American health care is unique among advanced countries in its heavy reliance on the private sector. It's also uniquely inefficient. We spend far more per person on health care than any other country, yet many Americans lack health insurance and don't receive essential care.
This week yet another report emphasized just how bad a job the American system does at providing basic health care. A study by the Robert Wood Johnson Foundation estimates that 20 million working Americans are uninsured; in Texas, which has the worst record, more than 30 percent of the adults under 65 have no insurance.
And lack of insurance leads to inadequate medical attention. Over a 12-month period, 41 percent of the uninsured were unable to see a doctor when needed because of cost; 56 percent had no personal doctor or health care provider.
Our system is desperately in need of reform. Yet it will be very hard to get useful reform, for two reasons: vested interests and ideology.
I'll have a lot more to say about vested interests and health care in future columns, but let me emphasize one key point: a lot of big companies are essentially in the business of wasting health care resources.
Bush's answer to this is, needless to say, private accounts. But no one, except the extremely rich, can save up enough money to pay for catastrophic medical expenses. The only practical, not to mention moral, way to handle this is for the whole population to share the risk. Sadly, the conservatives just don't believe in it. They'd rather see people suffer and die for lack of medical care.