Which brings us to a second principle: unification, not fragmentation.

For decades, the health care system has been broken into several distinct layers: Medicare, Medicaid and employer-provided coverage. The first two are paid for directly by the government. The third is subsidized implicitly through the tax code, which does not tax health benefits provided by employers as income.

This tax break is the original sin of the United States health care system. Worth more than $250 billion annually, it has enormously distorted the market, creating an incentive for employers to provide ever-more-generous insurance while insulating individuals from the true cost of care. It discourages job switching and entrepreneurship, and offers an unfair advantage to the comfortably employed.

Medicare, meanwhile, offers a huge system of federal benefits to older Americans that typically run far beyond what most have paid in. Its introduction was associated with explosive growth in hospital-costs inflation during the 1970s.

Rather than overhauling this fragmented system, both Obamacare and the Senate bill leave its distortions largely in place. Obamacare nibbled at its edges by paring back Medicare to finance new coverage and by applying a tax to high-cost health insurance plans provided by employers. But President Barack Obama delayed that tax until 2020; the Senate legislation would delay it until 2026, suggesting it may never take effect at all.

The result is an unequal system in which health insurance is understood more as a way of prepaying for medical care than as a protection from financial risk.

That’s where the third principle comes in: Health coverage is not the same as health care. Instead, it is a financial product, a backstop against financial ruin. Health care policy should treat it as one. There is some question about how much programs like Medicaid contribute to measurable physical health outcomes, but there is no arguing that it effectively insulates beneficiaries from financial shocks.