One of the big topics related to the government right now is the ongoing debate over “health care.” Specifically, allowing the Affordable Care Act subsidies to expire, finding a better way to pay for health care, and blaming the other side for the mess we’re in (well, that last is pretty standard for every issue at the federal level). As a person who tries to use words precisely, to best communicate my thoughts to you, I cringe every time a politician or pundit says “health care,” because that’s never what they mean.

Health care is when I go to the doctor and say “this hurts.” The doctor checks me out, diagnoses what is causing the hurt, and treats it (or tells me what to do) so that it stops hurting. That’s health care. And in that respect, health care in the United States is great. We have excellent doctors and nurses and physician assistants and therapists and… a whole slew of people who do remarkable things to make us feel better and keep us healthy, along with the equipment and medications and more. And none of that is what they mean when the politicians and reporters talk about health care.

No, what they’re talking about is “health insurance”: a system of paying for the health care we get that keeps us going. And health insurance in the United States is a disaster, falling apart and falling fast. And none of the tweaks they keep proposing at each other are going to fix the health insurance industry, because we’ve been misusing it and expecting far more from it than it can ever possibly provide.

The thing is, health insurance isn’t some unending pool of money which pays for our every smallest medical need. Health insurance—indeed, any form of “insurance” (except the half-wager when you’re playing blackjack and the dealer has an ace showing)—is a collection of people betting on something they hope won’t happen.

Start with something slightly less controversial: car insurance. You pay a small amount every year to someone managing the money (the insurance company), against the (hopefully very small) chance of being in a crash and requiring a lot of money to repair your car (or one your actions damaged). This only works if there are a lot of people paying in for this insurance and very few of them actually get in crashes requiring large pay outs. In the ideal world, if you had enough money to cover those potential expenses, you wouldn’t bother buying insurance; you’d just pay the repair/replacement costs yourself if you ever needed to (I’m ignoring your responsibility for the other guy’s car, and why states require car insurance). What this all means is that most people pay for car insurance and don’t ever get any money from it, because the entire group of people is funding the expenses of the one or two people who will wind up actually needing it. It only works because relatively few people need it, and no one knows if they are going to be that one person who does. So everybody pays a little, and most never get anything but peace of mind from it.

Health insurance is similar to car insurance. At least, it used to be. You would pay a small amount every year against the (statistically) small chance of having a catastrophic illness or injury that would be very expensive to treat. And the few people who did have such needs would have their expenses paid for by the insurance company (again, in an ideal world), while everyone else in the insurance pool would wipe the sweat from their brows and say “I’m glad I wasn’t the one who needed the money.”

But health care has evolved. Most people used to only see a doctor when they had a major injury or illness. As we’ve developed more of the concept of wellness care, more and more of us go for regular check-ups, low-level medical treatments to prevent (or earlier detect) major problems, and so forth.

And while these are (theoretically) inexpensive health care events, we now expect “insurance” to pay for them all. (Admittedly, the costs of those inexpensive events have been rising, too. And if our politicians were serious about this whole debate, that is where they would be focusing: why does it cost hundreds of dollars for a regular check-up?) But as we expect most people to have those regular check-ups and those preventative treatments, we’re over-stressing the ability of health insurance to cover the catastrophic costs it was designed for. That’s not a fault of insurance; it isn’t a money-multiplier. Way back when, if everyone paid $100 a month for insurance, it was against the fear that one person in a hundred would have a medical problem this year that might cost $100,000 to treat. At those numbers, the insurance pool was sufficient.

But today, we’ve gotten to the stage where, instead of everyone paying in against the rare major need, everyone is paying in their $100 a month… and everyone is expecting insurance to pay the doctor $400 for our “see me in six months” regular check-ups, and we’re expecting insurance to pay for the $25-a-month prescription medicine, and suddenly there’s no money in the insurance pool for the $5,000 the emergency room is going to charge to treat your broken leg, and that $100,000 expense will be enough to bankrupt the insurance company.

The failure is that we’ve spent a couple of generations teaching people that medical treatment is health care, and it’s not just for emergencies, but that everyone should seek it out continually as a preventative. Medically, that’s a good thing. But financially, it may be ruinous. Our methods of paying for it have not kept up.

The recently signed discharge petition means the House of Representatives is going to vote on an extension of the Affordable Care Act subsidies sometime in January. Even if it passes, it’s not going to fix anything, because the entire concept of health insurance is broken. I readily admit that I don’t have the solution, either. But someone smarter than all of us is going to have to figure it out. Because if it’s something we expect most people to use, then the only way to pay for it is individually. And the costs have risen so far so fast that most people simply can not afford to pay for it.

The president’s proposed fix—“we’ll just give everyone $2,000, rather than paying the insurance companies”—is naive at best. Where is the government getting the money to give everyone $2,000? The same place the government gets all its money: from the people. It’s a non-starter.

Indeed, the whole debate has become the Second Law of Thermodynamics for finance: if everyone is paying for insurance, but everyone expects to use it, then insurance is nothing more than a drain on everyone’s wallet.

Blackjack table image by Frerk Meyer, shared under Creative Commons Attribution-Share Alike 2.0. https://upload.wikimedia.org/wikipedia/commons/thumb/7/7e/Blurry_blackjack_table.jpg/640px-Blurry_blackjack_table.jpg