Health Care Facts
Let's get one thing straight. When politicians and others in the political sphere use the term "health care" these days, they're typically not talking about health care; they're talking about health insurance or some iteration thereof. The Affordable Care Act (also known as ACA or Obamacare), Medicare, and Medicaid: none of them are health care. They're methods of paying for the health care you obtain from your doctor or other medical practitioner. 
​
​Details: The ACA provides access to health care policies sold by private insurers in what is commonly called a health insurance market place; the providers of that insurance are for-profit companies. Medicare and Medicaid are health insurance programs run by the government--the federal government in the case of Medicare; a combination of federal and state governments in the case of Medicaid. Large-scale government programs are typically called single-payer systems because virtually all payments are processed and paid by a single entity, resulting in significant savings.           
There's a crucial difference between the motives of for profit companies versus government insurers. The bottom line is this: the bottom line.  Private companies have to make money; ergo,they have to charge you more than it costs them to provide the services you need. They're in competition for your business; ergo, they have to advertise to get your attention or send reps to your employer if that employer provides insurance.  All of that increases the premium you and/or your employer pay. A national health insurance plan, a la ​Medicare, which would cover all of us, has virtually none of those expenses. Operating expenses, yes; but profit, advertising, traveling field reps? No. 
Speaking of operating costs, one of the major ones for medical facilities of all stripes is billing expense. Invoices are prepared by “coders” trained in the nuances of a complex system of alpha-numeric codes that you may have seen on an alarmingly incomprehensible bill from your medical provider. The cost of preparing that bill in a system which must accommodate the demands of many different private insurers is baked into the price you're charged. Duke University Hospital, for instance, with only 900 beds,  was reported in 2016 to have 1,300 billing clerks. Also baked in is the cost of the coder wars which often ensue as those who bill for providers file claims for the most lucrative procedure they can justify and those employed by the insurers seek to deny those claims. 

In contrast, Medicare uses a simplified system for hospitalization expense, paying a fixed fee based on the patient's diagnosis. 
​In an annual publication that appears in my mailbox unsolicited, the Medicare people spell out the details of my plan in surprisingly clear English with a simple table of contents. Take a look at the current one here.   The Medicare website supplements that information, and anyone covered by Medicare can create a personalized page to track bills, payments, and their own health information on My Medicare here. All of this is not to say that Medicare is free. We pay for it, partially in advance through payroll taxes while working and partially via a premium, usually deducted from Social Security checks after retirement. See details here.  
At this point, of course, Medicare covers primarily the elderly and disabled. But here's the good news. Whenever a major new program is rolled out, the usual protocol calls for a "pilot program," a small-scale adventure to determine whether it's reasonable to expect that a larger program will work. Well, we've already run that pilot program with 50-plus years of existing Medicare for the groups mentioned above. It has been tweaked and expanded and revised in various ways, of course, but it has become a clear and user-friendly system. Sometimes government does​ get things right, and the existing program provides a well-worn path to expansion. See my opinion here.
                                                                                                                                                                                              
May 15, 2017
It was once said that the moral test of government is how it treats those who are in the dawn of life, the children; those who are in the shadows of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.

--Hubert Humphrey