Let us begin our activism right here: with the money-driven villainy at the heart of American foreign policy. To do this would be to give up the illusion that the sentimental need to “make a difference” trumps all other considerations. What innocent heroes don’t always understand is that they play a useful role for people who have much more cynical motives. The White Savior Industrial Complex is a valve for releasing the unbearable pressures that build in a system built on pillage. We can participate in the economic destruction of Haiti over long years, but when the earthquake strikes it feels good to send $10 each to the rescue fund. I have no opposition, in principle, to such donations (I frequently make them myself), but we must do such things only with awareness of what else is involved. If we are going to interfere in the lives of others, a little due diligence is a minimum requirement.

Twenty years ago, Switzerland had a system very similar to America’s - private insurers, private providers - with very similar problems. People didn’t buy insurance but ended up in emergency rooms, insurers screened out people with pre-existing conditions, and costs were rising fast. The country came to the conclusion that to make health care work, everyone had to buy insurance. So the Swiss passed an individual mandate and reformed their system along lines very similar to Obamacare. The reform law passed by referendum, narrowly.

The result two decades later: quality of care remains very high, everyone has access, and costs have moderated. Switzerland spends 11% of its GDP on health care, compared with 17% in the U.S. Its 8 million people have health care that is not tied to their employers, they can choose among many plans, and they can switch plans every year. Overall satisfaction with the system is high.