When it comes to national healthcare reform, I think we should throw participatory democ­racy out the window. This one policy debate would go better if the American public were silent and disengaged, refusing to blog, carp, watch Fox News, or exercise its voice. It would also be helpful to suspend the constitution, strip all interest groups of power, and install a temporary dictatorship. One smart person would make the final decision how to address the healthcare disaster. She’d be advised by other smart people. She would wave a wand. Then Congress would return from a short hiatus, and the sausage-making would resume.

It’s a heavenly fantasy: a complete stealth makeover of our unquenchable, unfair health system. All of the nation’s most alarming prob­lems would instantly be made much less so. As is, the American economy is barely sustainable, propped up only by a collective national credit card that can be shredded by China at any time. We are a superpower with an Achilles’ leg—and our runaway health spending, which doubles every decade, makes it impossible for us to save enough to ease that vulnerability.

Nor can we control an increasingly insane federal deficit. (People who worry about that aren’t just blowing conservative smoke.) We’re heading slowly to the poorhouse, friends, and there’s no way out without taking radical steps on healthcare. As an empire solely in our own minds, not in our bank accounts, we can’t afford to win in Afghanistan, backstop the banks, and also throw more money at this broken system. Yet whatever healthcare “solution” comes out of D.C. shortly will deal with precisely none of the above—it will be a tweak, not a reckoning.

If only the nation were more like San Francisco.

For anyone who follows the city’s tortured politics, that sounds like a bad joke. But I’m almost serious—because here, the smart people actually had their fantasy window of freedom a couple of years ago, and they did some­thing truly bold: They cooked up Healthy San Francisco, a universal-access plan to help anyone who doesn’t have insurance get decent healthcare quickly and easily. Then, when few citizens were paying attention, they actually got it passed.

Healthy San Francisco hasn’t gotten much press. As Justine Sharrock points out in “Heal Thy People,” the program is essentially irrelevant to the debate in Washington because it is such a commonsensically local creation. Unlike most of the nation, we already had a network of high-quality public and charity clinics and hospitals that stretched all over the city. Why not, said the reformers, go ahead and let anyone who’s uninsured use that system for a minimal monthly charge?

Sharrock, herself enrolled in HSF, presents a rich picture of a cost-effective, workforce-friendly policy that somehow manages to work for the down-and-out and the up-and-coming alike. The star of her story is the city itself—a place where people don’t always agree on the details, but do share certain values. And one of them is the belief that rationing out healthcare based strictly on your ability to pay for it is just wrong.