It has been interesting to observe how much TV airtime in 2007 and 2008 has been devoted to the concept of universal health insurance as the various presidential candidates jockey for your vote. There is no doubt that it is vital to have everyone covered by some sort of insurance for health care. However, universal coverage will not make the cost of healthcare cheaper for our society. It will probably be more expensive - maybe much more expensive.

How can I say that? Well, consider what insurance is on a very simplistic level.
1. Everyone tosses money into a pot in exchange for the right to draw from the pot to make payments for care.
2. Care is provided by medical professionals and facilities in exchange for payment from the pot.
3. A keeper of the pot manages the records and disburses the money from the pot.

If the group collectively (our insured society) is no more or less healthy than it has been in the past, there are only three reasons for the amount paid out of the pot to go up:
1. Medical professionals and facilities might demand more for the same work.
2. Medical breakthroughs might make it possible to treat more diseases or injuries so more work might be done by medical professionals and facilities resulting in more charges.
3. The keeper of the pot might demand more for the same work and/or might have to do more work in response to factor 2.

When any or all of these events occur, more money must be tossed into the pot to make up for the greater amount being taken out. At the simplest level, this is "medical inflation" and we have experienced it virtually every year.

So, if universal coverage is provided, it may actually cost us more collectively. Notice that I have not yet taken account of the persons who are presently uninsured. Putting them into the insured pool will make more outflow necessary - and therefore more inflow to the pot will be necessary -- or so it would seem.

In fact, it is not known how much more providing coverage to the uninsured will cost. At present, uninsured people receive some substantial amount of emergency care from hospitals and clinics free of charge. If they don't pay for the care they receive, who does? We all do because the hospitals and clinics must increase the price they charge to those who CAN pay to cover the care provided to those who cannot pay. The same is true to a lesser extent for medical professionals and pharmaceutical companies. Where the cost WILL increase is in the care that will be provided to low income persons that they previously did not receive.

For example, if you have no insurance and awaken with a sore throat, you might "tough it out" instead of seeking care. It is not right that anyone should need to tough it out; they should be able to get care. It is the cost of this "new" care that defies estimation.

So, the overall cost to our society will go up by an unknown amount and we will all collectively pay the increased cost.

What has not been extensively discussed is the expected delay in receiving needed care. With the stroke of a pen, universal health care can be instituted. But, who will provide the care? More doctors and nurses cannot be similarly created by the stroke of a pen. It will take years to ramp up the educational institutions to turn out more medical professionals. In the meantime, the existing group is going to need to provide the higher amount of care. That means that some sort of triage system will be needed to ensure that the sickest and most treatable will be taken to the front of the line while those who CAN wait will be MADE to wait.

So, what should you do? If you can, get insured now and begin to establish a relationship with doctors (especially) and hospitals so that when the crunch comes you will have some claim for preferential treatment as a "regular customer". If you have pre-existing conditions that prevent your being insured presently, or if you simply cannot afford to buy insurance now, make your needs known. Get involved in the political process so that the lawmakers know what they need to do. Most of them have a fabulous medical insurance program and have no concept of what others may experience. Tell them. Don't make them rely of lobbyists (who have their own agenda) to get the information they need. Write letters or e-mails. And, show up at meetings.

We can do this.