Almost all industrialized nations share the following attributes of health care that distinguish those nations from the U.S.

1. It's universal
2. It costs less per person
3. It gives its citizens better health as judged by the standard criteria - life expectancy and infant mortality

What follows is a "child's guide" in the sense that it simplifies a complex issue, a reflection of the limits of my own familiarity with some of the subtler details.  At the same time, it captures - accurately I believe - the critical principles.  It may not guide every step of your understanding, but I don't think it will misguide you on any.

A preliminary caveat - universal, affordable, effective health care elsewhere in the industrialized world is divided between single payer systems and those utilizing public/private partnerships of the type our Congress is debating.  I don't discuss the comparative merits of either choice here, but one can find informative comparisons at the following site and links within it -  http://en.wikipedia.org/wiki/Universal_health_care 

CAN WE AFFORD UNIVERSAL HEALTH CARE?

Current estimates suggest that the cost of President Obama's proposed effort to extend health care to all Americans will cost upwards of $1 trillion.  Can we afford to pay that much? 

We are already paying it.  In fact, as comparisons with other nations imply, we should actually be able to reduce costs - by eliminating duplication, excessive charges, and excessive paperwork, and by rectifying the inadequate attention we now pay to preventive medicine.  The problem, and it is mostly a political problem, is that the anticipated one trillion will be spent in full public view, while our current costs are hidden.

WHO PAYS NOW?

Health care may be a "right" but it can't be had for free.  Doctors, nurses, technicians, and administrators must buy food and pay the rent, as must those who build hospitals or put pills in little bottles with labels on them.  Some of these individuals live well, others less so, but it would be unrealistic to assume that we can get sick, get treated, and get better with no-one paying for it.  Reducing some of these costs is a topic worth more attention than it will receive here, but eliminating them would be an illusory solution, and we must acknowledge that someone will pay.   Who pays now?

We, the health care consumers pay, in two different ways - with money and with death.

When an indigent patient comes to an ER, he or she may not be charged, but the hospital must recoup its costs.  As a result, our medical bills rise, or our health insurance premiums rise.  Often, the ER visit is delayed until the illness grows so severe (and so expensive) that further delay would be fatal.  We then pick up the tab.

If that deathly ill indigent waits too long, we may be spared that expense.  The question then becomes - who pays the undertaker?

 I hope the colloquial style of what I write here is not mistaken for frivolity.  Health care and its costs confront us with momentous political, economic, and moral demands.  Most other countries have faced up to those demands in ways we should learn from - we don't need to consider our options in a vacuum.  We do need to be honest about costs, and that honesty compels us to recognize that we, as health care consumers, are already paying costs that are enormous and growing.  In that sense, the proposed plans would not add to costs - indeed, they would reduce them to levels operating elsewhere in the civilized world.  Rather, what they would do is shift those costs - transferring them to taxpayers from, well, taxpayers.

NOT ALL TAXPAYERS ARE THE SAME

Although we pay for health care now, the distribution of costs is capricious, regressive, and often egregiously unfair.  The sickest pay more, and if medical and insurance bills are similar for most of us, they consume a larger share of income the poorer we are.  Conversely, a system that asks taxpayers to contribute to a universal health care plan in a manner that includes income taxes would begin to allocate costs more in proportion to income - progressive rather than regressive. This is probably one reason why some groups favor universal health care more than others.  We must all decide, along with our conscience, where we stand on this. 

I love this country.  I don't wish to live in any of those other places that treat their citizens to better health care than we do.  I want us to do the same as they do.

Actually, I want us to do better.  But let's start with the same.  We must walk before we can run.