America’s Affordable Care Act (ACA, otherwise known as ‘Obamacare’) is supposed to provide insurance to those who previously couldn’t afford it and to those who couldn’t qualify. In order to achieve these goals, the Act requires every American to sign-up for insurance. It’s those payments from healthy young people who are not likely to need access to health care for years which will enable the insurance industry to offer reasonably priced insurance to those who require frequent or expensive access.

But insurance industry executives will tell you insurance is not bought, it’s sold. This means that the millions of Americans who are not inclined to pay a couple of thousand dollars a year for an insurance product they don’t see a need for, won’t. Yes, the Act imposes a penalty for not signing up but the penalty is often less than the cost.

Just as in Canada, a small percentage of American citizens consume a disproportionate amount of the country’s health care expenditures. Some studies suggest one per cent consumes 30 per cent, and five per cent consume up to 60 per cent. This means that a huge number of otherwise healthy people have to subsidize the few. People will not do this happily any more than they will endorse an increase in their tax bill for such a purpose.

Now let’s get to the really ugly bits. In more than 50 per cent of the United States, people will only be able to buy insurance from a single provider or from one of two providers. Premiums will undoubtedly reflect that uncompetitive market. Moreover, as it becomes apparent to insurance companies that many young folks are electing to pay the no-insurance penalty rather than an expensive premium, the inherent subsidy transfer to the heavy policy users will not occur, requiring premiums to go up.

Then wait till the prospective patient finds out they can’t use the doctor or hospital of their choice because their insurance company has done a deal with a facility 200 miles away from the one in their community.

As for the temporary respite offered up by the president (that you can keep your current plan), that’s a maybe dependent on the willingness of your insurance provider. In any case, that provision is only active for a year. The Act will then require you to buy coverage for stuff you probably don’t want, at a cost you definitely don’t want.

Let’s add this up: we have voters who are mad they have to buy coverage they don’t want, others who are mad at having to pay a penalty for not buying any coverage, others who comply but are mad at the extent of the cost versus their current situation, and others who are not going to like to be told where they can access care. That doesn’t sound like a pretty political picture to me because the size of those constituencies is many times larger than those folks who will be happy that they now have coverage.

Still, one cannot argue with the principle of universal access. It has been enshrined in Canada for a long time and almost no one in this country would argue against it. The question is, how do you get there? The ACA has done a very poor job in bringing government and the private sector together to provide better access for all Americans, to control health care costs and create a more efficient system, one capable of better outcomes at lower cost. While it will be fun to watch the American politicians blaming each other and wrestling with repairs to a poorly constructed initiative, we need to focus in this country on figuring out our own fix.

Our state-run system is not working either and we desperately need to get on with the job of acknowledging that so we can begin to fix it. There is no joy in the misery or problems of others, but lots of lessons. Let’s look at the good and bad in other systems around the world. Forget the senate and all that related foolishness, let’s focus on something important, something which can and should meaningfully improve our health care system, and in so doing make Canada an even better place to live.