Free health care for everybody.

That sound good?

Say it again.

Free health care for everybody.

No paperwork. No premiums. Get sick. Go to a doctor. Get a pill. Go home. Get well.

England has it. Canada has it. Germany has it. Japan has it. Why can’t we have it?

Who are these people against it? And why?

Why do they call it “socialized medicine”? England, Canada, Germany and Japan are democracies, aren’t they?

Well, sure, “free” doesn’t mean “free.”

It means splitting the total bill for all health-care services provided in Mississippi and elsewhere in the United States, proportionally, among Americans.

And it will be a big bill.

In 2003, according to the Kaiser Family Foundation, if everybody in America shared equally in everybody else’s medical costs, we’d each pay almost $6,000. That’s by far the highest outlay in any developed nation — and the gap between what we spend and what’s spent elsewhere is growing.

When people talk about reform in health care, it’s not about the quality. That’s fine. It’s about the patently absurd situation as regards who pays for what and how.

Who doesn’t have health insurance in Mississippi?

Mostly, they’re the working people — owners of small businesses, waiters and cooks, construction workers and such.

And even though these people — about one of every four working people statewide — have no coverage for themselves, they pay for the health care of others.

Mississippi has 3 million people. Here’s the breakdown:

• People 65 and older have Medicare, a federal program. It doesn’t pay all health-care costs its 450,000 Mississippi enrollees face, but it’s a lot better than nothing.

• People who are poor or disabled and their children have Medicaid, a federal-state program that has 600,000 on its rolls.

• Up to age 18, children in families with incomes up to 200 percent of the poverty level have S-CHIP, recently expanded to cover just over 100,000 young people in Mississippi.

• About 1.3 million people in Mississippi have private insurance and pay premiums on their own, through employers or get policies as a job benefit.

• And that leaves about 500,000 with no coverage of any type.

People without insurance get stuck two ways.

First, they join everyone who pays state and federal income and Medicare taxes to pay for public health programs.

Second, when uninsured people need health care, they are charged more than people with public or private insurance. This occurs (1) because regardless of what a medical business sets as a charge for a service, Medicare and Medicaid pay at government-set rates, and (2) because medical businesses provide deep discounts to insurance companies to be included as preferred providers. The uninsured must pay list price. It’s nuts.

Up in Washington, there are two major approaches to fundamental change.

One, preferred by President Barack Obama, keeps the private companies in operation. His “best of both worlds” approach requires employers and the self-employed to buy coverage or to pay the government, perhaps an equal or greater cost, if they don’t. An uninsured worker who isn’t offered group coverage by an employer may buy private coverage through a government program at an affordable premium.

Sound confusing? It is. Everyone who has studied models and charts has come away with a migraine.

The other is to chunk everything out and nationalize the health-care industry. Just let Uncle Sam handle everything, cradle-to-grave.

Part of the appeal is that it sounds so simple. But that’s deceptive.

A complete government-run, single-payer system would require dismantling existing private health businesses, from the smallest to the largest, as well as insurance companies from a for-profit model.

And it would require an across-the-board equalizing of the availability of services. The Medicaid client would be on equal financial footing with the senior corporate or federal executive with the most comprehensive coverage Blue Cross offers.

Another issue is whether people who don’t now have coverage and don’t get routine care start seeking regular checkups once they’re “free.” Is there sufficient capacity?

A really large factor is what happens when anything becomes an entitlement. This is hard to describe, but visualize the difference between a government-funded clinic, where people complain about making $10 co-pays on $300 prescriptions, and a church-run clinic in most any Mississippi town, where the uninsured are sincerely grateful for the compassion of others.

And it’s no mere footnote that government is notoriously less efficient with dollars and services than a private business.

Free health care for everybody. Sounds simple. Sounds ideal.

But the real question is whether it’s better than what we have now.

And the answer is, “In some ways yes, in some ways no.”