Next time you're out teabagging, or otherwise encountering someone who sees universal health care as evil, ask around: "tell me about YOUR health insurance."

What are the chances anyone opposed to making health care affordable to anyone and everyone is personally living without any way to pay for medical care?

I know multi-millionaires (really, I know several, well). They ALL have health insurance policies. None of them would risk losing everything (or perhaps just millions) because of medical expenses. Will they ever use that insurance? Who knows? That's why you buy insurance.

You and a large group of others join a pool of people to be able to shift some or all of your risk to an insurer. The insurer knows that the pool will be diverse. In fact, it's the diversity that makes it work. In exchange for the money you pay the insurer, the insurer assumes your risks and pays (or is supposed to pay) when those risks materialize.

If insurers 'cherry-pick' from the pool, the system breaks down. The only for way for a risk-transfer system to work is if the pool remains diverse. Notice that insurers vie to sell policies to big 'group' plans - large employers. Any large employer's pool is diverse. Yet, the insurers want the business in spite of the danger of 'acquiring' some high-risk people's potential medical expenses. Group plans cover pre-exisiting conditions (except pregnancy). So we know that insurers can - and do - profit from insuring without cherry-picking. And they like it that way.

A thought: is it ever OK to segregate high-risk insureds into a cherry-picked pool? Auto insurers have to be licensed to do business in a state (any state). Part of the licensing is an agreement to participate in insuring a high-risk pool, e.g., drivers with many tickets or 'accidents,' or with drunk-driving convictions. The premiums in that pool are subject to state regulation. In other words, if you want the 'good' business, you have to get some of the not-so-good business. That accomplishes several things. Among them

1. the 'diverse pool' system works - and the good drivers don't have to bear part of the burden inposed by the extreme risks
2. the societal goal of having all drivers (OK, most drivers) be able to pay for at least some of the damage they do

In health insurance, as in auto insurance, in ANY insurance) most people rarely - if ever - file claims with their own insurer. That's why the whole thing works for insurance providers.

The simplicity and success of universal auto insurance explains why and how universal health care can and does work (except in the USA). Remember - some companies fought viciously to prevent the high-risk pool rules. They lost the battle, but they are still profit handsomely, and they still pursue auto insurance risks.

There's one model for universal health care.

If the insurance companies won't co-operate and get back into the legitimate game - then they need more stringent rules and probably competition to force the issue. Either way, the insurance industry will be better for it.

But there's no time to wait. People are literally dying (and I literally mean literally) because of the health insurance companies' intransigence. A recent Harvard medical School study places the number at more than 120 people every day dying because they cannot afford to get the care they need and deserve. And personal bankruptcies are at record highs - and increasing every year. 60% of those are because of crushing medical expenses.

All told, we need to correct course. Either the insurance companies get on board, or we should make them compete with an effective, inexpensive public option for health care. Or they can pack up their rigged game and go somewhere else or find something else to do. trust me: they won't get out of the business, even in the face of real competition and tighter rules.