An exorbitantly priced, inefficient healthcare delivery system that kills more than 28,000 Americans each year is an obscenity.

Do the math. 

According to a 2009 Harvard medical study nearly 45,000 Americans die each year simply because they can’t afford health insurance.  That figure did not include the numbers whose deaths are occasioned by insurance company refusals to authorize life-saving medical procedures. The study was issued before Congress passed the Affordable Care Act (ACA).

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At the time of that Harvard study, 47 million Americans were uninsured.  The ACA extended at least minimal coverage to an additional 17 million Americans.  That modest 36 percent reduction in the number of uninsured Americans came at a high price.  By 2025, the U.S. government will have forked over $1.207 trillion in taxpayer-funded subsidies to the privately-owned health insurance cartel.

Simple but ghastly arithmetic suggests that even under the ACA, 28,800 Americans die each year for want of coverage.  This is the tragic reality of a healthcare system that places a higher value on the profits of the health insurance and pharmaceutical industries than on the health and very lives of our citizenry.

The U.S. sports the world’s most expensive healthcare system. In 2013, the U.S. spent per capita $9,267 on healthcare.  That's nearly three times as much as the per capita $3,480 the U.K spends on healthcare.  The U.S. healthcare delivery system came in dead last amongst eleven (11) industrialized nations in terms of "quality, efficiency, access to care, and healthy lives," according to a recent Commonwealth Fund study.   The U.K., with its government run National Health Service, ranked number one.

America needs health insurance carriers like an honest businessman needs a Mafia protection racket.  More than thirty-one percent of U.S. healthcare expenditures are squandered on these unnecessary and parasitic middlemen – profits that enhance the already exorbitant wealth of health insurance industry CEOs and their Wall Street investors.  This contrasts sharply with Canada's meager 1.3 percent single-payer administrative costs, according to Physicians for a National Health Program (PNHP).

In a classic understatement, Sen. Bernie SandersBernie SandersSunday shows preview: Trump sits down with Fox Democrats: Where the hell are You? Sanders on Trump pick: This is how a rigged economy works MORE (I-Vt.) complains that Americans pay far more for prescription drugs.  Last year, for example, CNN reported that the average cost for one month's supply of Nexium in the U.S. ($215) was nearly ten times more than the price paid ($23) for the same prescription in the Netherlands. 

Hillary ClintonHillary Rodham ClintonFive takeaways from latest campaign filings Trump sparks imitator in Ohio Senate race Trump: Five things we know and five things we don't MORE accepted millions of dollars in campaign contributions from her former "enemies" (the health insurance and pharmaceutical industries). Prior to his release of his detailed plan, Clinton complained that Sanders had failed to explain how he would pay for a single-payer system. The unstated and entirely erroneous assumption is that it would cost more to provide healthcare as a right to every American than it costs to fund the ACA which leaves 30 million without coverage.  Actually, the opposite is true.

In 2013 U.S. taxpayers footed the bill for "64.3 percent of U.S. healthcare -- about $1.9 trillion." That $5,960 per capita tax bill was nearly double the per capita cost of healthcare in the U.K. The PNHP estimates that by 2024 taxpayers will fund 67.3 percent of total healthcare costs in the U.S.

According to Gerald Fineman, Ph.D., a professor of economics at the University of Massachusetts, Amherst, a Canada-style single-payer system would "save an estimated $592 billion" per year.  Fineman argued that while a single-payer system would require a "modest” but "progressive" tax increase, it would save money for "95 percent of all U.S. households."

As revealed by Sanders's recently released detailed plan, Clinton's no new healthcare tax pledge amounts to a form of bait-and-switch.  For many, it amounts to a promise to save pennies in taxes while spending dollars on premiums, co-pays and deductibles.  Sanders estimates that even after a 2.2 percent tax increase, the average family will experience a $5,807 net savings.

Unfortunately, because of his focus on average costs, even Sanders has understated the true costs of our corrupt and dysfunctional healthcare system.  What about the costs in lives and financial ruin? Under the ACA 28,000 Americans die each year for want of coverage.  No one dies for lack of coverage in a single-payer system.

More than 1/2 of all personal bankruptcies are caused by unpaid medical bills.  Three-fourths of those bankrupted had health insurance at the time they became ill or injured.  As observed by the PHNP’s Dr. David Himmelstein, “unless you’re Bill Gates, you’re just one serious illness away from bankruptcy.”

One cannot defend an obscenity.  Single-payer is the moral and economic imperative of our time.

Canning is a retired attorney, author, Vietnam Veteran (4th Infantry, Central Highlands 1968) and a senior adviser to Veterans For Bernie.  He has been a member of the California state bar since 1977.