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Alex Rose is exasperated by the continuing rise in health care costs, increases that threaten to take away his health insurance. But Alex also is disgusted by the larger picture: a United States health care system that is inefficient, uncaring and so confusing to health care consumers that they figure out how to navigate it only with great difficulty, and sometimes not all at all.

"The whole thing is outrageous," says Alex, a self-employed, 51-year-old art and antiques dealer and appraiser from Santa Barbara. His Blue Shield premium jumped this year to $391, which Alex says is "unaffordable. What do I do? I can't pay, but if I don't pay don't get care."

It is a question that tens of thousands of anxious Californians are asking themselves.

Unlike most Californians, Alex, who came to the U.S. as a teen-ager, went back to Canada, then returned here for keeps in 1982, has something to compare the system to: the much-maligned (by U.S. physicians and media) Canadian health care delivery system.

He believes the single-payer system should be imported.

While he concedes that the Canadian system has its difficulties, "for the majority of people in Canada, it is extremely efficient, extremely good. It raise the (general) health level, because people aren't afraid to go in" to see the doctor. They know they're covered in case of a calamity, he adds, so there is some peace of mind as well. It costs $50 a month today, and Canadians know they will be taken care of.

Alex points to a study that showed a dramatically lower rate of breast cancer in Canada, brought about because women were getting checked up regularly because it didn't cost anything. "Here, they put it off until it's too late."

"Down here it's a for-profit business. They don't want the people who are high risk. If you're healthy, you go in the asset column. If you're unhealthy you go in the debit column. They don't bother to see the people who are cast aside. It's outrageous."

That attitude is especially brutal to California's aging and elderly population, now being squeezed out by insurers and their rising rates, he says. "They work their whole lives," Alex says, only to be treated scurrilously at the end. "We're supposed to be civilized, not living in the Stone Age. The whole thing stinks."

"Health care should be like education," he adds. The industry and the nation "should think about the health of the citizenry."

One of the many nonsensical aspects of California's health delivery system, Alex says, is the fact that you have insurance when you work for someone else, but face exorbitant rates when you're on your own. "If you quit your job, or lose your job, you're basically out of insurance," he notes.

The entire system, Alex goes on "is incredibly confusing. Nobody can figure it out." It generates an endless amount of paperwork and files, he adds, which not only creates confusion and inefficiency, but also increases costs.

"There's nonsense and legalese up the wazoo. They should keep it simple."

Some Americans fear that single-payer is unwieldy. President Bush played on that fear during his state of the Union address, when "he decried the prospect of a government-run health insurance system, invoking the ghost of bureaucracy. That is really unfair. He doesn't complain about the government-run military as being an inefficient bureaucracy. If the military is government-run and supposedly the best in the world, why then can't the health care system be government-run and also be the best in the world?" Alex asks.

"We always seem to feed the special interests," he went on. "What kind of disgusting society is this, anyway? I say put all the insurance companies out of business; they're all just one step up from gangsters."

"Years ago," Alex notes, "British Columbia decided that the automobile insurance business was an outrageous scam and threw them all out, establishing a quite efficient provincial insurance plan. California might set the trend by tossing out the health insurance companies and establishing itself as the first state to offer universal single payer health care.

"A single-payer system is the way to go."