The U.S. healthcare system is unique. It is the best there is, and the worst because for tens of millions of Americans it doesn't exist.
With Republicans and Democrats fighting it out for the White House, health care reform is back on the agenda and both parties are sticking to their guns. It is time for voters to decide which way they want their medicine.
Terms like 'freedom to choose,' 'individual mandate,' 'Romneycare' or 'Obamacare' are touted to liven up the debate. But neither camp dare utter the SM phrase that describes health care systems many of us have happily lived with in other parts of the world for decades.
Socialized medicine is a term few like in the U.S. While American politicians endlessly debate the merits of private and not-so-private care almost everyone else, including their closest neighbor, gets on with the business of practicing cooperative rather than competitive medicine.
But forget images of endless queues, worn out faces and the Soviet collectives from the '50s when you contemplate European or Canadian health care models.
Their systems match that in the U.S. Some cost half as much to run and nearly everyone has access to affordable, quality health care.
Governments may control, even own, much of our medical hardware and tell insurers what to do but we are not socialists, even if our medicine gives the impression we are.
We believe access to health care is a right, not a privilege. Thousands of ordinary, working Americans queuing outside an LA sports arena, marveling at the miracle of 'free' health care being provided by a philanthropic organization, would probably agree.
We also believe the healthy should subsidize the ill, and the young the old while they can. We find it disturbing that someone who is dying could be denied care because they are not insured, or that their home could be taken from them because they cannot pay their medical bills.
America has talked socialized medicine for decades but that's as far as it went. It threatens the American principle of freedom of choice, a mantra the GOP likes to claim as its own but it is one few really disagree with.
Freedom to do has inspired the entrepreneurial spirit that has made the U.S. a world leader in so many fields.
But it makes for difficult health care planning when money is limited and freedom to choose is not.
After years of trying to make their largely private system work, with deeper pockets and an incessant flow of new treatments constantly driving the agenda, more and more ordinary Americans are beginning to see beyond the hype and realize it will not work for them.
They know because they are at the receiving end of its worst excesses -- deductibles they can't pay, jobs they can't leave, premiums they can't afford, co-payments which can be ruinous, pre-existing conditions that render you persona-non grata and illnesses that go untreated because you have no cover.
The cost of health care keeps on rising because money and profit, not need is setting the agenda. The pace is set by the private sector which drags costs in the public one as they are inextricably linked.
And yet well insured libertarians or politicians keep drumming the same message home: "Stick to your principles and don't touch socialized medicine. It sucks."
Whose freedom and interests are they really trying to protect? Is it the American family on a moderate wage and nice job that could disappear along with their health insurance and lifestyle in the morning? Is it the struggling one above the Medicaid threshold that is at the mercy of insurers happy to squeeze as much as they can? Or the stretched business that can ill afford employee insurance costs which keeps rocketing each year? Is it the uninsured, the uninsurable or the indebted insured for whom private insurance was never really meant in the first place?
The U.S. healthcare system fails many for whom it is supposed to work because it is designed around the needs of providers, not patients. This has been the case for decades.
The real winners in American health care are the insurers which rake in tens of billions in profits, medical device and drug companies which sell more and charge more for their products and for-profit organizations which make their own agenda.
There are marketing companies, administrators to check, agree or contest a claim, lawyers, lobbyists, advertisers, advisers and a plethora of hangers on whose reach extends to the corridors of power. There is little central control. Why change a health care system when there is nearly three trillion dollars to play with?
Obamacare goes some way towards remedying the situation and is a step in the right direction. It acknowledges flaws in the system and the strain it imposes on individuals and families. Romneycare, surprisingly given the Republican candidate's insightful approach to health care in Massachusetts, now sings from the more traditional hymn sheet and threatens to undo much of what has being done, leaving individuals at the mercy of insurers for years to come.
Neither unfortunately really addresses the elephant in the room -- the rising cost of medical care -- but that is for another day. What is important now is for America to decide which direction it want its health care system to go.
Socialized medicine does work -- most countries combine it with nonprofit insurance schemes and minimal for-profit input -- but it is not necessarily the answer to a particular American problem.
For most voters the choice is straightforward. Do you want the 'freedom' to choose a health care package you maybe can't afford? Or do you want a guaranteed one you can, even if your choice is limited?
'Freedom', like health care, comes at a price. The question is which can you do without.