, Zilch, Nada.  It seems universal healthcare systems, while they are castigated mercilessly in our country, are loved by the people who have them.  None is perfect, but all far exceed ours in lower costs and better outcomes for more people.
The Affordable Care Act (Obamacare) was a Democratic attempt to modify a Republican plan (the Massachusetts model) to insure those who fell through the cracks between government assistance (medicaid) and private insurance.  The biggest complaint I have heard about it was that premiums were still too high (or subsidies too low).  Most people were paying in more than they were getting out.  But that is the way ALL insurance works.
How many of us, at the end of the year bemoan that we didn’t have a car accident to collect on our auto insurance, that our house didn’t burn down so we could collect on our fire insurance and that we didn’t die to collect on our life insurance?  As long as the emergency room has to take us if we have a serious problem, many who are already strapped financially, find it better to forgo health insurance and hope for the best.
We are required to have car insurance to license our vehicle; if we have a mortgage, we are required to have fire insurance, and that cost is factored into rent; we pay for medicare with taxes & monthly premium.  We seem to have accepted these involuntary payments; why not expand medicare to serve everyone and pay for it through higher payroll taxes?  With the medicare system some (those in good health with high incomes) pay in more than they get out, and some (those with lower incomes or health problems) get out more than they pay in, but that is how all insurance works.  If you paid more for health insurance than you collected, shouldn’t you be thankful?            


James Rhoades writes a column for the Neosho Daily News.