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Under socialized medicine everyone is paying, according to their ability to pay measured against their need. Right wing propaganda has it that the poor riffraff no one wants in their neighborhoods will get a free ride. They won’t. They’ll pay, too. In taxes, not at the hospital.

Look – I pay $180/month for Medicare. I have a 20% deductible. So when I need a test or procedure that costs more in deductible than I can afford, I don’t get it. I’m cut out just like anyone else who has health insurance. But because our system is partially socialized I am paying less in premiums than I would for regular insurance, and (most importantly) I can’t be denied Medicare for preexisting conditions. I lived through the 2-5-year application process and I get insurance, from a private company. I go last class, though: I have to go to a county clinic where I see an underpaid doctor or a nurse practitioner (who can act as a doctor for us Medicare-only peasants). If I need anything more than a prescription or a cast or a bandage, I get referred to another doctor outside the clinic. If there is a doctor in the required specialty available who accepts Medicare. Often there isn’t, in which case my choice is to travel long distances, move, or suffer. Some procedures aren’t available to me as a Medicare patient. All care takes more time as I shuffle from doctor to doctor, and am scheduled for “interstitial” appointments: meaning the doctor will see me in-between better-paying appointments – so I get shuffled from exam room to exam room as they are vacated, seen for two or three minutes, then left in the hall to wait for the next vacant exam room, and the doctor picks-up where he left off for the next two or three minutes, and so on sometimes for over an hour or more. The level of care is abysmal.

Under a true socialized system I would probably pay about the same, but get a better level of care, because the stinking vulture insurance company would be cut out of the picture! There would be no profit motive to do things like interstitial scheduling or denial of high-cost services. Doctors would not be able to cut deals with specific insurers that give them a higher profit margin by turning away people insured by other companies (which is done to exclude Blue Cross, the main Medicare insurer in California, to try to force people to buy more expensive insurance in addition to Medicare), or by getting doctors to give people cheaper treatments even though they may not be as effective, or by teaming with pharmaceutical companies to get doctors to only prescribe one company’s drugs for certain ailments even though another company’s drug might be better, and on and on.

Over time, as the new system replaces the old one, medical costs will come down because the profit motive is gone, and because salaries for doctors and nursing personnel even-out, and because as more people pay into the system the pool of available capital increases. This has been proven over and over in other countries, and in some states, most notably Hawaii which has an exemplary system that the federal government should use as a model.

No one gets anything for free. There are no riffraff poor freeloaders getting a ride on the middle class’s back. The tax bite is distributed across a broader pool of “customers”, and while in the short-term the actual yearly cost of coverage will increase for higher income persons, in the long-term, like 10-15 years, it will be less expensive than privatized care because costs won’t increase as quickly as in a for-profit system.

Unfortunately “Obamacare” isn’t socialized medicine, it’s just a minor reshuffling of insurance regulations that will benefit the insurance companies more than anyone else. The individual mandate was demanded by their lobby to cover the potential profit loss from people putting-off buying insurance until they are actually sick because of the lack of a preexisting condition clause. If the public option hadn’t been gutted from the thing it wouldn’t have needed the individual mandate.

I dislike Obamacare as much as anyone because it won’t reduce costs, it won’t provide care to the poor (who are going to lose options due to the individual mandate), and it does nothing to eliminate the insurance companies and their profits – and that’s the main problem with our system: health care is a commodity like light bulbs or bars of soap. But it’s too important to the success of our society to be treated as a commodity. It should be a participatory right. But the Affordable Care Act of 2010 (“Obamacare’s” actual name) is slightly better than what we have, and any improvement is desperately needed.

Americans will probably never have a worthwhile health care system because we don’t have any sense of duty to our fellow citizens: they’re all just potential customers.