As a child I was sick a lot. I’d get three or four colds a year, always with a nasty strep throat. I missed most of fifth grade with mononucleosis. I’d been born with some sort of digestive difficulties (never diagnosed; I now believe I was allergic to baby formula) that persisted as chronic diarrhea. Then, around the age of nine, I started passing blood in my stools.

By that age I was already averse to doctors and especially terrified of needles. So as my condition developed I kept it secret from my parents. Somehow they missed the fact that I was going to the bathroom twenty times a day, and another two or three times at night, usually just to pass a dollop of mucusy blood. Nor were they aware of the belly cramps, so bad that I’d have to stop whatever I was doing for several minutes until they abated.

Thus I grew into a skinny, pale, chronically tired teenager. Finally, when I was fourteen, I was hospitalized and tests revealed an advanced case of ulcerative colitis — the interior wall of my large intestine was one open, bleeding sore.

A core principle of “commonhealth” holds that the health of individuals cannot be considered apart from the health of their surroundings, including family, workplace, community, and the environment. No body is an island. Individual health fluctuates relative to local inputs — we experience good or ill health in significant measure due to the good or ill health of the world we inhabit.

Michael Marmot, British epidemiologist and author of The Status Syndrome, has shown that individual health rises or falls with one’s high or low status in society. But this is not a simple matter of the wealthy having more money to buy better food and medical care:

As important as it is to move America to a single-payer heathcare system that eliminates the administrative costs of profit-driven insurance companies, it will do little good if we do not simultaneously change the way medicine is practiced in this country.

This flies in the face of a basic assumption in the current debate: that for all of its expense, and despite those millions of uninsured, the American medical system (AMS) is the best in the world. Saudi princes, we’re told, come here for their coronary bypass operations. Canadians eschew their long waits and slip over the border for hip replacements. Supposedly, every sick person in the world would prefer an American hospital over the second-class offerings of their government-controlled systems.

Makes for a patriotic narrative. If only it were true.

Between Michael Moore’s “Sicko,” and an election cycle in which the American people are naming healthcare as their number two issue (after the war in Iraq), American healthcare is about to undergo a long overdue and hopefully deep examination. If, however, all we do is focus on access to and payment for care — arguing, as Moore admirably does, for the elimination of private health insurance — then it is likely that the status quo will prevail, because the insurance companies will win that battle.

The insurance industry is a major contributor to and thus part-owner of the Congress. The men and women who make up the Senate and House are beholden to the industry for much of their financing yet, ironically enough, not for their own healthcare. Instead, all of the people who run the government (executive, legislative and judiciary) get their care through a government-run and -financed, single-payer, universal (for them) system.

We have to appreciate their conundrum when they get together to decide what to do about the rest of us — the fifty million who have no insurance at all, and many others who have the sort of tragically inadequate insurance that Moore highlights.