I received an email from a friend two days ago. She lives in a developing country. The email was short:
"Is it true that in the US companies don't have to insure their workers? And if so, what do people do?"
(Note: In the country she lives, all employees and their dependents are covered by mandatory state insurance.)
I wrote back to her and explained how the American health care system (does not) work. I asked her why she was suddenly curious. She replied that an American friend of hers had told them about this, but they couldn't really believe it. He had also explained that uninsured people went to the ER because ERs had to accept patients by law. After thinking about it, my friend decided that she must have misunderstood what she had heard. She could not believe that health care insurance would not be mandatory for workers. She decided to ask me.
I thought her very short question spoke volumes: "And if so, what do people do?"
I started complaining. "It is true. Insurance is not mandatory, even if you're employed. What do people do? Millions live without an insurance. They hope that they get a job with decent insurance (and increasingly fewer jobs offer that), not lose that job, or never get sick. They go to the ER, if they have to and they are charged ridiculous amounts for it, but at least they can get treatment. If they are horribly poor or above retirement age, they get government insurance."
She wrote back, "Why don't they just make insurance mandatory?"
I replied, "Because...oh, it's a long story. All you need to know is that some people are making tons of money off of this system. And some people are duped into believing that government regulation always means less freedom."
She responded, "What freedom? You said many people had no insurance."
At this point, I wrote a really long email explaining the conservative perspective on health care in the US, the health care crisis and the pharmaceutical/insurance/big business lobby.
She wrote to me that none of this made sense. I had managed to upset her.
I wrote my final reply, "No, it doesn't make any sense. But it's going to change."
Here's hoping.