Thinking about universal health care, I'm always reminded of the Woody Allen joke in which one person says something like, "The food is just terrible here!"  And the other responds, "Yes.  And the portions are so small!"  

Do we really want to make sure everyone gets a portion of the ridiculously expensive slop currently on the menu?  Or would we rather fire the chef and shop for some fresher and more healthful ingredients?
 
Fortunately, in my life, I've been able to afford health insurance.  I say "fortunately" though only because it's comforting to know I have the ability to get treatment, if really, really need it.  Like, for example, one time I had to see a doctor because I was in agonizing pain for weeks and my foot was hanging from my ankle like a limp fish. Through magnetic resonance imaging, it was determined that I had a ruptured disk, which was useful to know. But certainly, I dread the thought of ever needing to go again.  And it's not just the illness itself that scares me.

To me, the thought of having treatment meted out by the current, profit-based system is even more horrifying than having to rely on a "government run" system - as some people seem to insist on calling it.  If it were up to me, I would call it a single payer system "patient run." We're all potential patients, after all, and share a common interest in the availability of good and necessary treatment. And if we really wanted to, we could construct a system that would, at least, have the health of the patient as its primary goal, even if it could never be completely perfect.

The point is that there seems to be an unwarranted assumption that the only major flaw in the current private insurance based health system is its lack of universality.  It seems to me, however, that the problem is much more fundamental. Moving from Woody Allen to my mother: "If you want to make really delicious soup, the first thing you have to put into the pot, is lots of good will."  But where is the good will in a health care system that's based almost entirely on the profit motive?  One the one hand, there's the cost-conscious insurance company, trying to spend as little money as possible on your treatment, and entirely uninterested in your well-being.  And on the other hand there are the hospitals and physicians, at least some of whom, may also be motivated by maximizing their own profits through surgeries, procedures and tests du jour. 

Did I really need back surgery, or would I have been better off lying flat on my back for a couple of weeks?  I still wonder, but will never really know.  And, by the way, are there really cancer drugs that are worth $50,000 a year, as I just read in a recent newspaper article.  Or are some very greedy drug companies, in effect, praying on sickness and desperation in pursuit of unjust profits?

Before we all decide to pay for something that's going to consume a good portion of our nation's resources, it seems to me that we should assume some control over what that something is and also ensure that we have some say as to how much we will or will not pay - before we are faced with no choice because of illness or injury.  The only real way we can do this is by implementing a single payer health care system that has good will, rather than the profit motive, as its first and most important ingredient.