(belated, because - ironically - I've been sick and am catching up on my reading list)

The thing about reform on the scale of what America's health care system needs - and I use the words "care" and "system" quite wrongly - is that it is, in fact, impossible to do.

It's too vast, too complex, too many details and vested interests and just too much. A solution that would fix everything correctly was not going to happen, because it didn't exist.

What is possible, and necessary, is to make a start. Obama managed that before he was even the Democratic nominee, because, for the first time, he somehow made the conversation be about how health care reform should happen instead of whether it should happen at all.

Currently, America spends more per capita than any other nation, to have almost a sixth of its population have no health care coverage at all - and even for those who do, the outcomes aren't better, and are often worse. That's insane, and incomprehensible to someone from a country like Australia, where universal health care is assumed as a right of citizenship. (Not even citizenship, actually - residence. Permanent residents and tourists also get health care in this country.)

But the thing is, even countries with universal health care generally didn't start out with a flawless system. What you do is start with something flawed, but well-intentioned, and then you make it better, iteratively.

Of course, one of America's biggest problems is the aversion to tax, which does seem to be a conservative thing. The American people, as a group, seem to want everything, but to pay for nothing, which in the long term, doesn't work. And they really, really seem to object to paying for anything which doesn't benefit them directly, without recognising that sometimes, the benefit applies to society as a whole, and their recompense is living in a better country.

Australia's public health care system is called Medicare. Unlike the American version, our Medicare applies to *everyone* - everyone has a Medicare number and a Medicare card, and it covers a lot of things. I recently broke my leg in three places, and I had the ER trip, x-rays, hospitalisation, surgery, assistive equipment, and outpatient treatment and services *all* provided by Medicare.

So who pays for that?

Everyone. There's a thing called a Medicare Levy, which is collected alongside taxes but isn't part of the income tax. It *is* income-based - if you're poor, you pay nothing, and if you're rich, you pay quite a bit. Because if you're rich, you can afford to, and in Australia, it is taken for granted that those who are fortunate in society should help support the less fortunate.

(After devastating floods in Queensland recently, a levy was imposed to fund the disaster relief efforts and repairs to QLD infrastructure. This levy didn't even touch you if you made less than something like $52,000 a year, and was only assessed on that portion of your income which was over that boundary. This, in Australia, is considered to be fair and reasonable.)