It is absurd to want or expect the U.S. Government to just give comprehensive health coverage to all of its citizens. It would be unbelievably hard on our pocketbooks, place an even greater distance between competition and quality of care, and further entrench the already deep-seated problems of a badly flawed system. There. I said it.

Don’t get me wrong. If somebody has a serious injury or illness and can’t afford the medical care for it, it is imperative that they receive aid in the form of universal health insurance. There is no excuse for a nation of our wealth and human rights record to leave its unfortunate citizens in the cold in these situations. Many people believe this, and I am one of them.

These two positions are not irreconcilable. However they may seem to be, you have to step back and look at the whole picture.

Pretend you’re Alexander the Great, staring down the Gordian Knot. (Some people read comics. Some people listen to Iron Maiden. I do both.) You’ve ridden into town and you find a cart tied to a post. You’re told you have to remove the cart in order to receive the kingdom of Asia, but the ropes are so densely knotted that no previous visitor to Gordium has been able to figure it out.

Health insurance is the rope—the realm in which the problem takes place, where all the parameters are set. The logistical problems with the current health legislation make up the knot. The problem is only insoluble if you allow the knot to dictate what you can and cannot do in your problem-solving, when it’s really the parameters that dictate the problem and not the other way around. Forget that you’re looking at a knot. Remember that you’re looking at a rope.

Universal health coverage, as it is currently on the table, has a number of obvious obstacles. Our current idea of health insurance covers everything medically related, in whole or in part. To give this to everyone would be unmanageable at today’s prices, without some serious bending over on tax day. If we can’t do anything about that, then maybe we can reframe health insurance itself in a way that will bypass the obstacles.

We could start by reexamining the idea of total coverage, which is where a massive amount of revenue in the current system goes. If all things medical are handled through insurance companies, then everything is controlled by enormous, overarching bureaucracies that stifle competition and obscure the true cost of the procedures and products involved. You’re basically inviting prices that climb steadily every year, in stark contrast with glacial technical advances.

What if we tossed the idea of total coverage out the window? Think of it like car insurance. For unexpected problems such as a collision with another vehicle, you’d file a claim. It doesn’t matter if you can’t cover an unforeseen auto repair bill, because there’s a safety net in place. But the regular stuff, like routine maintenance, you’d pay for yourself. With budgeting, you can plan and afford to pay for it. Filing an insurance claim would be ridiculous. Total coverage for automobiles is widely viewed as a wasteful idea.

If health insurance were more analogous with auto insurance—that is, if we generally handled routine checkups and other stuff we can plan for on our own, without interference from insurance companies—then the world of medicine would be subjected more directly to the market forces that keep prices down and advances up. The consumers would have more of a hand in their own destinies. And there would still be a safety net in place in the event of unforeseen health problems, and likely a much less expensive one. If anyone is having trouble budgeting for their routine health care, they can apply for government vouchers. For a much better overview of this argument, I recommend reading this article. It’s a lengthy read, but very illuminating in comparison to the myopic ideas currently being kicked around by our legislators. (Thanks to VI on the Freak Safari Forums for the heads-up on that article, by the way.)

For anyone who doesn’t read comics or listen to Iron Maiden, Alexander removed the cart from the post by drawing his sword and cutting the rope. In bypassing the knot altogether, he laid the groundwork for centuries of needlessly erudite references that pad the word count of articles like this one.

As for the title of this entry, I had a lot of possible set-ups, some of which were painfully clever. (“Universal health care: treatment or cure?” Try that on for size.) In the end, I couldn’t settle on any of them, so I went with the least clever, most irrelevant one I could think of.