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!)

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.

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.

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.

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?

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.

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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.

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.

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.

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>

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

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.

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.

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

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.

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?

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.

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.)