Settle down, Robin Hood. You have to pay the doctors.

Healthcare is NOT a right. It’s too expensive to be guaranteed.

Medical professionals have extensive schooling and loans to pay back. They have malpractice insurance to pay for. And they self-select what specialties they’ll pursue and some specialties are more abundant than others.

Litigators drive up insurance rates with malpractice lawsuits that hold medical professionals responsible for mistakes and negligence as if they were the same thing.

Insurance companies have negotiated rates with care providers and facilities. They set the budgets for care with algorithms and balance sheets, not compassion and logic. Health insurance companies are legalized gambling. They’re betting you won’t get sick and you’re betting you will. You both put money on the board and wait for the dealer to distribute the cards. The companies have done everything they can to hedge their bets: pre-existing conditions, a network of providers, lifetime caps. Not only did they rig the game in their favor, they have lobbied congress and state lawmakers to enable them to do so.

How can regular citizens get affordable care when insurance companies are unwilling to sell affordable insurance?

As long as the insurance companies are hedging their bets and rigging the game, there will be no insurance reform. As long as they can pay lobbyists to influence congress and policy wonks to write bills that protect their interests, there will be no insurance reform.

To frame the insurance reform debate around healthcare was a gross miscalculation by the Democrats as long ago as Bill Clinton’s first term. Healthcare means people are sick and can’t afford treatment. It means they need rescuing and the government is the only entity big enough to do it.

But healthcare is not a right. It’s a business and the care providers deserve to get paid for the professionalism, experience, and compassion they bring to the equation. Insurance companies do not provide care. They provide financing. Like bankers, their role is to take on the risk. Why should they be allowed to minimize their risk at the cost to the common good?

When Paul Ryan said healthcare is complicated, what he meant was that everyone in the debate has a valid position and it’s difficult to broker compromise. What he should have said was the citizens have leverage over the politicians, the insurance companies have leverage over the politicians, and what they want is diametrically opposed.

How can we convince insurance companies that offering coverage to the most expensive, at-risk population is in their best interest?

Saying “it’s the right thing to do,” doesn’t work.

Forcing them to compete in a government-sponsored exchange doesn’t work; many just opted out.

We could tell them that if they don’t participate in the exchange, they will not be allowed to sell insurance in our state at all. We could tell them that if they don’t offer coverage for the least among us, then they can’t offer coverage to anyone else.

But we also have to tell our citizens they should expect to pay for coverage. They should expect to spend some of their money betting they’ll get sick and need coverage. Because taxing people on what they make to fund a healthcare system for people who pay nothing is the worst kind of unsustainable Robin Hood economics.