As things stand, the United States now has about 50 million people who are uninsured, as well as average healthcare costs that are twice as high as in other developed countries.
By any reasonable reckoning, that's evidence of a dysfunctional healthcare system. But it's not surprising that this has happened.
Left to their own device, profit-seeking health insurers have every incentive to keep costs down by minimizing the amount of treatment they cover and maximizing how much policyholders pay in rates and deductibles.
Consumers, meanwhile, have every incentive to avoid paying for insurance while they're healthy and to instead wait until they need it.
These self-interested goals are why the free market has failed healthcare — and why the government had to step in with remedies.
Thus, coverage requirements for insurance exchanges. Thus, a requirement that most people pay for coverage or face a tax penalty. Thus, a requirement that insurers cover everyone, including those with preexisting medical conditions.
"You need the whole package of reforms to make the whole thing work," Curtis said.
That's not socialism. Or communism. Or totalitarianism.
It's good old-fashioned capitalism, with a little helping hand from Uncle Sam to overcome personal and corporate considerations.
It's also humanism — an acknowledgment that healthcare, unlike most other products and services, is a necessity that requires all of us to band together as a society.
There is still much to be done. The exchanges remain a work in progress. Some rates undoubtedly will have to be tweaked before being offered to consumers. Insurance plans may need to be revisited by authorities to ensure equitable coverage.
Opponents of change should brace themselves for bumps ahead. The healthcare system is too complex for any overhaul to go smoothly.
But change, in this case at least, is good, and long overdue. Any healthcare system that excludes tens of millions of people, requiring them to fall back on costly and inefficient emergency services, is a system that brings nothing but shame on us all.
On Thursday, California took a big step toward a more honorable way of doing things. We can be proud.