I'm opposed to anything that doesn't feature single-payer. The most logical choice would be to expand Medicare, an existing system. It's the most efficient system and the best insurance I've ever had in my life--and I had the best of private insurance in my working life. Medicare is far superior to what I have--which has since been bastardized by the insurance industry.

I've lived in countries and have friends in countries with single-payer systems. Unfortunately, what I've observed over the years is the erosion of those systems as private insurance has made incursions into the social fabric. What has happened is what opponents of school vouchers fear--those financially able to purchase other options bail out of the system, refuse to provide support because it has nothing to do with them and the end result is a broken system.

Private insurance is nothing but a blood-sucking leech on the body politic. It takes our health care dollars, invests it to make a profit, then shuffles the paper work to pay our bills. It provides NO service whatsoever, in fact it prevents us from receiving the service we're paying for whenever possible. It's too entrenched in our society (basically owns our pols, including Obama) to be gotten rid of but, boy, would I like to see it go belly up and get off our backs.

Keep up the good work, Philip. Your research is appreciate, as is your willingness to provide people with a forum for discussion.

Don't give up on Grassley and the finance committee yet.

He does want health care reform and he's a fiscal conservative. If he can do it without breaking the bank he will.

Ron,
Thanks for the encouragement.

Sherry,
Your comments are interesting. As with the education system, the health care under Obama would be supported on the shoulders of the "wealthy". I believe that it is likely that health care will then go the way of the public education system. Right now we have excellent doctors, and world class facilities. This would be diminished under a government run plan. Quality of care would diminish, as would the availability of choices for people for their health care. You spoke of school vouchers. I have been on a local school board, and I have seen first hand how the mantra seems to be "If everyone can't have something good, no one can." In following this motto, many poor decisions are made.

Dirk

Dirk,
I'm on a government health plan, remember? I have access to doctors my husband, who is on an "excellent" private plan does not. My coverage is far superior to his and the quality of care I get is the same as anyone else's.

I've lived in countries with government health care, one of them a nearly third-world country which was very poor. One of my friends comes from a third-world country. He's completely mystified by the American health care "system." "In X (his country) which you're sick you go to the doctor. How come you can't do that here?"

Unlike in the US where I was uninsured (I was young and poor), I was able to see a doctor and got fine care in other, far poorer countries. In fact, I was referred to one of the best hospitals in the world in the next country where I got better care than I ever got in the US. Gosh, I actually got an accurate diagnosis. I wasn't a citizen, remember. When I asked them what I owed them I was told "You're not in the US now. We take care of our people here." That was almost 40 years ago and the words are still true.

A close friend of mine lived in a country with a public system. He died of asbestos-related cancer, as he would have here in the US since there is no cure. I was able to track his care and compare it with US NIH recommendations. He got state-of-the-art care--and home visits by his doctor in the last year of his life. He'd never get that in the US. Without insurance he also would have died much, much sooner and been reduced to spending his last days bankrupting his widow and waiting in ERs.

The fact is, most of the time most of us do NOT need "the best." Most of the time we have something very garden variety or the beginning of a disease process which can bloom without treatment into something serious--the sure course in the US without adequate insurance. Or we have chronic conditions, something the US medical system does very poorly.

In the end, the proof of the pudding is in the eating. It really doesn't matter a whit how great our facilities are if our children die at third-world rates, if our life expectancy lags behind our industrialized peers, if our general health remains poor by any measure. I'm unlikely to need that fancy brain surgeon in Houston (and my husband could never see him anyway because it would be "out of network" so he'd have to stay in our podunk state and be treated by hacks instead of riding 90 miles to Boston to see some of the best doctors in the US). But if I'm uninsured I won't be able to see anyone for my thyroid condition or diabetes or other chronic condition.

We have a supreme and unwarranted arrogance in the US about our health care "system." I know a US citizen who lives in Russia. She's on a group list I'm on. Here husband had a heart scare in the middle of the night and was hospitalized. The US members of the group immediately went into "Ohmigod, you're stuck in RUSSIA! Is there no way you can get him to the US, Mecca of Medical Care" mode. She informed us that not only was he being treated by one of the best cardiologists in the world, the guy got out of bed at 2:00 am to see her husband when he was in the ER. She was, in fact, quite relieved they were in Russia and not in the US with its fragemented and impersonal care.

As for school vouchers, the problem is the matter of the middle class bailing out of a system. Basically people simply are not altruistic by nature. We're all pretty self absorbed. I've seen it happen when private insurance came along in countries with public systems to suck up the middle class. People lost interest in supporting the public system in a rather nasty "I'm alright, the hell with you, Jack." That's the issue with vouchers, although I really don't see anything wrong with "everyone having something good." I should think that would be your goal, actually, if you're on a school board. Wanting to play favourites with tax monies hardly seems like great service to your community.

Anyone got thoughts on the private deal made with PhARMA that public insurance plans (whether Medicare or new plans yet to be) will NOT try to negotiate lower prices?

http://www.swamppolitics.com/news/politics/blog/2009/08/white_house_healthcare_deal_te.html

This is in exchange for PhARMA's (pretty much unenforceable) pledge to give Medicare $80 billion in savings over 10 years.. and for its pledge of $150 million for "pro-reform" TV ads. The promised "reform" is getting so close to the status quo that I have a hard time listening to appeals for me to turn out and demonstrate to defend it from "corporate interests." The only real reform has to start with single-payer!

Yeah, I'm pretty disgusted with the Pharma bonanza. Not surprised, but definitely disgusted. They got their nose in the tent via Medicare Part D, to which I refuse to subscribe, and they're not about to let go until they get all the way in.