Uh, UBS? And is the Swiss corporate intransigence on Holocaust survivors and tax evasion such an advertisement for their corporate culture? This “small-European-countries-have-a-better-model” point of view would, I should also note, also have supported the idea of Iceland's banking model being ideal. Before it imploded, that is.

The problem, Jim, is that it's a serious structural flaw to tie prosperity directly to votes, as we've seen in the looming bankruptcy of social security. It's like a populist version of corporations using their power to acquire more power. People will always vote themselves more benefits, which provides a serious disincentive for politicians to do the wise thing and stand up for unpopular positions like “we can't afford it.” (My home city, Philadelphia, has been struggling with the economic populism of union-catering politicians for decades, which simultaneously gives a bigger share of the pie to single-issue voters at the cost of shrinking the pie overall.) If we're going to do this, it cannot be as simple, structurally speaking, as you appear to me to be suggesting.

A significant portion of health insurance now is self-insurance plans that are administered by outside organinzations. When a company switches plans, it really only switches the administration from one set of providers/administrators to another. The money still comes from the companies.

As a result, healthcare is an important cost of business and it puts US business at a disadvantage in the global market. The trick will be to find a way to get around all the regulation/de-regulation (which has a lot of regulation on its own) problems that have caused the cost of administration to sky-rocket and to free the businesses that want to be freed from the burden of health care costs.

As businesses cut costs, their employees lose because in this economic environment significant savings can be had by not offering insurance, especially if employees are unable to find other jobs. This leaves a lot of earners in the lurch if a medical problem occurs. Businesses have the choice of to insure or not to insure. I don't think that most of us want our health care to be a business decision, but right now it is for a lot of us.

The politics of this kind of move will be massive and the lobbyists will have a field day (Daschle will make much more money!) until the situation becomes so bad that even the Republicans will see the advantages of setting our businesses free from this burden. The issues of state autonomy and regulation will have to be solved and the specter of a two tier (or twenty tier) health care system will have to be addressed. This will be a difficult if not impossible undertaking, but it has to be done.

Health care is 17% (or whatever the latest figure is) of our GDP which means that there is a lot of money out there to be made by someone unless there are good workable regulations to deter the crooks. And the crooks have been at it since about 1975, they have a lot of experience at gaming the system and taking over the system. (Just ask the Frist family.)

Our present schemes of Medicare and Medicaid have some advantages (a single short paperwork trail is very possible, for example) but are far from perfect for a variety of reasons in this regard. They will most likely be the starting point of any set of rules.

In a country as large as ours with so many factions and critical masses of interest groups, there will not be a simple straight forward answer to a question that is so vital to our economic future (not to mention the moral and public health issues driving this debate.) There will have to be a lot of give and take but what is happening in Congress right now is any indication, it will be a long process with only moderate results. No one plan will fit all no matter how successful it is in a smaller Western country.

But we can look at other schemes and see what works. Our advantages are that we have a superb medical establishment that has made a significant difference in health care (I know there those who will dispute this but that is for another forum), a large pool of participants to spread out costs, and a fairly decent infrastructure of hospitals, clinics, etc. Whatever happens will change this, no question, but medicine has changed significantly in the past 30 years and will continue to change no matter what we do.

The answers will have to be worked out now that we have someone in the President's office wwho is willing to try and not just put band-aids on every thing or just want to help their buddies out with large amounts of money and not worry about the consequences. I know that none of the pie in the sky stuff will ever come true (universal health care for very little money, total access for all, etc.) but we can come closer than we are now.

No, Dennis, I can't agree with you that keeping the system dominated exclusively by publicly held companies would be a good idea. One thing that must be recognized is the differences between someplace like Switzerland and the U.S. I think it comes down to culture. Where are the Swiss versions of Enron and all of the other corporate scandals of the U.S. private sector? Are their levels of executive and board compensation anything similar to ours? The more I see of how things are going with Wall Street I think there is a very basic problem with our system of publicly held companies. And leaving that system in charge of our citizen's health care seems like a bad idea.