Everyone gets sick, and lots of people have accidents, but not everyone can access healthcare when they need it. Even though the Affordable Care Act has signed up 13.6 million Americans this year, 28 million American men, women, and children in this land of plenty still have no health insurance at all, often preventing them from receiving even the most basic healthcare services.

But even Americans who do have health insurance still struggle to afford its costs. Roughly 155 million people rely on employer sponsored insurance (ESI) plans whose premiums have risen by 47%, and deductibles by 69%, over the last decade.It’s no wonder that the inability to pay medical bills is the country’s number cause of personal bankruptcy, outpacing those due to credit card bills or unpaid mortgages. And yet we still cling to outmoded, overly-expensive and wasteful ways of insuring ourselves against the economic ravages caused by disease or plain bad luck.

It’s interesting that most people don’t realize that the “normal” and accepted way of insuring ourselves through the workplace was not a deliberately designed policy, but was, in fact, due largely to a series of unplanned accidents of history. The first event occurred during WWII, when Congress passed the 1942 Stabilization Act, a law that limited the amount of wage increases employers could grant their workers during wartime.

As more and more American men joined the armed forces, the labor market contracted. Nonetheless, the country still needed bodies on its assembly lines. But because of the wage cap, employers were forced to find other means to entice workers and keep them on the job. The incentives they decided on were benefits like health insurance. These health benefits packages were not considered a part of employees’ wages, so it was a convenient way around the federal government’s limit on pay hikes. Labor unions accepted these new benefits, in lieu of raises, in their collective bargaining agreements with company managements.

The second event occurred in 1943, when the Internal Revenue Service ruled that employer-based healthcare should be tax-free, meaning that employers could deduct what they spent on these benefits packages from their corporate tax payments. The impact of these two events propelled the rapid growth of employer-sponsored health insurance. Plan participation grew from 9 percent of the population in 1940 to 63 percent in 1953, and 70 percent by the 1960s. Today, it’s about 55%.

For many years, this system worked well. Health care costs were low, as were insurance premiums, because companies were able to bargain with the insurance carriers for bulk coverage. The majority of Americans were insured against catastrophic medical events, and employers were saving on their taxes.

But as medical costs began to spiral out of control over the last few decades, and more and more companies cut back on the generosity of their plans, we soon began to realize that healthcare, when doled out by profit-making hospitals, and with costs increasingly controlled by rapacious insurers concerned only with their shareholders’ bottom lines, was going to become a national burden that we no longer would be able to afford.

And that day has finally come. And it isn’t because wiser men and women did not see the writing on the wall. Some form of national health insurance has been on the presidential back burner for a hundred years, dating back to Teddy Roosevelt and his unsuccessful 1912 comeback bid for the White House. Franklin Roosevelt toyed with the idea as part of his 1935 Social Security Act but decided it would be too controversial to include in the legislation.

Harry Truman picked up Roosevelt’s mantle and proposed national health insurance legislation in 1945 and again in 1948. When he was president, Dwight Eisenhower proposed a comprehensive health and welfare program that was rejected by Congress. John Kennedy tried to enact Medicare, which was subsequently passed, along with Medicaid, by his successor, Lyndon Johnson, in 1965. In 1974, Richard Nixon proposed a comprehensive health insurance reform that included an employer mandate to offer private health insurance and the replacement of Medicaid by state-run health insurance plans available to all with income-based premiums and cost sharing. In 1993, Bill Clinton proposed the “Health Security Act,” which would have provided universal health coverage to all Americans.

But, over the past century, every attempt to create some sort of national healthcare coverage was defeated by the special interests – insurers, hospitals, doctors, and the pharmaceutical industry, as well as their bought friends in Congress – a cabal of profiteers and their stooges, who stood to lose untold riches should the power to ration and charge for healthcare be removed from their purview.

Finally, in 2009, a Democratic Congress, without one single affirmative Republican vote, passed Barack Obama’s Affordable Care Act, but without a “public option,” which, if included, would have been the first concrete step in taking away the power to insure from the country’s large insurance companies. So, today, America is still the only industrialized, democratic state on the planet that does not have some sort of national healthcare insurance plan for all its citizens.

And that must change. It’s time to expand what Medicare is doing for our citizens over 65, what the military and the Veteran’s Administration does for our men and women who currently or formerly wore the uniform, and what Medicaid does for the poor and indigent among us. The best possible solution to our current healthcare crisis is a comprehensive, single-payer, universal health insurance program that covers every American citizen. Period.

It’s finally time to recognize that healthcare is not a privilege for the well-off, nor should it be a profit-making enterprise that makes insurers, drug makers, doctors, and hospital shareholders, wealthy. Healthcare is a basic human right. And just as every American can expect to have the fireman show up if his or her house is burning; just as every American has the right to a free public education; every American should have the right to expect that in time of need or emergency he or she has the right to affordable, adequate, and necessary healthcare. We must fix this outdated, broken arrangement between citizens, healthcare providers, and our government. Now’s the time!