Health Care: Slow-Motion Katrina

Single payer will very quickly become national planning. If the government can set a reimbursement below actual costs, the drug, procedure, etc will stop being performed. The proponets of single payer must believe that upper class white Democrats will always be in charge of single payer and will just pay for everything. However, since the economy cannot tolerate such a system, the government will be in the business of managing care. So, instead of one insurance worker in a cubicle determining your care, it will be a GS-13, HBCU graduate in a cubicle in Baltimore working for CMS who determines your care.

The Katrina analogy is actually a good one to argue for McCain's proposal, not the Dems'. Anyone remember FEMA? How'd that work out?

Well, of course I disagree with both SD and CS. The current system includes 35% profit and overhead for private insurers who fight to avoid paying for the health care needs of their "customers". 45 Million are uninsured and seek emergency room care, the only care available to them, at a cost far higher than the cost at a regular doctor. How's that working out for us? [hat tip to CS for the red herring. I love fish. Katrina was the result of incompetent Bush cronies. FEMA has worked admirably under better leadership.]

All the doomsayers about government-paid systems ignore the fact that we have over 40 million covered by Medicare, 55 million on Medicaid, over 10 million covered by FEHBP (federal employees health plan), 25 million covered by Veterans Administration and even more by state plans like California's CalPERS. Over 1/3 of Americans are already enjoying "socialized medicine" and guess what: it works pretty well, at far lower cost than private insurance. Now, subtract the 45 million not covered by private insurance and government-funded programs in the USA already rival private insurance in enrollment. Now for the clincher: Divide the total outlay (including overhead) for Medicare by the number enrolled (to give per capita cost) and offer ME that cost instead of private insurance. I'll pay my share. YOU can stay with the increasing expense and decreasing benefits of private insurance. No one's trying to make private insurance illegal. Cmon free marketeers. Give us a choice and let the private insurers compete.

Truth is, with some innovation and new thinking, and especially the will to solve this mess, and we can do it. Hell, we're America (enthusiastically waving tiny flag) !

I'm sorry but the FEMA meme is partisan and misses the points of
competence, partisanship and largess. Clinton and Witt expanded FEMA and improved disaster response, but spent huge sums of money to buy votes and save lives WHEREVER a disaster happened.

http://en.wikipedia.org/wiki/James_Lee_Witt

Witt's term in office saw approximately 348 Presidentially declared disaster areas in more than 6,500 counties and in all 50 states and the U.S. territories. Witt supervised the response to the 1997 Red River Flood -- the most costly flood in the nation's history at that time -- the most costly earthquake, and a dozen serious hurricanes.

Witt was mentioned as a potential candidate for Governor of Arkansas in 1997 but took himself out of consideration and stayed at FEMA until he was replaced by Joe Allbaugh, the first appointee of Bush and predecessor to Mike Brown. FEMA's current director is R. David Paulison, former Fire Chief and Emergency Manager for many years in Miami-Dade County, Florida.

http://query.nytimes.com/gst/fullpage.html?res=...

http://www.fff.org/freedom/0197f.asp

Clinton's Biggest Disaster Fraud
by James Bovard, January 1997

President Clinton proclaimed in campaign ads last fall that "my job as American president is to take care of the American people." Fewer events present more opportunities for the flaunting of compassion and buying votes than do natural disasters. As a result, under Clinton, the Federal Emergency Management Administration (FEMA) has become far more high-profile and generous than ever before.

Bush took a larger FEMA and appointed hacks and incompetents, Allbaugh and Brownie. But when serious , but not major hurricanes, hit Florida in 2004 W sent Brownie with a blank check to buy votes. The results were quite different from NO.

http://www.perrspectives.com/blog/archives/0002...
http://www.govexec.com/dailyfed/1104/110304cm1.htm
In

http://www.perrspectives.com/blog/archives/000246.htm

http://www.govexec.com/dailyfed/1104/110304cm1.htm

In 1992, the last time a major hurricane pummeled Florida in the homestretch of a presidential election, FEMA was caught with its pants down. Its response to Hurricane Andrew was disorganized and chaotic, leaving thousands without shelter and water. Cleanup and resupply efforts were snarled in red tape. After watching the messy relief efforts unfold, lawmakers questioned whether FEMA was a Cold War relic that ought to be abolished.

For then-President George H.W. Bush, the scene proved to be a public relations nightmare. He managed to regain his footing and win Florida three months later, but his winning margin was dramatically reduced from 1988.

In 2004, George W. Bush and FEMA left little room for error. Not long after Hurricane Charley first made landfall on Aug. 13, Bush declared the state a federal disaster area to release federal relief funds. Less than two days after Charley ripped through southwestern Florida, he was on the ground touring hard-hit neighborhoods.

In 2004, George W. Bush and FEMA left little room for error. Not long after Hurricane Charley first made landfall on Aug. 13, Bush declared the state a federal disaster area to release federal relief funds. Less than two days after Charley ripped through southwestern Florida, he was on the ground touring hard-hit neighborhoods.

Well, let me clarify that the abysmal FEMA performance around Katrina was largely due to "good-job" Brownie's ineptitude. Katrina itself was a natural disaster not caused by either party (just so you don't think I'm making a rev. Hagee claim about it being "God's punishment".)

FEMA was never tested by such a catastrophic event prior to that though, GD. And I love the way we conservatives are never allowed to say that the Bush administration has mucked up by not representing true conservatism (any criticism has to be applied to conservatism in general, not just to him and his cronies) but when it works to liberals advantage their happy to use the narrow brush to apply the criticism to Bush himself rather than to big govt solutions in general.

To be more clear, I didn't mean to imply that Bush himself isn't partly to blame for the failures after Katrina. But my point is that it was never before expected that the federal agency would act as a first responder, particularly to act in a way to ameliorate the failures of the local and state agencies.

And when we expect the federal government to be able to act with the kind of flexibility and efficiency required in such a thing, we're kidding ourselves even if we'd had the best of leadership (which we didn't.)

My main point is that bringing up a comparison to Katrina seems odd if you're trying to argue that federalization of a problem can work well. Don't you at least have to have some evidence of a federal bureaucracy being able to tackle an enormous and complex problem before advocating this as the best solution?

greendreams,

You do realize that FEHBP, VA VISTA, and DoD Tricare all use private insurance companies to administer their programs. And that the participants pay premiums. At least they provide comprehensive care unlike Medicare and VA that does not have to worry about OB, Pediatrics, neo-natology, etc.

You said that you disagreed with me but did not indicate how the system would not be used to centrally manage healthcare. Even today, if Medicare sets the reimbursement rate too low, physicians will not performance the procedure. Or that many physicians have stopped dealling directly with insurance companies but let the patient do all of the work.

If you want to see a world class hematologist/oncologist, you being paying a huge amount out of pocket to make up the difference between your insurance and what the physician will demand. How does single payer fix that unless you plan on enslaving all health care workers?

CS says: FEMA was never tested by such a catastrophic event prior to that though, GD.
I believe the Red River floods, the 1992 hurricane Andrew , the 1999 hurricane Floyd, and the four hurricaines (Charlie)of 2004 were major disasters, but the results weren't as bad or partisan in total response compared to Katrina. But after 2004, Bush was reelected so "Mission Accomplished".

Rudi,

The problem with Katrina is that is was a flood in New Orleans that occurred right after a hurricane. Responding to floods is very different to responding to hurricanes. In addition, New Orleads was probably the worst city in the U.S. to try to response to a mass humanitarian event.

Two other things that people usually ignore is that managers in FEMA were already worried that with the emphasis on WMD and the next 9/11 that they would lose their ability to respond to other types of disasters. In addition, FEMA/DHS had changed its doctrine right before katrina with the National Response Plan http://en.wikipedia.org/wiki/National_Response_.... The NRP failed due to the managers not really understanding it and that it magnified the weakness of Director Brown. I would guess that Brown had never actually participated in an exercise where the NRP was played.

In each of those cases, Rudi, the local and state agencies were able to act as first responders. Katrina's effects on NO didn't allow for that, partly because of the magnitude of the storm itself, partly because of the problems with the levees (which went back many years and involved federal as well as local failures, and the fact that no one has ever been willing to spend the kind of money that would really be necessary to protect NO from anything more than a CAT 3 direct hit) and finally, because of failure of the local govt to plan the evacuation of citizens without cars (they do get credit for FINALLY getting the auto evacuation right- it was the first time ever that my family didn't get stuck in interstate gridlock trying to get out of town.)
And it takes two to do the partisanship dance. You could say that the MI response to Katrina worked better because the Bush administration had a better relationship with Barbour than with Blanco, but the blame game went both ways as to why those relationships were drawn on party lines.

http://www.geo.mtu.edu/department/classes/ge404...

The Flood of the Century
A look into the 1997 Red River Flood at Grand Forks, ND

The flooding of the upper Midwest was just as devastating. Initial response and later response was greatly different. The folks of the Dakotas and Minnesota weren't ignored. And these states didn't all vote for Clinton or have Democratic govenors. FEMA also forced people away from the flood plain as stipulations for disaster relief.

FEMA also forced people away from the flood plain as stipulations for disaster relief.

Just one of the many differences in the two situations. Not possible to force everyone from the flood plain in NO- the entire city is in the flood plain. And the worst areas were the ones where there was local opposition to any plans which didn't allow for rebuilding on the same site- that wasn't FEMA's indiscretion, it was the political reality of the 'leaders' from the 9th Ward.

The NO hurricaine and flood was a somewhat unique situation. This doesn't happen yearly or every few decades. The Red River flooding is similar to wild fires in California.

Enough of the Katrina hijacking, I wonder where the US stands in life expectancy and infant death in the Western world. The only non-socialist medical plan has to have the best life expectancy and lowest infant mortality, or are we more like the Balkans or a Third World country?

The title of this thread is a lie and the original posting contains drivel. There is no "right" to health care provided by Washington or any other government and people who want Washington to provide health care should grow up and face reality. There will be no massive cost savings (you're a joke if you're not joking when making such a claim) and while extending Medicare to everyone (the logical thing to do if we want Washington to provide health care to everyone, or at least to citizens, even if that disappoints partisan Democrats and activist losers who want aliens to get it as well so they're more loyally Democratic than before) will solve a number of problems with the way things are now, we will be exchanging one set of problems (that exist with the way things are now) with another. Grow up, please. Thanks in advance.

"I wonder where the US stands in life expectancy and infant death in the Western world"

The USA is far from homogeneous. Inner-city stats are far worse than those of the suburbs and it is dishonest for activists to incorporate inner-city stats and claim this is a general state of affairs in the nation overall.

I'm reminded of misleading claims that are thrown out when discussing the long overdue raising of the retirement age of Social Security that some inner-city minority groups are thereby disadvantaged because of reduced life expectancy. We are not obliged to use misleading figures for retirement programs that are subject to downward influence due to high homicide rates by younger members of a cohort. What matters is _expected remaining years of life_ at any given age, which can be obtained from the CDC. As with infant mortality and other problems that are obviously not due merely to inadequate health care but to lifestyle and cultural decisions -- knowing the truth is like having X-ray eyes, that enable the intelligent easily to SEE THROUGH BULLSHIT.

"In each of those cases, Rudi, the local and state agencies were able to act as first responders."

*** AND THEY SHOULD HAVE BEEN THE PRIMARY RESPONDERS ***

Only _children_ look first and foremost, by instinct like infants, to Washington, as their surrogate parent!

"Even today, if Medicare sets the reimbursement rate too low, physicians will not performance the procedure."

You know what the perverse people will do. They'll make Medicare a monopsony.

Look at Conyers-Kucinich. Ignore the constitutional question about providing health care to people in the first place; Medicare for seniors is accomplished fact. Ignore the blatantly unconstitutional low-life theft in the confiscatory refusal to pay for lost profits when forcibly converting all "covered" medical care to non-profit status. Just consider that with "covered" medical care Washington becomes a monopsony and providers such as dialysis clinics lose money already under Medicare _already_ underpays for all kinds of care -- it's a nation-wide scandal. The perverse people will want that to apply to as much medical care as possible.

""Even today, if Medicare sets the reimbursement rate too low, physicians will not performance the procedure."

But we know how to "fix" that. Make all procedures subject to government control and escape is impossible. If necessary "we" force the procedures to be performed even at a loss.

"How does single payer fix that unless you plan on enslaving all health care workers?"

*** BINGO *** Slavery is illegal unless "single payer" [sic; WHO'S THE PAYER?] is sought, then it is desireable and fully legal insofar as many activists are concerned.

"At least they provide comprehensive care unlike Medicare and VA that does not have to worry about OB, Pediatrics, neo-natology, etc."

Neonatology? Shhh.

Wait until ABORTION surfaces as a federal-government-provision issue. Heh, heh

"I wonder where the US stands in life expectancy and infant death in the Western world"

Those numbers are also skewed by the differences in how 'live births' are recorded. Many neonates born with severe developmental problems or profoundly premature are not recorded as births at all in other Western nations- thus the reality is that for such infants, the US is virtually the only country where they have any chance at survival at all. The fact that many of them don't survive even our best efforts means that we take a hit on the infant mortality rating- because we're actually willing to admit when an infant has died.

CS - Please supply a link for your assertion about "live birth" recordings. How many of those problems are due to poor prenatal care do to neglect and lack of health care?
Here is what I could find.
http://www.statehealthfacts.org/comparebar.jsp?...
http://www.cdc.gov/omhd/AMH/factsheets/infant.htm
http://www.childtrendsdatabank.org/indicators/6...
http://www.unicef.org/sowc05/english/sowc05.pdf (Page 115)

Two different issues there, Rudi. One is looking at the actual cause of increase in premature or high risk births, and there's a good bit of data to suggest that the increase in recent years is due to much higher rate of multiple births (which is mainly due to in vitro). See here:
http://pediatrics.aappublications.org/cgi/conte...

Other issue is whether various nations are on the same page in reporting their rates- fact is they're not, because US reports babies as live births even if they're unlikely to live and need intensive care. Other nations simply don't treat those births the same way- they're recorded as stillbirths which skews the ratio to look like they're doing a better job in saving infants, when really they are just giving up on them and not recording them. You can research it yourself or if you need me to find the verification of this I will- unfortunately I probably won't have time until at least tomorrow (if I can get to it I will and will come back to post.)

Ah, I remembered a source and was able to pull it up quickly...this piece from qando breaks it down:
http://www.qando.net/details.aspx?Entry=3848

To clarify though, I'm not denying that prenatal care is a big issue- and there is a racial component that suggests that black women are not getting as good prenatal care on the whole (some of the disparity in their preterm and underweight babies may be biological too though, because Hispanic women in similar socioeconomic conditions actually have fewer underweight and preterm babies, even though you'd presume similar access and education about prenatal care.) In short, it's complex- but people certainly do misuse the stats, that's my point.

Secret Squirrel says thanks for the links. I will look into this to see if Western G7 countries skew the stats as you say.

"The current system includes 35% profit and overhead for private insurers who fight to avoid paying for the health care needs of their "customers"."

Private health insurers return 80 to 85 percent of premiums on average to consumers in the form of health care benefits. I don't understand where the 35% profit and overhead is coming from.

More importantly, suppose we do get single payer national health insurance. Where are all those Canadians who don't want to wait seven months for a hip replacement going to go?

CStanley refers to a conservative blog which in turn refers to an OpEd piece in one of the most politically conservative papers in the country that cites as its only proof that the comparisons are unreliable a fellow of the American Enterprise Institute, one of the primary conservative think tanks that thinks government should do nothing outside of defense and basic interstate law enforcement. I have my doubts as to the validity of their claims.

As far as FEMA is concerned, let's just say that conservatives should never be trusted near a moder government because they don't want it to work properly. If it actually does something right it destroys their entire world view.

While defending what FENA should not be expected to do, the President and FEMA executives should just ignore a disaster the size of Katrina, right?
Rising to the occasion, apparently would be a much greater disaster, because it would violate some conservative pinciple or other.

When were common sense and personal respondibilty outlawed (by executive order, of course)?

It's hard to keep up with all the irrelevant arguments.
I'll just take up the mention of inner ciites as being responsible for our lousy health record, when compared to Europte.

Since when deos Europe not include its own inner cities? Or don't they count, because the residents in Europe's worst enclaves also have good health care?

I'll let the rest of the nonsense from the same source go.

Weightman,
I don't' know where the 35% profit figure came from.
I had read 25% Let's just say, it's a lot more, while also excluding many more people from coverage.

Universal health insurance or single-payer health insurande does not mean copying the Canadian model or the English model or any particular model. There are enough countries wih good health care from which we can learn and create our own model.
Even the countries experiencing the worst problems are busy innovating to improve their systems amd contain costs rather than arguing endlessly about he need to do what is needed.
South Korea invented a much cheaper type of MRI machine, which it is now exporting around the world, for example.

The US is becoming synonymous with standing still while the rest of the modern world passes by us to solve problems, think long term, and insure a better future..

We just talk about it.

Runasim,

It is hard to claim that other countries are ensuring a better future. What most European Countries refuse to face is that to maintain their current level of services, their taxes will have to continue to rise. IN places like Germany, they will soon be at a point where they will not be able to tax enough out of their economy to maintain their level of services

Runasim,
First, you seem to ignore that I already stated that the Bush administration and FEMA bear some responsibility for failing to 'rise to the occasion'. I'll also note though, on this point:

Rising to the occasion, apparently would be a much greater disaster, because it would violate some conservative pinciple or other.

One bit of irony is that it was the Democratic governor of LA who was resting on a conservative principle of states' rights when she held up the sending of Natl Guard reinforcements because the feds wanted to send them but under federal control. I can understand the arguments for both sides there but in the face of the unfolding disaster I think ALL such concerns and principles needed to be put aside for the short term.

Look, if you want to argue that a federal agency can be flexible enough to respond to massive disasters immediately, go ahead and show me some evidence of that. Would it have been laudable if Bush and Co had made that happen? Of course! But the fact remains that the incompetence was something that added to a problem that was already pretty unteneble- a situation where local response was insufficient in the first stages of the disaster. That's something we should address no matter what, because there certainly are some disasters large enough in scope that the disaster itself makes it impossible for the local help to arrive- but to think of FEMA as ordinarily filling that role makes no sense, and pinning it all on FEMA makes it too easy for local governments to duck their own responsibilities in planning and executing response.

Jim S- if you'll point me to an 'acceptable' source that will actually discuss the issue, I'll be happy to look at it. <rolls eyes>

CStanley,

RE: 'go ahead, show me some evidence'

You prove my case.

There is a disaster of epic proportions. You want to argue which Democrats are to blame vs. which Republicans. I want to talk about what should have been done by those in a position to do it. I'll sacrifiece my aversion to using overused phrases, by saying that 'Heck of a job. Brownie " remarks weren't helpful on the part of the mpst powerful man in the US. There was a problem with the LA Gov? Why not get his top people to find a way to solve ithe problem instead of vanishing triumphantly?

For the sake of the argument, I'm willing to say that everything was the fault of the Democrats, that even Katrina was a card carrying Dem. Party member.
Where does that get us? A disaster is still a disaster. It's not an election race.

Whether it's health care, disasters or anyhting else.
I'm tired of talk, talk, talk for the sole purpose of avoiding doing anything or showing who is to balme.

I'm looking for discussions that look seriously at what could be done, done, done.

Runasim, I reject your assertion that I'm being partisan- what I'm saying is that there's fault to go around, and yet you continue to ignore the parts where I say that the Bush administration didn't rise to the occasion. I'm actually trying to have the discussion you say you want to have, but because any analysis of the situation does involve a look at how the various parties acted, what we believe their responsibilities should have been, and whether they met the bar that was set by this extraordinary event or whether they even met the bar of their ordinary responsibilities, you don't want to engage in that discussion. I say that there's no point in talking about it at all then- and since this really is getting off topic anyway, it's probably best to drop it.

You ask why not get top people to solve the problem of Blanco's resistance, but that's exactly what did happen- the point is that that takes time though and that's why a coordinated federal/state response doesn't function well. There will always be concerns and turf battles going on- so this is one reason I don't think it's logical for the federal agency to be expected to fill a first responder role.

Maybe it'll make more sense (and be more clear that my intentions aren't to assign blame along party lines) if I say that in my view, a lot of the failure was due to lack of coordination of the Homeland Security office. With the structure that was put in place which put FEMA under HS, it was very important to have the local HS offices responsible for being able to step in immediately to assess whether or not there were problems with the normal local agencies being able to function (whether due to ineptitude on their part or due to the effects of the crisis itself) and to have immediate jurisdiction to solve the problem in any way necessary. This would create a situation where the federal coordination was immediately in place, without the possibility of a governor creating a hesitation- and I say that not because Blanco is a Democrat, because as I pointed out her hesitation was actually based on a principle which a conservative would typically have, states' rights- and this could very well occur in a future event if a Democratic administration needed to send Nat'l Guard into a state with a GOP government. But what I'm suggesting to avoid that turf battle from occurring is for the LOCAL branch of the HS security office to have the ability to declare a necessary condition for federal response to occur without restriction during a temporary state of emergency. Basically the principle there is that when a governor asks for a federal emergency to be declared, he/she would be ceding certain states' rights to the feds in order to avoid red tape which would impede the federal agencies from 'rising to the occasion'.

Now, you still may disbelieve me that I don't make these judgments on a nonpartisan basis, but I think that a fair reading of what I'm saying shows otherwise. If you choose to simply believe that I am arguing in bad faith, there's nothing I can do about that.

SD-
I'll consider discusintg health care in Europe with you when you shw the first sign that you know something about it.

Starting point: There is no such thing as the European Plan or European problems. Each country has its. own., and they are all diffrent both in structure and in problems. Innstead of wasting time arguing about it, they are busy looking for ways to improve.
Almost every country has surpassed us, while we argue, argue, argue and nothing gets done.

We could learn from the vaiety of models around the world and devise our own.
Instead, like many of the commenters, you just want to put your head in the sand and block others from takcling one of the worst problems this country has.

That's your choice.
I prefer to use my time considering ways the US could actually do something, for a change.

CStanley,

Let me put it this way. What all went wrong with Katrina has been disected autopsied, parsed and spun to death.
I think we're way past the need to inspect it yet it again in the hopes of unearthing, here at TmV some overlooked fact. All we have to do is to read past analyses and reports, which are all over the Internet.
EX: communications? That's been done, over and over..

The only reason now to go over it again, would be to make some ideological point.
I'm saying that's a waste of time.
I
My bad. I allowed myself to get sucked into other people's advocacy efforts instead of spending my time reading up on how FENA has improved or should be improved further.



.

Fascinating discussion as always. I'm not sure if those here who are so adamantly opposed to government healthcare solutions are just being partisan  or are actually open to considering other viewpoints. Perhaps you just don't have any friends overseas, and are relying on Republican talking points to shape your opinions. I'm not trying to be insulting, but I do have friends all over the world, and without exception I have found them to be more satisfied with their health care system than my American friends are with ours (oh yeah, and everyone is covered; every single citizen of nations that are eating our lunch economically). Further, I think a lack of exposure to other systems on a more personal level has allowed many Americans to accept untruths about this system, and I see some of that here.

Those who actually live with single-payer systems do not report problems accessing the best physicians or hospitals. However, if they want to seek the best, most elite and most expensive medical care available, that is available to them too. This idea that physicians under universal health plans are "slaves" is simply misinformed. Residents of Canada, England, Switzerland, Germany and most other places with universal health care always have the option of buying supplemental insurance, as many Medicare recipients here do, and they are free to spend more for a physician than the national health service will pay for. Just like here, the overage comes out of their pockets. Want a face lift? Pay for it. Elective surgery? Some's covered, others not.

As I wrote here recently, many physicians now prefer Medicare to private insurance, for one simple reason: Medicare pays, and pays quickly. There's no department in Medicare that is determined to deny coverage in order to enhance profit. It costs much less to prevent outright fraud than it does to scrutinize every claim for any tiny mistake made by the insured or the physician as an excuse to deny the claim.

We and they are at cross purposes. Our national priority is to provide health care for our people. The priority of the for-profit insurance industry is to maximize profit. I would imagine that most of us has experienced the heartlessness of insurance companies when they see a way to deny coverage. I certainly have (Blue Cross be damned!). So we have conflicting goals. Our goal is to provide health care, while their goal is to make tons of money.

Now why is the cost so different? Blue Cross in Massachusetts employs more people to administer coverage for 2.5 million New Englanders that are employed in all of Canada to administer coverage for 27 million Canadians. Multiply that by every city in the United States, and you start to see the massive private "bureaucracy" that we can avoid with a single-payer system. Compensation for insurance company CEOs ranges from a low of $1.4 million per year (Humana) to a high of $76 million per year (Oxford). Insurance companies (and hence their customers) spend tons of money on advertising, marketing, promotion, brochures, executive salaries and travel, fancy offices , taxes and many more expenses that are not a feature of our government funded programs. And of course there's profit, which varies according to who is being paid. Washington hospitals report it's 14%.

Additionally, it costs more for providers to deal with all the insurance company forms and requirements. Twice as much, because with the single payer system there's no need to determine eligibility, get permission for the procedure, etc. They know what's covered and how much to charge.

We're still the richest country on earth (not for long probably), and it is shameful that we deny basic medical care to anyone based on money. A government nonprofit system will always be less expensive than a for-profit system.

Finally, let me get back to a very key point that seems to have been lost in this discussion. I'm not suggesting that a government funded health care system be mandatory. So for those of you who are really satisfied with the private insurance model, and those employers who can still afford to pay the skyrocketing costs of private insurance for their employees, this discussion is not about you. You are welcome to embrace your current model wholeheartedly. For those of us for whom it is not working, we want to change. We want a different system. We want a system that is providing better health care at lower cost to every industrialized nation on earth. So let me ask you, what's wrong with some of us opting for a system that you think will be a disaster but we think will be less expensive and provide better care?

GD- That was a good comment, a good model for a very moderate tone of discussion. You defend your own views and elaborate on them without attacking others. You explain a concern that people with other viewpoints might have arrived at their views without knowing all of the facts- but you don't assume that that's necessarily the case. Kudos- that's all quite excellent and rare these days. I only wish I had more time to get deeper into the discussion!

The only thing I can say quickly to try to make you understand my position better is that I don't think that it's as valid to compare the US with other countries as you do. I think there's a very big size differential and that size does matter (heh.) Plus, the innovation that we value so much, and that other Western nations also benefit from, does in fact stem largely from the for profit system.

So that's the best quick way I can explain why it matters to me that some people want to set up an alternate system- because it will in fact have an effect on me too. Not to mention that I'll be paying to fund that alternate system, and then if I want to continue to exercise the choice that you mention, I'll have to pay twice (much like public education, so my feeling about this isn't too far removed from the way I feel about vouchers for education, because that's the only way to truly allow people to opt in or out in order to make private choices if the public system doesn't meet the standards that we'd choose.)

Does that mean I don't think there's a problem with the current costs of the system? Heck no! Of course there are problems- but I think it'd be much better to keep the system privatized but give vouchers to those who are above poverty line but still can't afford healthcare- while also addressing some of the other factors that drive up cost and make health insurance difficult to obtain.

GD- one quick addendum-
One reason I find your comment so praiseworthy is that it's very rare for anyone who holds your position to NOT assume that conservatives are just not informed, and it's often impossible to even discuss your approach vs. mine in that kind of environment. I hope you are serious when you say that you really don't know if people here are just relying on talking points- because I assure you that that kind of partisanship isn't where I'm coming from. I actually do believe that a well crafted and comprehensive reform done on a more conservative model would be the better solution.

Thank you CS. I have always appreciated your rational and moderate tone as well.

As I mentioned before in comments, I was a Republican once, and feel that my party left me more than I left it. I still believe in what the party once believed in: fiscal responsibility, states rights, individual rights, the right to privacy and the rule of law.

I watched as the GOP villainized the "tax and spend" Democrats, then showed us that their model is "borrow and spend"; shamelessly borrowing trillions of dollars from our children while shirking our national responsibility to maintain the infrastructure and to spend those tax dollars wisely. Perhaps a better description would be "credit card Republicans" because the administrations of the Reagan and Bush era racked up huge debt to foreign banks with no intention of paying it back, but with a very clear intention of passing that down (with interest) to our children and grandchildren. Meanwhile, there was wholesale pandering to corporate donors (of both parties) to excuse them from their responsibility to protect the environment, their workers, the communities in which they work and even their shareholders. It has been unbridled greed for decades.

Returning to the health-care debate, I'm very much interested in what you believe is a realistic market-based solution to our dilemma, and I pledge to listen with an open mind. However, just remember that I'm probably 20% closer to economically covering the cost of the nonprofit model than any for-profit model.

As for your reluctance to pay taxes for services you don't take advantage of, it's appropriate that you mentioned the education model. I don't have a school-age child and my wife has no children. Why should either of us pay anything for education? I'll answer my own question. The future of America depends upon an educated workforce and our democracy depends on a well-informed electorate. Thus it is to my personal advantage, and that of my children, to have a vibrant and effective public school system. There's no way any of us should be using our tax dollars to give you a voucher to send your children to elite private schools. Many Americans lack the financial resources to send their kids to private school, and anyone who doesn't have the resources without a voucher can just join the rest of us who can't afford it.

Now on to that question of innovation. That argument might apply better to pharmaceutical companies than it does to insurance companies. What innovations have come out of the insurance industry? As for the pharmaceutical industry, 6 of the top 10 pharmaceutical companies are European, not American. These companies are every bit as innovative and competitive as the American companies. I don't think anyone can accuse Bayer (#3, Germany) of being a slacker in drug research and development, nor could that charge be applied to GlaxoSmithKline (#4, UK) or Novartis (#5, Switzerland). 6, 7 and 8 are also European. Plus, J&J is #1 because of Tylenol which was not their innovation (just good marketing) and Pfizer #2 because of Viagra, hardly a lifesaving innovation for world health.

I'd say among the worst and most ridiculous pandering to the pharmaceutical industry of recent years is the Medicare prescription drug plan. To protect the profits of the pharmaceutical industry, the Republican administration insisted that Medicare be forbidden to negotiate drug prices. This is the very antithesis of running the government like a business. Who in their right mind would insist that Wal-Mart be forbidden from negotiating the best price for the products they buy? I have no need to provide any sort of government guarantee of profitability to any industry. Drug prices are lower all over the world than they are here. As we struggle to deal with our health care cost crisis, it makes no sense at all for us to get any less than the best deal we possibly can. Pharmaceutical companies are not selling drugs at a loss overseas. Their European profits are good, their Asian profits are good and of course their American profits are phenomenal (despite the pathetic state of the US Dollar). Don't cry for big pharma, they'll be just fine.

GD: Again, time is short (and frankly, my patience and mental capability are in short supply due to personal stress today) so I really don't think I can get into the details of my ideas- I realize that may sound like I'm ducking the debate but honestly it is one I'd like to engage in when I have the time.

You make some good points- first, I agree with a lot of your criticism of recent Republicans though in some cases not to the same degree- and since I've always felt cynical about many practices of the Democrats, I don't find myself with anywhere to go so I still tend to vote according to the principles each party is supposed to stand for and mine still align better with the GOP than the Dems. IOW, I still favor more conservative policy, and I'm as frustrated as anyone else that we've had inept governance from those who represent the more conservative side. Sometimes I see that as due to nominal conservatives NOT acting according to those principles, and sometimes I see it as a case where the pure conservative stance should be modified- but the current incarnation of my party tends to do the modifications in all the wrong places and obviously a lot of that is due to pandering to their monetary interests.

One more point that I'll address is your comments about education (I knew I was opening a can of worms in making that comparison!) In both cases, I don't think it's wrong to be taxed in order to support the common good as well as my own personal interests. But what I'm saying is that it's disingenuous (I don't mean you personally are intentionally disingenuous) to say that I shouldn't care about a govt funded health system being offered as an alternative- because of course it still has effects on me and my personal choices.

Now, a further point is that having agreed to be taxed for the common good, I think I have just as much right as you do to voice my opinion about the manner in which that taxation is used for the stated purpose. Again, since I think it makes more sense to keep the system privatized and handle the gap in people who fall between Medicare qualifications and ability to self insure/ pay by having the govt directly pay for their private insurance. Although I said I wasn't going to get into details, I'll add that there are a few things that I think could help greatly in then also allowing more people to get covered on their own: uncouple ins. from employment by equalizing the tax deduction, allow people to buy health insurance across state lines, and allow more creative pooling options for small businesses and self employed individuals so that their bargaining power can compete with larger pools such as big corporations.

BTW- I completely agree with you on the Medicare prescription drug plan. It's a boondoggle, which brings me full circle to what I was saying in my first paragraph.

Oh, one final point- one of the main reasons that I can't even entertain supporting the Democratic plans on healthcare is that they focus exclusively on getting everyone covered. That's one of my biggest pet peeves- creating a bureaucratic solution which ends up covering up the real problems. That's not to say that lack of universal coverage isn't part of the problem, but fixing only that WILL NOT do what they say it will in terms of cost savings.

Now I realize you could come back and say that the GOP side only fixes some things and not others- but I guess I have less problem with that because it's not going to have the kind of momentum that a govt payer system will have- generally those kinds of things can't ever be stopped once they're put in place. (Here's a cue for Runasim or others to say that I'm making excuses about why we should do nothing!)