In 1972, I was backpacking around Europe with a buddy. We were on a bus in Copenhagen when I suddenly felt ill. I dashed off the bus, my friend following, and retched on the sidewalk as the bus pulled away. Minutes later, an ambulance pulled up and the driver told us, in English, to get in. "It’s free," he said. "We just want to make sure you’re OK." So we hopped in. The doctor said I was fine, and we left.

Today, in Austin, a mile ride in an ambulance can easily cost more than $1,000, even with good health insurance.

A friend of mine lives in rural southern Oregon. One of his neighbors was bitten by a rattlesnake. He was medivacked to the nearest hospital. His bill: more than $100,000.

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Medical bills are still the leading cause of bankruptcy in the U.S. Estimates are that 1.7 million people will face medical bankruptcy this year, and 1 in 5 will hear from a medical debt collector in 2017.

The effectiveness of our health care system is not in doubt — it’s highly ineffective by the most basic standards. In a list of 34 advanced countries, we rank near the bottom in infant mortality rate, ahead of Slovakia, Chile and Mexico. In terms of life expectancy, we rank 31st, per the World Health Organization.

We certainly have advanced medical technology and highly skilled physicians. The problem is with the system itself, not our ability to provide medical care.

We Americans have private, for-profit health insurance. In countries that achieve lower infant mortality rates and higher life expectancies, citizens don’t rely on private, job-based health insurance.

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Health care in America consumes 18 percent of our economy. The average cost per person is $8,200. The most expensive health care in any of the other 34 Organization for Economic Cooperation and Development countries is still $3,000 less per capita, and the portion of the gross domestic product consumed by health care costs averages under 10 percent among other advanced nations. And they generally provide coverage for all of their citizens.

Out of 300 million Americans, roughly 50 million had no health insurance before Obamacare. Under the Affordable Care Act, that number has been cut in half. The Republicans’ most recent failed plan, according to the Congressional Budget Office, would erase all the gains. It estimates 22 million Americans would lose coverage by repealing the current system and returning to private health insurance.

When will we realize that the for-profit, employer-based health insurance system we chose after World War II costs a great deal more and delivers inferior results compared with the single-payer systems used by most other advanced countries?

When will we realize that our system depresses wages and forces small businesses to limit the hours worked by their employees to avoid the cost of providing health insurance?

When will we realize that our system restricts would-be entrepreneurs who can’t risk losing their family health insurance if they leave their job? When will we realize that the so-called free-market system has given us the highest prescription drug costs in the world?

When will we insist that our government regulate prescription drug costs? It works everywhere else. Here, the so-called market system works only for Big Pharma and the politicians it buys.

Our private health insurance system has catastrophically failed to control prices or match the quality of health care delivered by most other advanced countries

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Improving health care requires that we address many complex issues, including price transparency, balanced billing, hospital safety and more.

We must shift from our fee-for-service system to a fee-for-outcome if health care costs are going to decline. There are elements in the ACA, such as lowering reimbursement rates for hospital readmissions, that can hopefully move us in that direction. We need more of that, not less.

When will Republicans realize they can’t come up with an attractive repeal and replace option until they reconsider the basic flawed premise of private, for-profit, employer-based insurance? Their inability to think outside the box will hurt struggling families across our country, regardless of which presidential candidate they supported.