Challenging, certainly, but I have a great deal of faith in American ingenuity and good old American know-how. I refuse to believe that France or Germany can come up with a first-class national health care system that works for their people but the U.S. cannot do the same. In fact, I am convinced that the argument you make here is not pragmatic at all, but just an excuse for a philosophical or ideological opposition to national health care.

Kathy, the “conservadems” and “Repubs” have been suggesting that insurance companies be allowed to offer policies across state lines throughout this debate.

Yes, Polimom, I get that part. What I am say is that this is mere anti-health care reform gameplaying. If health care reform is defeated and Republicans actually have to come up with legislation that includes specific provisions for health care reform, allowing insurance companies to operate across state lines would violate the rights of individual states to regulate cost and coverage. I don't think that would go over too well, and conservatives know that perfectly well.There are a number of other serious problems with allowing insurance companies to operate across state lines, and if we want to get into that discussion, we can, but for now my point is that this so-called “idea” or “proposal” from Republicans is hogwash.

Kathy, the “conservadems” and “Repubs” have been suggesting that insurance companies be allowed to offer policies across state lines throughout this debate.

Why, Kathy — thank you so much for clearing that up for me. I did, in fact, have this all mixed up with rocket science. I will immediately cancel my late-night physics tutoring (what a relief!).

Mikkel, of course, replied that it's because the states have different regulatory bodies, and they're setting their rates and standards independently of one another. He probably used the same tutoring service I did. I'll drop him a note so he can cancel as well.

“Friendly” little joshing aside — I see that both CStanley and Mikkel were able to decipher my late-night comment and understand that I wasn't actually concerned about little bureaucrats trying to deliver x-rays on bicycles or something. I had nothing to do with geography, and everything to do with population. In scholastic terms, this translates into numbers and math (though it's still less complex than physics). And I'm amused that you used Canada, since that's one of the countries I had in mind. At 33 million people versus our 300 million people, their logistics are roughly 1/10 what ours would be — even with a federalized system. The UK's population is about 1/5 of ours (though I suppose they could use bicycles given their compact geographical size).

It is these very complex, higher-order mathematical equations, in part, that make me think administering a national health care plan would be… um…. logistically challenging.

Another area is tort reform that will reduce physician's costs, thus insurance costs.

Really? I am sure that you have a list of states that have passed tort reform & studies (by someone other than the insurance companies) showing that the cost and quality of health care has gone up.

Now, if they want meaningful reform now that the horrible idea of the government running it (like other troubled programs, Social Security, Medicare, the Post Office, etc.) is essentailly off the table, Congress can get to the real work of coming up with pragmatic solutions and not liberal pipe dreams.

Meaningful reforms?
Community rating at the state level, the inability to reject people with pre-existing conditions and standardized insurance packages (policy X if bought from Aetna or BC-BS would have identical coverage) would turn most health insurance companies into public utilities or put them out of business.

There are so many possible reforms that have no reliance on a public option, going for a system that once implimented we could never be rid of was anything but serious thinking by the democrats, now that the pipe dream is over, hopefully they can get back to what they should have been doing all along, trying to work with their republican colleagues and come up with a practical reform that the public can be happy with.

The belief that the Republican party is going to help the Democrats pass any kind of health-care bill is either a sign of naivety or extreme stupidity (the kind that keeps you in third grade until you're sixteen). These are the people who came up with death-panels, Obama not American, etc,,, They have no interest in health-care, they had eight years to do something about it, they did nothing.

But she was talking about population size, not geographic size. And actually, although I don't know all the details, I don't think Canada has one nationalized system- I believe it's a federation of systems organized by province, with some autonomy in each region. So, even if their population size were similar to ours, they would not be an example of a one size fits all nationalized healthcare system.

I agree, but Polimom thinks the U.S. can't handle a public health care option because of our size.

Actually it's because each state has their own regulations and that is the primary reason for cost discrepancies.

Uh-huh, and how likely is it that Repubs and conservadems will agree to abolish state regulations or tell states they have to abolish state regulations so Americans can get the same health insurance rates no matter where they live?

“This is why huge national insurance companies ask you where you live and have regional branches even if headquartered in one particular state. Did you realize this? “

Actually it's because each state has their own regulations and that is the primary reason for cost discrepancies.

I didn't say “the same.” No two health care systems are “the same” but all countries that have some kind of national health care system (every industrialized country but us) have in common that they provide at least basic preventive health care to *all citizens.*

Re your But all those other countries are 1/10th our size! I would point to Canada, which is, I'm guessing, about twice the size of the United States. Then there is Australia, which although smaller than the U.S. is comparable in size. .

You can't seriously be saying that an American living in one state has twice the care needs and risks.

I'm saying that certain health risks are higher or lower depending where you are in the country. For example, incidence rates for certain types of cancers, like breast and cervical just for two, are higher in certain parts of the country than in others. An insurance company in Omaha, Nebraska, is not going to give me, living as I do on the East Coast, the same coverage policy — or perhaps more accurately the same premium cost or the same deductible level — as a woman in Nebraska. This is why huge national insurance companies ask you where you live and have regional branches even if headquartered in one particular state. Did you realize this? It's not rocket science.

Also — in response to Leonidas question about why someone in one state pays twice what someone in another state pays for the same coverage, you said “the health care costs and risks are different”.

Hunh? You can't seriously be saying that an American living in one state has twice the care needs and risks. Worse yet — if your statement were correct, that alone would negate any one-size-fits-all solution, would it not?

The fact is, there is no specific plan, government or otherwise. Most Americans want to be able to get the health care and medical services that they need without worrying about how they are going to pay for it. If a public health care option can do that for them, they will be in favor of it. Nobody who lives in a country where you can just make a doctor's appt when you need to or go to the hospital ER when you need to, show them a card, and know that you will not be billed for thousands of dollars, thinks it's a bad thing to have such a system.

Allow folks to buy insurance from other states. After all can you think of any reason why someone in New Jersey pays twice what someone in California pays for the same coverage? Can you?

Yes, I can, because the health care costs and risks are different.

Now, if they want meaningful reform now that the horrible idea of the government running it (like other troubled programs, Social Security, Medicare, the Post Office, etc.) is essentailly off the table, Congress can get to the real work of coming up with pragmatic solutions and not liberal pipe dreams.

There are areas where bipartisan solutions can work. Allow folks to buy insurance from other states. After all can you think of any reason why someone in New Jersey pays twice what someone in California pays for the same coverage? Can you?

Reform the way doctor and hospital costs are hidden from the patient beforehand and make healthcare professionals required to send their costs (udated when changes are made) to a national database so that people can go online and compare services offered and prices for all facilities and doctors in their area. Such open competition will bring down costs.

Strip away the levels of government regulations and you will find savings too, as well as removing barriers between the doctor and patients. Before government got heavily involved costs were much lower and the doctor – patient relationship was probably better.

It also must be understood that insurance companies do not provide healthcare, they provide risk management. As long as the actual costs of the services remain high, the cost of risk management will as well.

Another area is tort reform that will reduce physician's costs, thus insurance costs.

There are so many possible reforms that have no reliance on a public option, going for a system that once implimented we could never be rid of was anything but serious thinking by the democrats, now that the pipe dream is over, hopefully they can get back to what they should have been doing all along, trying to work with their republican colleagues and come up with a practical reform that the public can be happy with.

That just may be, since it was just announced. Congress has apparently decided that business is more important than people. We have learned that conservatives, whether it be blue dog democrats or the republican party, can buy congress against the people's will. Continue down this path and as more Americans are squeezed out of any hope for even the palest description of prosperity and you can expect violence.