In Washington there is much ado about health care these days. I have two problems with all the fuss.
First, the actual subject is not health care at all but health insurance. Our real problem is not with insurance, but with the unjustifiable expense of American health care. The insurance debates are smokescreens designed to make the public think Washington is trying to take our health expenses seriously. They are not.
Second, the Republican bills, one passed by the House and one proposed by the Senate, are not even health insurance bills. They are tax cuts for the wealthy and insurance cuts for the needy. There can be no moral justification for such heartless legislation.
A fundamental problem with the Republican plans, I believe, is that they betray a failure to understand what insurance is. The insurance industry provides a way to protect people from impossible medical expenses by spreading the costs over a large pool of customers. Healthy people are "overcharged" so that the insurance companies will have the income to cover the expenses of the less-healthy and make a fair profit. The Republican plans want the needy customers to pay more of their own costs, which of course denies the very purpose of insurance altogether.
One obvious implication of the nature of insurance is that the larger the pool of customers the less the cost to anyone or any subset of customers. The logic points inevitably to a single, national pool of customers.