World AIDS day is upon us, and while reflecting on the medical and social advances that benefited those of us living in the U.S., and on the lack or cost of health care, I read an editorial written by one of my acquaintances here in the Philippines.

As my friend observed, for the last two decades America’s power was based on three pillars: soft power - the attraction of the American dream of wealth and freedom; hard power - the only military machinery of worldwide reach; and cash power - the US had the largest internal market of the world everybody wanted to export to, and the Americans had a finance industry that saw to it that the rest of the world wanted to make dollar loans available, to finance the demand. All three pillars are shaking, to put it mildly.

America’s soft power went almost up in smoke during the Bush-administration; the hard power has suffered substantially given Iraq and Afghanistan; and the cash power is now vanishing in the financial melt down.

My friend nailed it: the U.S. economy will no longer be the global engine that drives the world?s economy, and there will be more nationalism and/or regionalism. Nationalism and regionalism have always existed.

So what does this all have to do with universal health care?

Empires rise and fall. It isn’t a reach to say that the dismal state of health care in the U.S. is but one more symptom of America’s decline, where the wealth of a few is preserved at the expense of the health of so many. I fear that universal health care may remain yet one more empty election campaign promise - Washington may decide that we can print dollars to bail out the economy but can’t afford to spend a few dollars to keep us healthy. Health care in America may remain a pernicious form of protectionism not unlike one region preserving itself at the expense of others.

The prognosis is guarded.