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Talk to Me Like I'm 4: Why Our Health Care System Failed Us and How We Can Fix It

The United States' health care system is like a patchwork quilt that we keep trying to mend when, really, we need a new one.

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That will not come from measures that try to increase competition in the private health care markets, not even from opening a federal insurance system such as the Federal Employee Benefit Program to all comers. The Canadian and British systems are not cheaper to run because the government can out-compete private firms; they are cheaper because they are run under one vast budgetary system. This is the one-purse model of health care financing, and it works to contain costs in ways that health care competition will not.

Now, the Obama administration as the Keeper of the Quilt may not want a single-payer system. Those of us who are quite comfortable under our good corners of the quilt might fear that such drastic remaking of the quilt would leave us less well covered. And perhaps the United States sleeps better under the current system of rationing care by consumers' ability to pay for it than under alternative systems of rationing, such as treatment protocols, triage and the use of waiting times for non-emergency care. Perhaps.

But one day, soon, the American patchwork quilt of health care will become unaffordable if we all we do is sew patches upon patches for greater access without any tightening of the societal purse strings. The time is now ripe to sew a new quilt.

J. Goodrich is an economist. Her writing has been published in the American Prospect, Ms. Magazine and on various political Web sites. She also blogs at Echidne of the Snakes.