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47 million uninsured.

Bracing figures from the Census Bureau: 47 million Americans (15.8 percent of the population) lack health insurance, up from 44.8 million last year. And the number of uninsured children rose for the second consecutive year--after years of steady decline. The Los Angeles Times reports:

Most of the problem with health insurance were traceable to the continued erosion of employer-based healthcare coverage. The percentage of people covered by employer plans decreased to 59.7% of the population in 2006, down from 60.2% in 2005.

Of particular concern, the number of uninsured children rose for the second year in a row, after a long period in which it had been steadily declining, thanks to the expansion of government health coverage. More than 600,000 children joined the ranks of the uninsured in 2006, a change that the Census Bureau called statistically significant.

"The increase in the uninsured rate [for children] can be attributed to the decline in private coverage," said David Johnson, chief of the Census Bureau division that produced the statistics.

The news about uninsured children comes as the Bush administration and Congress are deadlocked over a plan to renew and expand a popular federal-state partnership that provides health insurance for children of the working poor. Known as Healthy Families in California, the State Children's Health Insurance Program insures about 6 million children nationally. But it will expire Sept. 30 unless President Bush and Congress can come to terms.

Bush has proposed a small increase for the $5-billion-a-year program, one that independent analysts say will not be enough to maintain the current levels of coverage. A Senate-passed plan would cover about 3 million more children over five years, while a House version would extend coverage to 5 million more children. Bush has vowed to veto both bills.

Yesterday, the New York Times editorialized on the subject:

The challenge to the White House and Congress seems clear. Theupward trend in the number of uninsured needs to be reversed becausemany studies have shown that people who lack health insurance tend toforgo needed care until they become much sicker and go to expensiveemergency rooms for treatment. That harms their health and drives upeveryones health care costs.

The most immediate need is toreauthorize and expand the expiring State Childrens Health InsuranceProgram. It has already brought health coverage to millions of youngAmericans. It should be reinvigorated to bring coverage to manymillions more.

Not to worry, the American Medical Association (AMA) is on it, as its recent ad campaign, "Voice of the Uninsured," makes clear. Last Thursday, the New York Times ran a heartstrings-tugging full-page ad from the AMA. "One out of seven of us doesn't have health insurance," its headline announced. "But we all have a voice. And a vote." Below that headline was a photo of a middle-aged black woman holding a stethoscope up to her mouth as though it were a microphone. And at the bottom of the page, the campaign's Web site: VoiceOfTheUninsured.org. Sounds positively empowering, doesn't it?

"One out of seven Americans is uninsured," the Web page repeats. "This isn't just a statistic. It's a tragedy." Indeed it is, so why would the AMA's proposals (PDF) track so closely with President Bush's inadequate plan? Laden with reassuring verbiage emphasizing the importance of "freedom," "choice," "security," the AMA's ad campaign seems to be a rather impressively executed bait-and-switch.

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Perhaps someone could set me right on this, but it seems that every time I hear or see a piece on this subject (the NYT, PBS, NPR, and so forth) the question is examined as if it belongs purely to the United States, implying that we have nothing to learn from any mere foreigners on the subject. But somewhere there must be a book (or even a long article) that looks at comparative health care systems and the ways in which they are paid for and the kind of care they give. Switzerland, I believe, has a combination of public and private (insurance company) funding as we do, but manages to do it better and spend far less. Why? Are there other places do the same?I would very much like to find something that asks what the Canadians (for instance) or the British or the French or the Italians (the last named ranked at the top in a recent comparison I heard about) or others do right, and what they do wrong, and what we can learn from both their successes and failures. Does such a work exist? Mary Ann Glendon's Abortion and Divorce in Western Law is a splendid example of this kind of comparative study, breaking out of our commonly constricting American parochialism. Perhaps someone has done similar work for medical care, but I don't know about it, and I don't hear either the media or the candidates raising the subject. Any suggestions?P.S. I was delighted to read about Italy's ranking, since a month and a half ago a new grandchild appeared in Florence. Our daughter told us that her hospital and doctors were very, very careful to give the baby the whole battery of tests for anything that might even be possibly wrong (not that there was), because it's well known that all Americans sue obstetricians at the drop of a hat. Gunboat diplomacy, in other words, with the trial lawyers at the helm. How nice that our country has such a awe-inspiring reputation in the world. Makes one proud.

To add insult to injury the plight of the uninsured is seen as a great market for lenders. Captitalism unchecked?http://www.nytimes.com/2007/08/30/business/30medloan.html?_r=1&ref=today... are studies and they show that the US spends twice as much while not as good as some industrialized countries. And look at all that support for Kucinich. (in the comment section)http://www.commondreams.org/archive/2007/05/15/1198/Is Kuchinich the only one with courage to take on the insurance companies?

I think the only solution from an efficiency and equity point of view is a single payer system. We've been talking about this on Vox Nova for a while now. I made the initial argument here: http://vox-nova.com/2007/06/26/health-care-reform-in-defense-of-single-p...

Insured Americans already gripe that their health care is dictated by insurance companies--and it is. You either accept the treatment your plan provides and go without the rest. Unless you're a multi-millionaire and money is no object.Universal health care will give some Americans (especially those without insurance) better care. Some (those with very good plans) will be worse off. Because businesses aren't going to support private insurance plans when they have to pay taxes to support a universal plan.The devil will be in the details, as we saw from the hash Hilary Clinton made of her effort to improve the situtation.I'm not sure it's necessary to go to other countries, whose economiies are very different from ours, to see what works and what doesn't. States and localities--even individual hospitals--have experimented with a number solutions for the un- and under-insured.A couple of years ago, the New York Times ran a cover story about a Catholic hospital which absorbed the care of its most difficult diabetes patients, who tended to use the emergency room. Providing them Cadillac care for their illness was incredibly expensive, but kept those patients out of the ER and ICU, which were even more incredibly expensive.There is a small community not far from my town where a retired GP has organized a group of physicians who staff a pro-bono clinic. A friend with complicated neurological ailments couldn't afford insurance coverage, but was able to get care on a sliding scale. The docs in the clinic cut a deal with one of the local hospitals to provide lower-cost services for the clinic's patients.One of my son's doctors has a special rate for uninsured patients.Michigan has long had coverage for children in families that are above the poverty/Medicaid line, but below the ability to pay top-dollar premiums. Kids are fairly cheap to cover.A local grocery store chain provides free antibiotics to any customer. It's increased consumer loyalty and helped them compete with the Rite Aids and Walgreens.Some drugs retain their potency after the "expiration date," and could be reserved for needy patients.It might be a good idea (and I can't believe I'm saying this, as both a liberal democrat and someone who has lived through a horrendous period of being uninsured) to let the local and state experiments continue.On a national scale, wider, cheaper--or even free--access to preventive care measures might be a good first step most people could agree on. Physical therapy and carpal tunnel splints have kept me off the operating table. Relatively inexpensive testing, lifestyle changes and simple monitoring have kept my kid out of the ER and hospital for his asthma. Sorry for the length of the rant. But I just don't think that Americans are philosophically ready for universal health care. And I'm not sure our economy--given our emphasis on national security, shot-gun diplomacy and loss of lucrative blue-collar jobs--could sustain it.Small steps that make big differences are the key, I think.

Jean: you aver that this country's economy cannot afford universal health care.How in the name of God can we NOT afford it? Look at what we have today .... a disgrace throughout the "first" world and an allegedly Judeo-Christian country. If 47+/- million people rely on an ER as their medical plan, look at what someone is paying! If the employers are bailing out of healthcare like it is the plague, the taxpayer will end up paying one way or the other. At least let's devise a form of care and coverage that gives us more affordable, comprehensive coverage for those who are adrift without coverage.When I retired I came face to face with the cost of the losa of my group plan's coverage. It wasn't pretty, folks!As far as Americans not being philosophically ready for universal healthcare, are they philosophically ready for the future which can only be worse? To play off of an old saw: A Democrat is a Republican who has lost his/her health plan coverage.

Jean is absolutely right on this. We, as a nation, are not ready or willing to fix this problem on a grand scale.First, we have to look at what the actual problem is. Many of the 47 million uninsured are uninsured by choice. That is something that is rarely discussed. For example, there are many well-employed young people who when given the choice of paying a $300 a month premium (even if subsidized by an employer) and having more money for a nicer car or apartment, choose not to get the insurance. This doesn't mean that there aren't a lot of people who have trouble getting health care, but that the "uninsured" isn't a very accurate gauge.OK Joseph - leave aside that the military healthcare system is barely capable of handling what it is already responsible for - suppose we do this. I will tell you now that most Americans wouldn't put up with it. This is where Jean is right on point. A socialized or single payer system must have built in restraints and scarcity. I spent 42 years under the military system. It's a good system, but now that I am out and using private insurance I can tell without a doubt the private system is more responsive to me as a patient. I never once got to pick my doctor. If you got one you didn't like, you might be able to complain and get assigned another - but you still never picked the replacement. For chronic issues, you might wait weeks and weeks for tests and procedures that I can now schedule in a week or two. You might be taking a medication for months or even years, and suddenly your doc changes it not because something else is better, but because the new pharmacy contract carries only the new med because it's cheaper and the doc has to write a justification why you need to stay on the old more expensive med and he won't - say hello to a whole new set of side effects - I know, it happened to me.Yes, there are millions of Americans who would benefit from a single payer system, but there are millions more that would suddenly have to deal with artificial scarcities and regulatory restraints that would be completely alien to them.

Jimmy, I'd love for us all to have free, universal health care tomorrow.I've written to legislators, voted for candidates who advocate for health care reform. But even when elected, they do nothing. I feel like I need a trip to the ER from beating my head against a wall. Practically speaking, I just don't think we have the national will to do anything about it on a grand scale. There are too many other problems, real and concocted, that take up energies elsewhere. Incrementally, I think we could do better. And I think, incrementally, is how things will improve. Believe me, I'm not looking at this like an uninvolved outsider. Two close friends died of cancer in their 40s of cancer, both leaving children at home. Both families had fairly good health care to begin with, but once you can't work anymore and pay the premiums, you're not only dying, but dying in debt.I know couples who are un- or underinsured who say they'll simply divorce if one becomes catastrophically ill just to protect the family assets.Just to keep it all Catholic, what are parishes willing or able to do to help alleviate these scenarios? A spaghetti supper is nice, but it's a drop in the bucket if you're on experimental chemo.

Maybe the govt. could require every able-bodied male and female between ages 18 and (X) to serve on active duty for a minimum of (X) years. In return, every extended family member --- parents, grandparents, in-laws, etc. --- (as well as immediate family) would be automatically enrolled in the military's healthcare system.This way, Georgie gets his troops for Mideast deployment and folks, uninsured and underinsured, get their healthcare coverage.To save money, however, coverage would cease in the event of a military fatality in the family."If ya' can't beat 'em, join 'em --- er, the military, that is!":)

Jean wrote,"Just to keep it all Catholic, what are parishes willing or able to do to help alleviate these scenarios? A spaghetti supper is nice, but it's a drop in the bucket if you're on experimental chemo."This is the most sorrowful scandal. I remember helping people in parishes and they were surprised that I was helping them. I said what am I hear if not to help. Oh I forgot the Sacraments. Catholic Charities is a shield for many parishes and dioceses whose pastors and bishops live better than the upper middle class. Catholic parishes do make sure the poor will always be with us.

There's an old saying: "An once of prevention is worth a pound of care."It's true. The moral right of every person to reliable, quality healthcare notwithstanding, single payer universal healthcare is the smart way to go from a strictly economic point of view. The truth is that in America the taxpayers already foot the bill for the healthcare of the uninsured in the form of expensive, unpaid Emergency Room visits, when patients present with serious, advanced complications. It would be a lot cheaper for taxpayers to pay for the 47 million Americans without insurance to have access to regular primary and preventative care, than to pay the even greater costs for the care needed when sicknesses or conditions become life threatening. Comparatively speaking, the US gets very little return on every dollar spent on healthcare relative to other countries that allow everyone access to primary care.

Not to beat a dead horse here, but we get free legal care in this country if we're accused of a crime because it's enshrined in the constitution.There is no corrollary right to medical care. Morally, I agree we have an obligation, but the federal government's been wrangling about where that obligation starts since the Truman administration. Anybody living on the shifting sands of Medicare/Medicaid knows how much depends on which way the wind is blowing politically.In my experience, you can get further trying to pull something together on the local level with hospitals, pharmacies, doctors, etc. One really easy way even a poor parish could help out would be to pick a saint's day--let's say St. Rocco the Hospitaller or St. Martin de Porres--and ask for a second offering of pharmacy vouchers to be kept on hand for people who need them.Another way is for churches to pool resources. In my town, if you want anything done, you call up the Methodist ladies. Need a wheel chair? Respite care? Hot covered dish? 12-hour turnaround, max. Those are the people who ought to be running our national health care system. As a Methodist lady, I'm surprised Hilary didn't cotton on to that!

The American Cancer Society announced yesterday that it will focus its 15 million a year advertising budget of the fact that cancer cannot be prevented unless the uninsured can get preventative care. By the time they get to emergency rooms the cancer is too far advanced.http://www.nytimes.com/2007/08/31/us/31cancer.html?_r=1&ref=todayspaper&..., good ideas on how churches can help. I'll give you a better one. Give the Christmas collection in every church to the uninsured. Traditionally, the Christmas collection goes to the Pastor personally. The reward of loyalty?This is so little known that one cannot even google it. Now you will.

Sean's experience with the military's health care system is probably what we could expect from a national health system in America. Pretty crummy care.Other countries can make it work, and they can make it work better than our military. The reason is that they have the will to do it. Americans don't. They haven't for 50 years, and they don't now.So, I think it's more productive to try to find common ground. And clearly there is some (or Hell has frozen over) where a conservative like Sean and liberal like me might be able, if we lived in the same community, to kick around some ideas that might help people we live and work with.FWIW, I don't know how many kids opt out of their insurance programs, and Sean doesn't provide stats. These kinds of claims strike me as a wish to believe the problem really isn't that bad rather than any hard evidence of the severity of the problem.OK, I'll shut up now.

Jean,I think you're way, way off on the will of the American people:http://www.cbsnews.com/stories/2007/03/01/opinion/polls/main2528357.shtm... times, they're a-chanin. And while I find it inspiring that the Methodists and other churches--sorry, ecclesial communities do that kind of work, they'll never be able to take on the health-care crisis in the United States. Bill, thanks for pointing out the Times story on the American Cancer Society. The article makes no mention of the fact that the AMA ad campaign is about more than simply raising awareness. Bad reporting.Not all VA hospital care is substandard, although a lot is. There were a few stories about this earlier this year. I'll try to dig them up. And I don't know that there are figures for how many spoiled rich-enough kids opt out of health insurance in favor of a plasma TV (it's tempting), but can the total be anywhere near that of those who simply can't afford it? And I have news for Sean: the health-insurance industry is built on "artificial scarcities." That big, bad hobgoblin Health Rationing is already running the game--he, or she, usually goes by another name: medical director.

Jean: I don't think that a lot of Americans were philosophically ready for the New Deal or Civil Rights Act to be enacted, either. But the then-sitting President and Congress acted as they should and this country took a major turn for the better.If the Democrats in positions of power would only stop being crypto-Republicans and push for universal health care, i.e., "do the right thing," we would have it.You are right about the churches, too. How much money has been lavised on exquisite appointment to buildings in our parishes that could have been put to better use? Here in the Diocese of Oakland we are spending close to $200 million (!) on a new cathedral complex. Talk about extravagance in an area of relative poverty here in the Bay Area!Yes, our new Cathedral will be beautiful and, yes, God deserves the best --- blah blah blah. But I don't remember Christ telling us that we would find him in buildings, appointments, clerical drag, etc., but, rather, in each other.

The whole thing about the necessary rationing of health care under single payer is a MYTH. Sure, if you do it on the cheap, like the UK, there is rationing. But there is virtually no rationing in France, which has an excellent health care system, and still manages to provide health care for almost half the cost in the US, with substantially better outcomes (the reason is simple: there are no middlemen "insurance companies" to gobble up the resources). As it is, there is substantial rationing in the US. The 47 million without insurance have limited access to care. Remember too that the leading cause of personal bankruptcy is unpaid medical bills. A recent study by the Commonwealth Fund shows that only 47% of U.S. patients could get a same- or next-day appointment for a medical problem, worse than every other country except Canada. And 40 percent of Americans stayed away from a doctor last year for cost reasons. In short, there is substantial rationing in the US, it's just that there are no firm statistics on it. European countries do keep these statistics, and they are preyed on by opponents of "socialized medicine".

I really am sorry to keep butting in here, but I feel that the conversation isn't really going deep enough.Morning, the French have a wonderful system because they have different national priorities. It would be interesting to do a federal budget analysis on a per capita basis to see exactly what the French have decided to live without (or live with, in the form of higher taxes) to make their system work. Moreover, the cost of health care here could be even higher, even if we followed a French spending model, if the average American is sicker than than the average French person.Grant, I guess I see a difference between opinion and will. Everybody wants the feds to fix the system (which might mean a variety of things), but the poll doesn't dip into what people would be willing to sacrifice in order to do so. A more revealing survey would look at national priorities and ask people what they're willing to do/give up to accommodate a single payer system, as suggested above. That's the crux of the biscuit the polls don't really get at.Jimmy, I don't disagree that health care should be a right, but I think political and economic realities are different from when Johnson signed civil rights legislation and rolled out the Great Society programs. I hope I'm not a bigot, but I no longer believe the government can run a decent health care program on a long-term basis. I think the erosion of Medicare benefits is a good case in point. A federal health care system doesn't mean you're out of the woods. It simply means you get care as long as Congress decides it's politically expedient to provide it.

Jean:Total health spending per capita in France: $2,401. In the US: $4,497. Public health spending per capita in France: $1,824. In the US: $1,989. When people talk about the cost of single payer, and its impact on the public finances, they forget that the cost is being borne already. Whether you pay in taxes or in premiums does not matter at the end of the day. What matters is the total you are paying, and what you get for it.

Jean,I don't have the time to look it up now Jean, but not long ago there was a poll that explicitly asked Americans whether they would be willing to pay higher taxes if it meant universal health coverage. Something like 60 percent said yes. That constitutes a major shift in thinking on this issue. Morning's Minion is right: the gov't can't do anything right complaint doesn't hold much water with me, considering what a bang-up job the bloated private insurers are doing.

Medicare has its problems but, unusual for a federal program, it is tons more efficient than private health systems. And Mirabile dictu, the Medicare staff is so much better trained than people at Aetna, Oxford, etc.We spent over 150 billion on Iraq in a war not willed by the American people. Conservative and too many liberal leaders, yes.Health care is a breeze. Lets just get it in motion.

Grant,Of course people say they want universal health care. The question is will those people who have very good and relatively inexpensive (for them) health care be willing to either pay more through taxes or have less responsive care etc. to make sure everyone else gets theirs? Just like Teddy Kennedy loves alternative energy sources until someone wants to put windmills in his view.

Sean, So those people are too stupid to know better, then? Is that what you're saying? Can you leave the dime-store Kennedy bashing out of it, please?

Morning, yes, you pay in premiums or you pay out-of-pocket. If you pay out-of-pocket, you wait until you're in bad shape and it costs you more, and if you can't pay, then you default and the insured pick up the costs, which the companies pass on to the premium payers. Insurance companies are essentially gambling operations, and the house never loses. But let me ask you if the figures above reflect two things that keep European health care costs lower.First, doctors in Europe make a lot less money per year because they don't have to pay off crushing student loan debt. Their educations are subsidized. Is the cost of educating doctors at public expense reflected in the figure above?Second, European governments that operate national health care programs heavily regulate drug prices. Glaxo and Pfizer offer European countries meds on the cheap:http://www.medscape.com/viewarticle/545322Is the difference between what we pay for a drug and what Europeans pay for the same drug (which amounts to our subsidy for the European system) reflected in your figures above?More to the point, are Americans willing to regulate drug companies? I think we can look at the cushy little agreement between the feds and the pharmeceuticals not to negotiate for lower prices for Medicare patients to find the answer to that.The notion that the business of America is business runs deep in the American psyche, and it's reflected in our national spending priorities. It will not change overnight, and trying to change it with a sledge hammer at the federal level is going to spawn threats from companies to send jobs overseas, raise costs, and blah blah. People will get scared, and it will all fail miserably. Chipping away at the problem at a more local level, allowing states and localities to prove they can come up with something American that works--or to point out why they've been able to make more gains because of market forces--is the only way you're going to change that attitude.

Morning's Minion:I think your heart is in the right place. Still, you should be a bit more careful so as to avoid inaccuracy (i.e, the claim about medical bankruptcies, which is simply not true, see http://judiciary.house.gov/media/pdfs/Zywicki070717.pdf), or overselling your point. For example, you claim that "there is virtually no rationing in France, which has an excellent health care system, and still manages to provide health care for almost half the cost in the US, with substantially better outcomes (the reason is simple: there are no middlemen "insurance companies" to gobble up the resources)."Then, however, you point out that our government already spends more money per capita than does France! ($1,989 to $1,824.) Thus, it's practically a logical necessity that your analysis is missing something big here. If the only reason that healthcare costs more in the US is those big insurance companies getting in the way -- as you suggest -- then what explains the fact that US *government* spending is higher? And, for that matter, is there any way that we could squeeze the entire American population into Medicaid and Medicare, and have the government costs go DOWN to France's level? That seems incredibly unlikely; as people like Paul Krugman have pointed out, Medicare is already administratively efficient, and it's impossible to imagine how Medicare could save money if you doubled or tripled its population coverage. Thus, as a logical matter, there must be some very significant difference that you are missing. Perhaps there is a lot of rationing in France of which you are not aware; perhaps France pays doctors in peanuts; perhaps Frenchpeople aren't as lazy and gluttonous as Americans, and hence don't need as much healthcare; perhaps American doctors are too likely to overmedicate and perform unnecessary surgeries (this certainly goes on); perhaps there's something else that we don't know. But there must be some very important reason -- other than insurance companies -- that explains why our *government* (outside the realm of insurance companies) already spends MORE than France yet provides coverage to many fewer people.

In other words, while it might be a very good idea to adopt France's system here in the United States, I'm not sure that it's very useful to claim that France does a good job of covering everybody and for half the cost, and thereby imply the Pollyannish proposition that the U.S. could save 50% of medical expenditures if it adopted France's system. After all, you yourself suggest that there is rationing right now in America but not in France. Thus, how is it that we would save so much money if we adopted France's system and encouraged more people to use the healthcare system more often (no more rationing)? Who knows, maybe healthcare costs here would RISE by 50%, especially if we left in place all the other factors that cause U.S. healthcare to be more expensive (doctors' salaries, unnecessary surgeries, bad eating habits, etc.). It might be money worth spending, but it seems naive to ignore all of the factors that affect healthcare costs other than the bare fact of who writes the check.

Sorry for joining this debate late, but I have a few questions.Are we assuming that the only strategy in public health care is to require that people give up access to private health care? Or are we assuming that people who wish to remain in private health care would have to agree to also fund public health care via extra taxes? I find the latter state of affairs much easier to argue for than the former.Early on, Jean wrote that businesses will not pay for private care when they are required to pay taxes for public care. Why is there an assumption that public care will be financed through business taxes? Providing health care has never been a natural responsibility of business. The system we have is a historical accident, due in part to the one time power of unions. If there remains a market for private care, businesses could still offer private coverage as a perk, and wealthy people could buy it with their own money. But businesses could also get out of the heatlh care business altogether without seeming like heartless goblins.I simply do not understand the following conclusion: mediocre health care that is available to anyone is somehow worse than tens of millions not having any health care at all. Again, though, I am still assuming that a private health care market could continue next to a public health care system. While such a system would certainly produce unequal health care, this does not concern me much. We have very unequal health care now. If we maintain the inequality, but get a lot more people into doctors for preventative and chronic care, even after long waits, then I'm all for it.These are genuine questions from one who has not had time to explore all of the public policy issues.

Joe, I didn't mean to imply that businesses would shoulder the whole (or even bulk) of the cost for a universal health care plan. Only that biz taxes are likely to go up with individual taxes, and "disincent" businesses to provide health care benefits. Granted, many small businesses are yanking their health care plans even now, and if there were a universal plan it wouldn't matter. But it could be used to justify lay-offs to offset a tax increase.I'm sure Grant is right that there is a study out there somewhere that shows Americans are willing to pay more for universal health care. But legislators don't really know what the tipping point is--how much would Americans be willing to pay and what would they expect for the money? And until legislators know that, they won't risk implementing that kind of program. Congress is not know for its collective guts, as the mess in Iraq should prove.Implementing a sliding scale payer plan is a lot safer for politicians; it doesn't diddle with what's in place, and it helps them figure out, incrementally, where the tipping points are. Gradually increasing the safety net, particularly with state and local programs to find out what works, is going to help more people than working on a great big federal plan that completely overhauls the system and makes everybody nervous.I thank Grant for bringing it up and providing the new info about the AMA's plan.

Jean:You raise good points. Yes, as well as subsidizing insurance companies, the US system also subsidizes drug companies (why can't we shift the debate in this direction away from the "socialized medicine" bogeyman?). Just look at Medicare, a perfect natural experiment. In the late 1990s, the government tried to entice people to leave traditional Medicare for private plans. The government paid a fee to the HMO, instead of doing it directly. Welcome, middleman! Not suprisingly, this turned out to cost 11 percent more per beneficiary than traditional Medicare. But, for ideological reasons, the administration continues to push this model.Enter Medcaire part D, a piece of legislation written by the drug companies, for which Billy Tauzin was richly rewarded. Possibly due to embarrassment with the earlier model, this time, traditional Medicare is not even allowed participate. You join a private plan, and the government sends a subsidy. Oh yes, and the government is not allowed to negotiate (again, this is not "socialist"-- it is a perfectly reasonable negotiation based on bargaining power). So, long story short-- the subsidy to drug companies also keeps health care costs high in the US. Of course, there are many arguments about why you should not reduce drug prices, related to innovation etc. Don't believe those arguments either; see here: http://vox-nova.com/2007/07/25/national-right-to-life-committee-is-cluel... made another good point on doctor's income. Yes, it is indeed higher in the US, but the problem is somewhat subtle. The problem is that the current system is biased against primary care, and favors high-earning specialization. GPs account for over a half of doctors in Europe, but less than a third in the US. I think, from the point of view of subsidiarity, we need to focus more on primary care, and the personal relationship between patient and doctor. We don't have that with a system of ER-based primary care coupled with extremely expensive specialist care.

I retired from working at a biopharmaceutical company. Years and millions of dollars go into research, development, manufacturing and marketing of new drugs.That being said, the final product comes into profitability very quickly (assuming that it is good enough to catch on with the doctors, who are essentially bribed to push the pills) and the profitability thereafter is almost obscene. Of course, one the patents expire and generic versions are available, profits diminish. But, by then, some serious money has been made.