Our health care debate is more boring than America's - thank goodness

With Barack Obama finally passing his wide-reaching health care plan through the House of Representatives yesterday, and our own leaders having their televised squabble at the National Press Club today, health care hasn't been the subject of this much media attention since Dr Jayant Patel's last rampage.

I've long been baffled by how bad America's health care system is – it's a prime example of that nation's love of doublethink, which allows millions of people to believe that their health care is the best in the world even though they can't afford to see a doctor. And yet, as we heard yesterday, health care makes up around 20% of the American economy. All I can assume that somewhere, private health providers are getting seriously rich.

Extending coverage to two-thirds of the 45 million uninsured Americans – not to mention all the uninsured illegal migrants who, by political convention, simply don't exist – has proven extraordinarily divisive. The idea that health care should be made more widely available didn't win a single Republican vote yesterday. It's been simultaneously described as fascist and communist by rabid Tea Partyists, and many Americans seem to have been having nightmares of Barack Obama coming into their homes and dragging them off to a medical centre against their will.

So I thought it might be taking a step back and discussing why this whole thing matters, and why the Republican notion of health care is, to my mind, so wrong – and, dare I say, immoral. Obviously, a certain percentage of people are going to get sick. Sometimes, lifestyle choices are to blame – to be honest, I haven't an overwhelming amount of sympathy for smokers who contract lung cancer. But for the most part, getting seriously ill or injured is simply a question of bad luck. Health problems are not the least bit fair, and nobody wants to spend a day in a hospitals if they can possibly avoid it. So, how as a society, do we manage this risk, which affects all of us?

In America, this has largely been achieved through private health insurance. The better your job, the more things are covered for you and your family, inevitably tying the quality of health care to wealth. Which is why we have the unappetising spectacle of rich Republican members of Congress granting themselves excellent publicly funded health care but refusing to do so for anybody else.

But when a system is purely private, it creates enormous vulnerability. Lose your job, and you're stuffed. What's more, since private health insurers obviously need to make profits, they have incentives to pay out as rarely as possible, which is why they hike up their fees as often as they can, and try to exclude as many people as possible who have pre-existing conditions. And that is precisely where we need the state to intervene, and say – hey, we as a society won't cop that.

It comes down to what you think the role of government is. Many Republicans think that the government should operate a strong army and otherwise get out of the way so that the magic of individual action can operate unfettered. And it was odd to hear all the Republicans over there, and some Liberals here, slamming the federal health bureaucracy when they have run it for much of the past decade – if it's not doing a good job, whose fault is that, exactly?

In the Republican worldview, the winners should be able to accrue as much money as possible – and good health care along with it – while the losers have to struggle for themselves, and if that means they can't afford health care, well; they should have worked harder when they were well, or started a small business or something. It's economic Darwinism – the fittest prosper and the others simply die.

By contrast, liberals in the American sense, and nearly everyone in Australian politics, accept that the government should intervene to make societies a fairer place. After all, our bodies differ enormously in their healthiness and intellectual capacity, and that dramatically affects our ability to work and earn money in the first place. So the metaphorical playing field has never been level from a health perspective, really, and that's why insurance is important. It seems fairest, given the random nature of physical healthiness, that we all spread the risk. The Australian Medicare approach, which levies that insurance on the basis of individual wealth, then goes an additional step towards true equity. Because in a civilised society, the link between personal wealth and the quality of the health care you receive should be broken.

One of the wonderful things about Australian politics is that neither party can attack Medicare – it's sacrosanct. In America, many Republicans have made dire warnings that Obamacare will never be able to be repealed – and that's a wonderful thing, in fact. It's no surprise that most people believe that health care should be made available to most people!

Australia is a much smaller country than America, and it makes sense to me to run health care on a national basis. Rudd's scheme seems wussy because it's only funding 60% of the overall costs – why not simply cut out the states entirely? But these are relatively minor details compared with America's debate – because, fortunately, we agree about far more things. And what's more, we're right.

Today's National Press Club debate centred around responsibility for funding and management – in other words, about the efficient operation of a system that almost all of us support. There are enormous problems on the ground, and we need to spend a lot of energy getting all of our hospitals up to scratch. But nevertheless, in Australia, those who are seriously ill generally get the care they need, and for that we should all be grateful.