In everyday talk about financing health care, such words as" insurance," "coverage," "choice,"" competition," and "plans" are solidly entrenched as synonyms for "health care." Such word usage is highly misleading.

The words have a powerful "All-American" appeal, generating visions of individualism; privacy; market magic; freedom from governmental interference, control, and inefficiency; and individual deal cutting with" Big Insurance." None of these visions is realistic.

Big Insurance can specify in a policy any of these illusions for a price—but only as their risk statisticians (actuaries) will let them. These "insurers" love their nonsystem. Even so, Big Insurance knows it can't outwit sickness and disability, so it minimizes its risk. Thus, a private-market policy will cover only what it says it will. To insurers, sickness and medical disability is a business loss, reducing profit. Profit is the lifeblood of Big Insurance, so health insurance can never be universal—there is too much risk out there

Sickness and medical disability, however, take place without regard to insurance "coverage." That's why we get so frustrated and angry when our policies don't provide what we need, and many individuals are underinsured.

Health care is a service—highly personal—and can never be completely covered by our current system. It is not a collection of" widgets." And it is very expensive. Families can be ruined financially. All of this we know, and we see it all every day. Yet, we continue the private market idolatry.

We need a new and true choice, not chosen by Big Insurance and not paid by it. We need a system in which we essentially insure ourselves—that is, an American system, like Medicare for all. It should be a single-payer (U.S. government), universal-care system paid for by a special tax, administered by the secretary of Health and Human Services, and negotiated with providers each year.

The new system would not change anyone's choices. It, like Medicare, would be a choice, a true choice, and Big Insurance could compete but no longer be artificially protected from the market.

This new voluntary system would soon gather the most patrons because it would be an infinitely better buy. The savings could go to reduce the special tax.