This is a great metaphor. Because if you don't change the oil in your car, your engine will slowly grind itself to death.

People need to consume healthcare; it's not a luxury good. And vaccinations are rarely given by the actual drs - that's what nurse practitioners are for.

The problem in the US is not -- let me repeat -- NOT because healthcare services are too available because people don't have to pay. Many people avoid and delay going to the dr, because of costs, or inconvenience -- even for lifesaving tests and treatment.

Hell, I had great insurance that cost $500 a month and still ended up paying amost $2k in total costs when I sprained both my ankles. (Long story.)

And something like 80% of US bankruptcies are due to unexpected medical bills.

The real problem is that there aren't enough doctors, and that's because the doctors' offices/hospitals are trying to be "lean" -- and that's because costs are so great.

Lean is great for software, not for social services. And the reason the costs are so huge is that the whole system, from education to insurance, sucks.

Compare the US to a country like Austria, with body of nationalized healthcare and -- to carry the metaphor -- a limb of private care. I moved here last August and I'm still constantly amazed by how well this country works (and how untrue most of the US' self-aggrandizement turns out to be).

There are barely waiting times to see doctors, even highly sought-after specialists in Austria. You can hop into the ER in a major city and get in and out in under 2 hours. You never see the kind of wait times here that you see in the US, even in suburbia. (I moved here from various parts of Maryland, not exactly the most populous place in the lower 48.)

There are more doctors. There are more female doctors. There are more doctors who really care.

To my mind, this is due to several factors, including but not limited to: a) free higher education, meaning anyone who can do the work can become a doctor; b) low cost/high standard of living, meaning it doesn't take much means to survive while going to school; c) an ethic of social services; d) a nearly-single payer system reduces a huge amount of overhead & cruft; e) it's easy to manage patient billing and relationships with the insuring parties, because there are so few and they are not structured to for-profit; and d) no doctors are being driven out of business by high malpractice insurance premiums, due to all of the factors above.

I had to go to the ER on a road trip thru the country a couple weeks ago. I immediately saw a doctor and nurse practitioner, and they were double-teaming me - one measuring my blood-pressure, the other drawing blood; one checking my blood-ox levels, the other listening to my chest, etc. I had x-rays, I had an EKG, and lab work, all inside of 2 hours. Then I got my medicines and left.

And I paid... $0 for the ER visit, and about $12 for the medicines.

On top of that, I was in there for what I suspected was bronchitis/pneumonia (I have crap lungs). But, unlike every time I've had that in the US, the doctors I saw looked at me and realized it was similar symptoms to both deep-vein thrombosis and congestive heart failure. Which is true. My heart's fine, but no one in the US has ever analyzed me that thoroughly when I presented with "obvious" symptoms. They were so on the ball, it was a world of difference. I felt safe and now I know my heart's fine.

I've never had a medical experience that good in the US. Not for a second did they treat me with the jaded disregard you usually experience in US ERs.

Clearly the cheap and easy availability of great care is not a problem.

I really wish that I knew why Americans are, on the whole, always blaming the end-consumer for what are systemic deficiencies.