Insurance is being referred to as a question of calculated risk and this definition is being used to discredit concepts like comprehensive coverage and even the idea of access.
And yet it must be remembered that the latter is actually the key issue. For the working class and the poor, health insurance is not a question of calculated risk. This is how the upper class and some of the middle class approach the question.
For those at the bottom health 'insurance' has nothing to do with a financial decision. This is purely about access.
Without insurance you are automatically cut out from a lot of coverage. Many offices will not deal with you. Those that do, tend to treat you poorly often demanding pre-payment for services. The whole doctor-patient relationship is often affected. Some doctors put the ethical questions above the financial and treat a patient without little regard to questions of remuneration. Their numbers are few. Others embrace an almost dismissive minimalism. Their attitude is 'pay-up or get out'.
Often the uninsured end up neglecting pending problems, delaying basic treatments and end up in the Emergency Room where they're granted a temporary type-of-access but little in the way of follow-up or extended care. Debts mount because the costs are amplified when relying on the ER for what often should be primary care.
The ACA has failed on several fronts but as many have pointed out since it initially made its way through the Supreme Court, the failure to mandate a Medicaid Expansion all but killed any possibility of success. The Court's ruling opened the door to further attempts at universal coverage under the auspices of a tax but at this point it may be a generation before it's attempted again.
The elimination of the Medicaid mandate means that as of 2017 over twenty million people (perhaps closer to thirty) are still uninsured in well over a dozen states.
This adds up to billions of dollars that are not flowing into the insurance industry. In the privatised model which originated with the Heritage Foundation the only way it could work is if the mandate for coverage was truly universal.
The 'Obamacare' victory celebrated in 2012 was premature and short-sighted. The failure to bring everyone on board as well as a failure on the part of the government to rein in costs has led to an escalation in premiums for both employers as well as those purchasing policies on the marketplace.
The medical industry is also experiencing what some refer to as the Wal-Mart effect, an episode of consolidation and monopolisation. Insurance carriers are consolidating and controlling vast areas, forcing out competition and leaving very few options for consumers. Smaller hospitals and even individual and group offices are being quite literally gobbled up by large regional conglomerates.
Lower payments mean that stand-alone doctors either have to take less from a shrinking pool of patients or join up. I've seen a few just give up and retire.
This privatisation is leading to... more choices for consumers? Hardly, it's leading to oligarchical control. Instead of a state run system we're ending up with a corporate controlled system which in the end is pretty much just like the state, except operating on a for-profit basis.
And of course when it comes to health care a for-profit model means the commoditisation of people's lives and rank usury... profiting from the suffering of others and capitalising on their misfortune and grief.
And we're told this is the Christian model. This is the model supported by the politicised and apostate American Evangelical Church. We should be proud indeed.
What is the solution? There aren't solutions in this world that will bring uniform justice nor solve all problems. But it would seem that the wealthiest nation in the world could probably do better.
Instead of Sarah Palin's government death panels we will now have the real thing... panels of accountants and technocrats that decide (based on the math) whether you will have a right to access... and for many a denial of access is the equivalent of a death sentence.