Except for the truly fortunate, health care is an unavoidable financial burden. Few can pay out of pocket. Insurance is necessary, yet unaffordable for most. Deductibles bring one closer to affordability, but without desired coverage. The entire issue is a straight-out gamble where the house is the insurance company, and the house, as they say, never loses. Patients hate the system. Health care providers hate the system. The only way to best the system is to stay healthy or suffer catastrophic illness. Once, you could just take your chances and bet that you’d never need insurance because you would never get seriously sick. Now, with Obamacare, a. k. a. ACA, you can’t even opt out. You must be insured.

Funny how insurers somehow came out the political winner and Obama’s original goal of universal health care became mandatory private insurance coverage. So much for the merits of bipartisan compromise.

The ACA does provide opportunity for a safety net expansion of Medicaid, but here it’s states that can opt out, taking an ideological stand on the backs of those least able to provide for their health needs, defeating Obama’s legacy being more important than caring for citizenry.

Fundamental health care should be something no one should be denied because of an inability to pay. It’s a simple matter of whether we are indeed a compassionate society, a great Dirigo state within a great nation.

MaineCare expansion should go forward. People shouldn’t go without health care, even if they want to. Putting off preventive care, or necessary timely care, benefits no one and contributes to escalating costs for everyone. We know this, but, divided by politics and economic circumstance, we continue to ignore it. A near majority of Mainers reelected a governor openly opposed to such necessary health provision, while others continue to press for what they see as a progressive “human right” issue. Though that is a far more compassionate ideology, its sanctimonious branding might alienate those less compassionate, those that may otherwise be convinced by purely economic motivation.

Ironically, necessary successful expansion of MaineCare, furthering ACA coverage goals, may ultimately be at cross purposes with achieving real affordable care for all Mainers, top to bottom.

The trouble with Obamacare is that it is better than what was, but its compromised realization hasn’t removed the for-profit profiteering that prevents both optimum care and truly affordable cost for everyone. An ACA that expands coverage, access and affordability, but still keeps health care costs costly, and inequitable, is a better than nothing disappointing missed opportunity.

Hawaii’s unique state regulated private insurance system is capped as to charges. No one in Hawaii pays more than 1.5 percent of their wages for comprehensive medical coverage. Employers make up any short fall in premium costs, but not more than 5 percent of their business income. Hawaii has the second lowest uninsured population, exceptional low cost of delivery, and the highest level of wellness. Unfortunately, the ACA, which Hawaiians can utilize selectively, was modeled on Massachusetts’ insurance-industry-friendly RomneyCare.

More progressive than either would be to go to a single-payer system, where everyone’s inclusion takes advantage of a truly maximized insurance pool, lowering cost overall. All businesses would benefit, instead of just the insurance industry.

That ain’t going to happen until enough people want to throw in with everyone else, and enough people aren’t going to throw in until they realize that the status quo is a common enemy, dividing and conquering, set on maintaining a system that serves all poorly.

MaineCare, Medicare, government and municipal worker insurance plans, military and veteran entitlements, self-insured plans, and a very flawed ACA still fail to insure everyone, and no one really gets a great deal anyway. The possibility of true fairness under a single-payer system, and true affordabilty for all, just isn’t going to happen unless we stop holding out for perceived self benefit, abandon competing health care scenarios, pool communal resources and cover everyone the same.

The ACA is “ Obamacare” in Republican contrived name only. Real Obama care was to be far closer to a single-payer system.

Vermont is nearly there. Even Hawaii is heading in that direction. Single- payer creates an affordable system equitable to all. Those over 65 almost have such a system now, called Medicare. Single payer is sometimes called “Medicare for All.”

Despite ACA’s significant improvements, our medical delivery system is still broke. Costs keep skyrocketing by market forces favorable to private health and insurance providers. Rather than tinkering with redistributing ways to meet excessive costs, costs need to be managed through a system principally serving the patient.

We need to stop treating the symptoms of medicine’s economic malady and cover everyone the same, as if everyone just turned 65. Some might not like to hear it, but Medicare is indeed socialized medicine, and it works extremely well. Keep repeating those words until its reality, spoken aloud, is finally politically acceptable to all.

We have no issue with communally providing for our fire and police services, or for our “public” education. Why do we have such a problem with embracing public provision of our health services?

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Gary Anderson lives in Bath.

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