The Obama Administration is gearing up to get community groups organized and making noise about reforming the health care system beginning June 6th. I've long been skeptical about the term health-care because, other than some basic preventive stuff like inoculations against infectious diseases, healthy people don't need care. Though, for one reason or another, often psychological, they may want and like it.

It was this latter impulse that the industry was counting on to conform a system that should be aimed at reducing the need for services to the requirements of a market that relies on continual growth. And, they've been wildly successful. Even as more and more people rake in more and more money for disparate services to fewer people that don't actually realize better health, much less an overall reduction of need for medical services. The upward spiral of cost is an intended consequence of market forces that thrive on growth. Also, there's the fact that a lot of ancillary services have latched on to the medical tit. Transportation and financial counseling for people stressed by the costs of live-saving or death-delaying measures are just two.

So, there's a lot to be skeptical about when considering health care and, although social funding for services that are needed but not necessarily wanted is really the appropriate way to go, the designation of a "single payer" program is problematic. First, that it's a misnomer in the sense that everyone pays into a publicly funded system. Secondly, while it's a simpler phrase than some others (Medicare for All, Universal Health Care, Socialized Medicine), the word "single" is quickly falling into disrepute, except with the singles population that considers itself self-supporting and not having children a virtue. Moreover, there's a good reason to suspect that the word will just alert singles to the potential that THEY will have to pick up the tab for the "irresponsible" married who have too many children they can't support. So, "single payer" is out--as both a description and an option.

But a public health program whose funding is centralized is definitely necessary, if only because that's how we'll best be able to realize economies of scale in an area where being prepared is critical to not being needed and utilized. Prevention of illness and injury and early death are the goals. They can't be achieved when profit is the measure of success. And even a non-profit system can't up-front the research and technical costs of a realistic program of preventive health care that actually improves health, longevity and productive lives.

So, considering that Medicare for All is a good model that needs some adjustments, as well, I'm inclined to go with what I'd call "Medicare Opt-in" or "Opt-in Medicare." It's true that Medicare for the aged is already an optional/volunteer program. But, that aspect has perhaps not been sufficiently emphasized to persuade people who have a strong preference for more specialized care than is provided to everyone who's sick. The Obama people are talking about "options." That's a good word. Much better than "choice" which has acquired a bad odor because of its association with reproduction and isn't appreciated by people who don't want to make decisions in the first place. "choice" used to be a good word when it was mainly associated with cuts of beef at the butcher shop at a time when even shopping for meat was a special occasion. Now "choice" is more like that red flag they wave in front of the bulls in Spain.

Also, "opt-in" is a positive, affirmative and voluntary action--not a passive acceptance of a perhaps inadequate offer. And then, of course, it lends itself to a riddle like, "what do you get when you take the O out of option"? Answer: Opt-in. Isn't that clever?