Ask most people that question and you’ll get a clear answer. It will be a quick “Yes” or “No.”
But two comments from respected observers make me wonder. I think you’ll wonder, too.
The first is from Phil Moeller, an astute reporter and business editor best known for his book “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs.”
In a November post, “What Is Insurance, Anyway?” Moeller made this stunning statement:
“What is news is that American health insurance is not really insurance. It is a program that legally sanctions the extraction of money from government and patients to subsidize providers. Nearly everyone feeds at its trough and it’s bankrupting the country.”
Behold the emperor, naked for all to see!
We know it is bankrupting citizens. Medical bills have been the dominant cause of personal bankruptcies for half a century. About a half million Americans file for personal bankruptcy each year because of medical bills. This doesn’t happen in any other industrialized nation.
We also know that it’s bankrupting our government. Health care expenses continue to rise faster than our economy is growing. This contributes to the ever-mounting federal deficits.
At the same time, none of us is truly insured. To understand why, consider this interchange between the late Supreme Court Justice Sandra Day O’Connor and economist Larry Kotlikoff, as he reported on Substack. (Kotlikoff met her at a conference in Washington where her topic was health care. His topic was tax reform.)
Kotlikoff: “Justice O’Connor, it’s an honor to meet you. I appreciate and agree with your comments. But may I ask you a personal question. Is a member of your family uninsured?”
O’Connor: “Yes, my grandson. He has a pre-existing condition. As a result, my son cannot purchase health insurance for his family.”
Kotlikoff: “I understand. That means you are uninsured. Am I right?”
O’Connor: “Yes, I don’t have health insurance. Of course, my husband and I are covered. But we’re responsible for my son and his entire family, especially for major costs.”
Kotlikoff: “I thought this likely. We’re all uninsured. But most people don’t realize it.”
The most recent statistics show that 92 percent of all Americans had health insurance for some, or all, of 2024. Chances are a large majority of those reading this have a health insurance policy that covers them and, perhaps, their immediate family.
But if anyone you care about is uninsured, you have an ugly choice to make. You can ignore them. Or you can volunteer to pay their bills. In effect, you are uninsured.
It would be easy, here, to simply note that 92 percent is a very high percentage and move on. But that figure was for 2024. Next year, 2026, is looking like it will be very different as the end of subsidies for the Affordable Care Act policies drives millions off their insurance.
Beyond that, being nominally insured and getting actual care aren’t the same thing. According to a Commonwealth Fund study, many of those with insurance are underinsured because they can’t afford to get the treatment or buy the prescriptions they need.
The solution, at least for Sandra Day O’Connor, was a single payer policy, Medicare-for-All.
Is our country ready for that? Are you? Let me know.
My personal take on this is that we may not be ready today. But every passing day exhausts the patience and understanding of more people. Meanwhile, we watch our government pretend that Americans have the best health care in the world.
Some Americans have the best health care in the world. But for most, just the management of health care is a source of stress, uncertainty and absurd experiences.
We can do better.
Related columns:
Scott Burns, “Measuring the First Wealth,” 12/7/26: https://scottburns.com/measuring-the-first-wealth/
Scott Burns, “A Heartening Experience,” 10/8/2022: https://scottburns.com/the-insanity-of-hospital-billing/
Sources and References:
Phil Moeller, “What Is Insurance, Anyway?”: https://philmoeller.substack.com/p/what-is-insurance-anyway
Larry Kotlikoff, “Justice Sandra Day O’Connor – “I’m Uninsured”: https://larrykotlikoff.substack.com/p/justice-sandra-day-oconnor-im-uninsured
The Commonwealth Fund, “The State of Health Insurance Coverage in the U.S.”: https://www.commonwealthfund.org/publications/surveys/2024/nov/state-health-insurance-coverage-us-2024-biennial-survey
This information is distributed for education purposes, and it is not to be construed as an offer, solicitation, recommendation, or endorsement of any particular security, product, or service.
Photo: Scott Burns, 12/7/22, Balancing Act: A woman balancing on a cable over Lady Bird Lake in Austin.
(c) Scott Burns, 2025
My concern with government health care for all is the government seem to allow cost to run out of sight and to withhold things on an almost arbitrary basis. But I believe our system now is unaffordable for our country.
Medicare for all is the only rational answer, and a review of the history of Canadian experience in the 1960’s is all the study you need. I practiced medicine in Canada until 1979. Physicians never had to think about whether they could provide appropriate care. An initial plan to have the payment administered by numerous insurance companies resulted in increased cost and complicated bureaucracy. With Medicare for all we can start to control the outrageous cost with poor outcomes of the present chaos. I had an uninsured young lady go blind because I failed to convince facilities to give care even though the physician agreed to see her at no charge. What a terrible cruel society we live in.
Thanks for those observations. Let’s hope we can move toward a kinder, gentler society.
We have a system in which no one has an incentive to control costs and it is not “insurance.” Real insurance is about getting needed financial help for something major, such as surgery or chemotherapy. It shouldn’t be used for routine care. As individuals, we should have the ability to shop around for routine visits like an annual physical with lab work, etc. Pricing needs to be transparent.
Amen.