American politics are so polarized at the moment around the issue of health care that it’s hard to envision a favourable outcome.  I would define a favourable outcome as a more cost-efficient system that guarantees coverage for all American citizens and provides non-elective treatment for free — or, at least, on a co-pay basis that is tied to personal income.

These issues do not affect most of my friends in the Unites States, frankly, because they are what would be considered to be high middle-class income earners in stable careers and working at large companies that provide family coverage as a benefit.  It is also true, though, that those friends — should they elect to leave their cushy jobs and form a startup, or move into consulting — will incur risk that they or their families could go without coverage.

This is one of those quixotic situations that often arise when there is no basic guarantee in a society.  Even the upper middle class must consider career and life decisions within the context of health care.  Leaving the warm embrace of your employer to pursue some new innovation is a tough decision, for more reasons than there should be, as a result.  So many employers view their health care packages as an employee retention tool and are not motivated to alter this.  COBRA does nothing to protect workers who leave their positions voluntarily, after all.

Regardless, lower-income families are under pressure in the US.  I posted this in response to a friend on Facebook:

… which is largely rhetoric but is probably true.  How can people who are repressed by the system (limited education, limited time) participate in the debate about restructuring that system?  With 40% voter turnout in recent US elections, we can see this actually impacting the functioning of a democracy in a real way.  The US is presently governed by an elite — much like China, and much like the Soviet Union.  And like modern-day Russia, the multi-billion dollar federal electoral process is now “democracy theatre” as the appearance of leadership is contested by two groups:  one which I will call the compassionate elites, and the other comprised of a group I can only describe as diffident elites.

In any case, and as I said above, the outcome of the US Health Care debate will reveal a lot more about which Elitist group holds sway over the other; or put more succinctly, which of the two groups of Elites is better able to hold in check the corporate interests the finance their electoral campaigns while simultaneously establishing some sort of remedy for the country’s desperately ill system.  The process will enjoy neither the participation from, or support of, the very lower-middle-class and poor majority that the system should benefit the most.

They are too busy trying to survive.