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The World Health Organization surveys all 191 member countries for overall health outcomes. Remember, health care isn’t just “hospitals”. It includes efforts to eradicate disease, provide nutrition, and discourage bad lifestyle choices.https://www.who.int/healthinfo/paper30.pdf?ua=1It also measures average outcomes, not the outcomes expected if you get the best health care available.And France finished first in “Overall Efficiency” - best health care for money spent. Health care is universal for all residents. It’s easy to get time off for recovering from serious illnesses like cancer. In major cities, it can provide house calls. School meals are delicious and nutritious. Italy was a close second and Spain finished seventh behind a few small countries. The U.S. finished 37th ahead of Slovenia and Cuba.

Even with insurance, it’s not good. I’m a teacher. Two years ago, I wasn’t feeling well at work so I went to see the school nurse. My blood pressure was sky high, my resting pulse was well over 100 beats per minute, and my heart beat was irregular. She said I should go to the ER and that I should go by ambulance due to my condition. With insurance, the ambulance ride was $250. Without insurance, it would have been over $1k.With insurance, just to walk in the door was a $200 co-pay. I think it would have been more had I not been admitted. I spent just over 24 hours in the hospital and had 3 meals. My statement of benefits informed me how much of that my insurance covered and said I could owe the hospital up to $33k dollars for a 1-night stay. Supposedly my insurance had an annual maximum out of pocket limit of around $5k, but since they said the hospital could bill me for $33k, I don’t trust that there really is a max out of pocket limit. I guess that I should be grateful that the hospital charged me only $2,900 for occupying a bed.In addition to paying nearly $3k for a bed, I had around $1,500 charges for tests, CT scan, and the different doctors that saw me. All told, I was out nearly $5k for one night in a hospital. My cardiologist would really like me to have an ablation, but there is absolutely no way that I can afford to even think about having that done.A few months after my stay in the hospital, I woke up due to chest pain. I googled heart attack symptoms in women. Then I came to my senses. I didn’t have another $5k to spend on my health. All I could afford to do was hope that I wasn’t having a heart attack and try to go back to sleep. I can only hope that if I’m ever seriously injured in a car accident that I will be conscious and able to refuse treatment. Just drag me over to the side of the road and let me die if I’m in bad enough shape because I can’t afford emergency medical care even though I have insurance.Back when the Affordable Care Act was being debated, Republicans warned of rationed health care and death panels. I’ve got news for them. We already have that. Health care in this country is rationed to those who can afford to pay for it. And for middle class people like me who believe in paying what we owe, we’ll end up having to choose to die because we can’t afford the health care cost of living when things go seriously wrong.

Trump’s supporters, and Republicans more generally, believe that health care is a zero sum game. They believe that if more poor people are getting health care, then Trump’s supporters are going to get less health care. They blame Obama, Democrats, liberals, and poor people for their increasing health care premiums.They are partially correct. The supply of doctors in America is limited. The American Medical Association is primarily responsible for that. But Obamacare didn’t include any new medical schools and it didn’t double the sizes of existing medical schools.Health care costs are going up everywhere. They were going up in the US before Obamacare. They are going up in other countries that have universal health care, although they are rising from lower per capita levels than in the US. Obamacare is part of the solution, but only a part.It’s magical thinking to believe that all your problems will vanish if you just make someone else worse off. This is very popular among Trump’s supporters. Repealing Obamacare after years of adjustment to it by health insurance companies, doctors, nurses, hospitals, pharmaceutical companies, and medical device manufacturers would create chaos. Chaos might make Trump better off. But chaos will not make you better off.