I can think of many reasons for a single-payer health care system, but one reason in particular absolutely convinces me that anything short of universal single-payer will never deliver effective care to all or control costs.

Being on Medicaid isn't a bed of roses. It's not the bottom of the barrel, in terms of medical access--that would be NO access--but it isn't like the medical insurance the upper third of our population enjoy, either.

When an operation for Dupuytren's contracture in 2007 left my right hand even more screwed up than before (nerve damage, new involvement of all fingers, accelerated progression), I sought a few second opinions. My choices were extremely limited because Missouri's Republican-controlled legislature has seen fit in recent years to slash Medicaid and tighten the reimbursement schedule. As a result, most doctors in the state won't participate in the program.

Although I did see a couple more doctors, I never found one who could explain what went wrong in that operation or could do anything about it.

Now you might think my experience makes a good argument against a universal single-payer system, but then you would be wrong. In fact, you would be making the same idiotic leap of logic that Republicans make.

As long as Medicaid exists as an alternative single-payer system, it will always be the red-haired, bastard stepchild of health care. Same with Medicare or local federally funded clinics. Because until we are all in the same boat, Americans will always tolerate second-class health care for those considered second-class citizens.

Understanding that if I'm dead, you're dead, too, makes all the difference in demanding the highest functionality from our health care system. Health care is a basic human right. Until it's implemented with that understanding, some will always be second-class citizens. And death will be more affordable for some than for others.