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Its over.Seventeen years ago, I was a health policy analyst for the Service Employees International Union and having the time of my life. President Clinton had been elected in November of 1992, and the union became deeply engaged in the fight to pass comprehensive health care reform legislation. In addition to writing countless reports, fact sheets and pieces of congressional testimony, I got to fly around the country speaking to union members about the bill and encouraging them to support it. We were working days, nights, and weekends. I felt like a warrior in a great and holy cause.In the summer of 1994, however, it all came crashing down. The Presidents bill was complex and difficult to explain. It was criticized by both liberals and conservatives within the Presidents own party. Support for the bill withered in the face of an advertising campaign led by the health insurance and small business lobbies. Eventually, the Democratic Congressional leadership ran for the hills, not even bringing the bill to a vote on the floor.I remember the last few days before it became clear that health care reform was dead. We were rushing around, trying to find something, anything that we could take to the floor that would pass. The idea that we could have worked this hard for two and a half years only to end up with nothing was just too painful to contemplate.Sound familiar?A few weeks ago someone asked me how I was feeling about the prospects for health care reform, given that the legislation had moved closer to passage than in any previous attempt. Im like those Boston Red Sox fans in 2004, I responded. Im not going to believe it until the final out.Well, it turned out to be 1986 not 2004. Again.Im joking because if I dont laugh, Ill cry. I work in health care. I know that health insurance makes a difference in peoples lives. It means that we catch cancer early, that people with hypertension avoid a heart attack, that diabetics hold on to their kidneys and toes, that people with depression get the treatment they need to face down soul-crushing sadness.My mother had an Uncle Bobby who was a driver for a small New England trucking company. He had 10 kids. He died in his early 40s from a heart attack. His kids grew up without a father and his wife was a widow at a terribly young age.If Bobby had been alive today, wed have the tools to help keep him alive. Weve got drugs to manage cholesterol and hypertension, health educators and nutritionists to help him develop new eating habits, and patient registries and alerts to track him if hes overdue for tests. Our patients have a cardiac death rate 30 percent below the statewide average. Health insurance and access to high quality health care makes a difference.Yes, yes, I know, the bills werent perfect. But they were better than a lot of people realize and probably the best that we were going to get in the year 2010. As Donald Rumsfeld might have said, you go to war with the Congress you have. With 30 million more people getting coverage, Im sure we would have saved more than a few Uncle Bobbies.Its possible that we may still be able to move the ball downfield. In the wake of the collapse of comprehensive reform in 1994, Congress passed the Health Insurance Portability and Privacy Act (HIPAA) in 1996 and the State Childrens Health Insurance Program (SCHIP) in 1997. The latter was the most significant expansion of public health insurance since Medicaid began in the 1960s.Painful as it is to say it, though, I dont expect that we will see much progress this year. The Obama Administration has clearly decided they need to focus more on job creation and financial reform in the run-up to the November elections. Without presidential leadership on health careand perhaps, to be fair, even with itmany members of Congress will not be willing to take any more tough votes on this issue.At times like this, I am inclined to recall words from the late Senator Edward Kennedy, who championed health care reform throughout his legislative career. They were words that he offered in the wake of another difficult defeat:

For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.

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I don't know about rights, but I believe health care (that's health care, not health insurance) is a basic human need, right up there with food, water and shelter. People can and do die without these things. I have pretty secure health insurance (for the duration of my husband's life) but I would be happy to pay more taxes so other people could have the same. The NY Times today has an article about a battle between a local hospital consortium and United Healthcare (which has 1 million subscribers in NY) over reimbursement rates and admissions approvals. The insurer is seeking major concessions from the hospitals and is, at the same time, seeking a rate increase from subscribers. http://www.nytimes.com/2010/01/25/health/policy/25insure.html?ref=nyregion

Irene said: "The NY Times today has an article about a battle between a local hospital consortium and United Healthcare (which has 1 million subscribers in NY) over reimbursement rates and admissions approvals. The insurer is seeking major concessions from the hospitals and is, at the same time, seeking a rate increase from subscribers."Let's look at this in the context of the discussion above. Your last sentence could imply that the insurance company is trying to squeeze both the hospitals and the subscribers, with the implication that they are seeking a cost cut on one side and a premium increase on the other. The article doesn't say, however, that United Healthcare is going to get a cost cut from the hospital. It said that the insurer led off the negotiation with a cost cut while the hospital led off the negotiation with a large price increase. And even if the insurer got a cost cut, it still has maybe 120 or more hospitals in the system whose costs are going up as well.The "admissions approvals" is actually a request for notification of admission, not an approval of admission. This is so the insurance company can put case managers on the case. The hospital at several points in the article wants to imply that these case managers are accountants. They are actually doctors and nurses. They are not trying to dictate care. They are trying to make sure that the care falls into the best evidence based guidelines for care. Also, the managers deal with the patients as well as the doctors to make sure that the patients follow their medical instruction, take their medications, get adequate follow ups, etc. The hospital doesn't like the idea that their payment would be cut for non-compliance because the pay cut would actually force them to comply and they do not want to be monitored in this way. The hospital is always going to argue that the insurance company is not qualified to monitor standards of care. The hospital is never going to accept any downside consequences for quality of care.

Unagidon: But the article does say the insurer is seeking cuts from the hospitals and increases from the subscribers. It may be a negotiation tactic, but it is still trying to do both at the same time. And the Oklahoma hospital consortium struggling to meet the "notification" requirement says it "doesnt feel to us like cost control, it feels like a revenue stream enhancement to the insurance companies".

UnagidonYour answer to my questions (especially the first one) actually demonstrates why people like me are suspicious of the motivations behind health care reform. Is it about helping people or equalizing them? If what we end up with in 10 or 15 years is a system that is wonderfully equal but inferior, have we solved the problem or just covered it up?

AnnFirst, I am not sure whay you are asking me this, but I would just say this is a faulty economic argument. Take for example a man who owns a factory. It employs 500 people. It is worth $500 million. Tax money that goes to protect it, provide transportation infrastructore etc. doen't just benefit the owner. If the place burns down, the owner is probably the person least affected in terms of day-to-day existence. The workers, suppliers, service providers, transporters of goods, creditors and on and on and on all have an interest in the factory that tax money helps satisfy.Moreover, not all tax provided services bear a relationship to wealth at all - in fact most don't. Since we are talking about health care, if Bill Gates pays $50million a year in txes and under a nationalized system $2million goes for the health care system, is he getting $2million in benefit?JeanAs for "living with casualties" - I would turn to you and ask, are you willing to live with the casualties that would occur under a nationalized universal system? I am not willing to live with casualties at all in the sense that I think they are inevitable. Like you, I want to see everyone covered, but I would like to see it in a high quality system.

Sean said: "Your answer to my questions (especially the first one) actually demonstrates why people like me are suspicious of the motivations behind health care reform. Is it about helping people or equalizing them? If what we end up with in 10 or 15 years is a system that is wonderfully equal but inferior, have we solved the problem or just covered it up?"And you'd have a right to be suspicious if there was a necessary relationship between Brazil's universal care and Brazil's quality of care. But there isn't and the proof is that I am sure you would rather get your heart transplant in France or Germany than Brazil (to name three countries with universal systems). It seems that some people believe that since the quality of American health care is high and was produced under the current system, it follows that if we depart from the current system the quality of health care will decline. We can talk about what kind of a theory of capitalism we would have to have for this to be true. But it strikes me (as a businessman) American capitalism seems tough, innovative, and robust until someone wants to change the current business environment. Then it turns into a tiny little hothouse flower shivering in the sun.

This is an excellent discussion with too many well-made points for me to agree with individually. Just a couple of comments:* If the majority of American voters wanted health care reform, it would have been done by now. The most important question is, 'Why is reform so unpopular?' My hypothesis is that voters are afraid. They are afraid of the state of the economy, they are afraid that if they do lose their jobs they wont be be able to find others, they are afraid because their wealth and savings were halved or worse in the recent recession. So many things that formerly were taken for granted are now uncertain. We live in a time of paralyzing fear. And so, faced with losing one more thing that they want to be able to take for granted (doctor visits and prescription fills with cheap copays, and affordable treatment for catastrophic health problems), voters are clinging tenaciously to the status quo. Just my reading of the psychology of the moment.Btw, if I am right about this - that fear is the overriding emotion right now - then a path is being laid for a demagogue to ascend to power. That is what we got in 1980 - an amiable demagogue. Someone who will say, 'I will make your fears go away.'* I do agree with Unagidon that the market by itself will never provide affordable health care for the poor, just as it doesn't provide affordable decent housing for the poor. If the market fails that sector and the government doesn't step in, we're left with what Jean described: suffering, begging and some private almsgiving that isn't nearly comprehensive enough.Folks who have read my comments here know that I am in favor of markets and don't have a high opinion of the efficiency or efficacy of government programs. But I recognize that the government is the last resort for basic human needs, and I believe that is where we are with health care.(btw, Jean, don't worry about hogging threads. Post more!)

If what we end up with in 10 or 15 years is a system that is wonderfully equal but inferior, have we solved the problem or just covered it up?Sean,It depends on what you mean by "inferior." Suppose we are talking about food, where the rich are eating filet mignon and caviar and drinking expensive wine, and the poor are undernourished. If it were possible to even things out a bit so that the poor could afford decent, basic nutrition, and the rich had fewer luxuries, would that be objectionable? Suppose it is necessary to provide everyone with health care to put a limit on extremely expensive care in order to pay for basic care for people who now must go to the ER if they want to see a doctor. Would that be a wonderfully equal but inferior system?

My hypothesis is that voters are afraid. Jim,I think you are correct. The question is whether or not they should be. I think Obama and the Democratic Party have failed to make the case that they should not be, and the Republicans have very effectively intensified people's natural fears (death panels! deficits! government takeover! socialism!). So both major parties are to blame, but of course the Democrats have merely failed to do what is good, whereas the Republicans have done is evil. Speaking objectively, of course.

"I think you are correct. The question is whether or not they should be [afraid]. I think Obama and the Democratic Party have failed to make the case that they should not be, and the Republicans have very effectively intensified peoples natural fears (death panels! deficits! government takeover! socialism!). "If people are afraid, I'd think the thing to do would be to demonstrate that they needn't be afraid. One of the commenters (it may have been Patrick Molloy - apologies if I'm misattributing) has suggested a couple of times that, rather than spring a vast new program on the entire country at once, we "proof-of-concept" it by running a much smaller scale test pilot program. Pick a representative sample of counties from around the country and show us how mandatory insurance would work, how insurance exchanges would work, and so on. If it works as well as it's purported to, we can ramp up from there.

I agree with you David, about your filet mignon analogy, and like your sly joke about objectivity.In order to prepare the public for this sort of thing, someone needs to explain the matter in terms people can readily understand, for example that the public should consider this as a matter of practical Christianity and not a matter of politics.Once the need to universal health coverage is adequately explained, and is settled in the minds of most Americans, two key issues stand out as needing to be explained:1 - The American public does not want to pay for abortions2 A national health insurance plan needs to cover everyone living here and that includes the indocumentados.No one party can simply breeze into this sort of reform without the proper preparation. Democrats have tried this before and failed. In fact the only Democrat who really tried to explain the need for national health insurance was President Truman. Granted he did not succeed, but at least he made the honest effort to explain the matter. Since then, Democrats have simply tried to ram this through any time they had the chance and each time, they have irritated the public to the point where they get temporarily voted out of office. Frankly, that seems likely to happen again.

Irene said: "But the article does say the insurer is seeking cuts from the hospitals and increases from the subscribers. It may be a negotiation tactic, but it is still trying to do both at the same time. And the Oklahoma hospital consortium struggling to meet the notification requirement says it doesnt feel to us like cost control, it feels like a revenue stream enhancement to the insurance companies."Please see what I wrote about his on the new thread.Of course the Oklahoma hospital consortium would say that. They want to make it sound like the notification thing is some sort of "gotcha". But unless the hospitals have really rotten billing and notification systems that would generate these all the time, how could this end up being something as major as a "revenue stream" for a payer. Could it be just as likely that they don't like the idea that they would now have to comply with their own contracts?

"Like you, I want to see everyone covered, but I would like to see it in a high quality system."Does not sound honorable to me, Sean. Unless looking out for #1 is our motivation for life. So what happens to the concept of the Body of Christ? So if others are hurting they should stay in pain because otherwise they will give me pain. What is wrong for the rest of us to put up with some lack of quality which to others amounts to great care. Seems very materialistic and non-Christian to me. You can choose to prefer not to lose quality of service while helping others. Just understand that it is not Christian.

I read where if a House-Senate compromise version of the proposed Congressional-Obama plan were actually made law, then fully 95 percent of Americans would be covered; the 95 percent noted in the article came from Nancy Pelosi or her office.Keeping in mind the 30 million Americans (and probably 10 million indocumentados) without medical coverage was one reason Democrats initially took up health care reform, and that there are about 300 million Americans; the upshot is that before any health care reform was considered, some 10 percent of Americans did not have coverage. And so if Congress enacts some version of the current reform plans (House and Senate) and spends the money as called for (a great sum of money it seems); some 5 percent of Americans (15 million people) will still not have coverage, and none of the indocumentados will be covered.Hmm.

CBO and JCT estimate that the direct spending and revenue effects of enacting the Patient Protection and Affordable Care Act incorporating the managers amendment would yield a net reduction in federal deficits of $132 billion over the 2010-2019 period. Decreasing the budget by $132 billion does not seem to me like spending "a great sum of money". Or am I misunderstanding this quote from the CBO Director's Blog?

Sean --Sorry to have misdirected my post to you. Thanks for replying anyway.Let me just say to your point that the richest rich have mainly what Keynes called "human goods subject to gravity" as opposed to other goods that can't be measured accurately. (Leave it to a first-rate genius to think up such a beautifully simple distinction :-) It seems to me that the goods you mentioned which are shared by the manufacturer and his employee are not in the subject-to-gravity category and so are not germane to my point. My point attempted to show by means of a measurable goods that the richer you are the more benefits you get from government by way of protection of your assets.When thinking about fair taxes you might bear in mind Leona Helmsley's infamous remark, "Only the little people pay taxes".

David,Unfortunately that's not what we're talking about. The cause of our health care financing problems is not the equivalent of filet treatments. We aren't in trouble because people are getting luxury care.The reality is that what is an inferior system is subjective to a great extent. Any choice will have trade offs. For example, I will admit that the French have what seems to be a very responsive and relatively inexpensive primary care system. They also have a system that does not use diagnostic tests at nearly the level of the US system - one of the things that makes it more expensive. However, French survival rates for most forms of cancer are far lower than in the US. So while your chance of getting cheap quick and universal primary care is better there, so is your chance of dying from cancer.We have a system that nearly 90% coverage and more than 80% of people have some level of satisfaction with the quality. So, I think that a system in which there is 100% covergae but most people aren't satisfied is inferior unless you think that acceessability is the sole criteria for judging the quality of the system.

AnnI don't know about human goods subject to gravity, but I do understand that the value of something is based on the what someone is willing to pay for it, or in that case of taxes the point to which someone is willing to put up with it.The problem with your view is that most of this wealth is not tied up in anything consumable, but in things tha themselves produce wealth. This mentality that is not about fairness, but based in resentment is ultimately destructive. There will get to be a point at which either the productive assets go elsewhere or when the owner finds it simply not worth the effort and risk to use them because so much of the return is eaten up by taxes.As for Leona - aside from being a nasty person, she apparently was an economic moron, and of course a a criminal. The reality is that "little people' pay relatively few taxes. This may be appropriate, but it shouldn't be an excuse for confiscatory taxation.

I just want to say I found Peter's introduction excellent but disagree with Jim that the comentary is execellent as well -a Scrooge like approach that says it's awful to pick a man's pocket to to help others.Bah humbug to that!

Are there no prisons? Are there no workhouses?

"Are there no prisons? Are there no workhouses?"Workhouses? There aren't even any jobs!

Oh please, Bob. Stop with the Scrooge nonsense.For years I have been listening to the left use this tired condemnation of the other side's generosity. What we need is effec tive answers to problems. Not answers that make us feel good and leave the people you say you want to help worse off.Spend some time in a public housing project or a welfare office. These are monuments to the idea that really smart people with enough tax money can solve any problem. Foolish non-Scrooge-like ideas like rent control provided cheap housing to the wealthy and condemned thousands of poor and middle class people to dilapidated housing or forced them to leave urban centers all together.I just happen to think that a system that places as much of the decision making authority about value and expenditures in the hands of the people actually using a system tends in the long run to be more beneficial than one that places almost all decision making in the hands of the government.In fact, as maybe Mark is pointing out - Scrooge is the liberal assuming that the state takes care of the problem - the charitable subscribers are the conservatives in the story.

"For years I have been listening to the left use this tired condemnation of the other sides generosity. What we need is effec tive answers to problems. Not answers that make us feel good and leave the people you say you want to help worse off."Sean, just because the Left always says this doesn't necessarily mean that it isn't true..."Spend some time in a public housing project or a welfare office. These are monuments to the idea that really smart people with enough tax money can solve any problem. Foolish non-Scrooge-like ideas like rent control provided cheap housing to the wealthy and condemned thousands of poor and middle class people to dilapidated housing or forced them to leave urban centers all together."They are monuments to failed experiments. But teh government experiments were in reaction to market failures. How come private sector entrepreneurs are allowed to fail as a matter of principle without it being a failure of capitalism, but if a government program fails, it proves that government can't solve a problem?"I just happen to think that a system that places as much of the decision making authority about value and expenditures in the hands of the people actually using a system tends in the long run to be more beneficial than one that places almost all decision making in the hands of the government."Here is the crux of the issue. You are not defining the poor as the users of the system. You are defining the tax payers (or the private sector). The poor have no power in the market, except through their votes. The market may attempt to create solutions for these problems (and fail) or government may attempt to produce solutions (and also fail). But there are several things for sure. First, political power is not opposed to economic power. Political power and economic power are simply two kinds of power in a society, but different people have different levels of access to them. People use the power they have. Second, any solution will be a mix of government and private power. The people whose power is mostly economic will try to control the thing economically and the people whose power is mostly political will try to control the thing politically. This isn't some kind of nascent socialism. It's democratic capitalism. Or to put it in purely market terms; the government CAN'T intervene unless there's already a market vacuum of some sort. This is why we are talking so much about health care, where the market has failed, and not cheeseburgers, where the market has not.

UnagidonHas the market failed? Or was there never a real market to begin with? Most critics (including the president) trace the underlying problem with our system to the use of employer provided health financing and specifically the provision of health care as a non-taxable form of income. It wasn't a free market failure, but government regulation that resulted in the problem. This all happened at the same time that most of the rest of the world was moving toward socialist models. That isn't the only model.

Sean, I'm in the private sector and what I am seeing in health care is a market. The regulation in it is irrelevant. For a market to exist, there has to be a buyer and a seller. I don't care if the seller is the employer or the member. Makes no difference at all. There is no impediment that I am aware of in terms of regulations that prevent anyone whatsover from buying their own personal insurance policy in the United States. It's just that for many people, these policies would be far more than they could ever possibly afford. That is a market problem, not a regulatory problem. If we took away all regulations at every level, we would still have buyers and sellers and I would still only be selling people who were buyers (i.e. who had the money in their hand). And there would be a lot of people out there (at least 30 million) whose empty hands would not be holding insurance policies.

Bob Nunz is still smarting because I made him work that half-day last 12/25 :-)

Unagidon--I think you are missing something fundamental that Sean is pointing out. It makes all the difference when the purchaser (employer) is not the end user (employee). The discipline of the market is not present when the employee's pocketbook is not (directly) impacted by the amount healthcare he uses. He has little incentive to be efficient when he does not directly bear the full cost his healthcare decisions. The employer can be as efficient as it wants, but this will have limited overall effect, since it has little control over the healthcare decisions of its employees.Although there is no law against an individual purchasing healthcare insurance, it would not make sense for him to do so if his employer is already paying for his coverage. In addition, the employer has a tax incentive for purchasing healthcare insurance, the individual doesn't. The market is simply reacting to the incentives provided by the tax code. Grant the same tax incentive to the individual, and the market will snap call.

Mark, it is truly a pity that this thread is almost dead, because what you (and Sean) said is very important and poorly understood and needs to be examined at length.My responses to Sean were against the idea that I think he seems to hold that there is a free market on one side and government regulation on the other side and that cases where the market is not performing adequately are the cause of regulation. There are theories out the on the right and on the left that business does not like regulation. This is simply not true in fact. Business doesn't like regulations that it doesn't like. They might be "anti-regulation" as a default position when trying to mobilize people that don't know any better, but in fact business people know that while regulations have costs, no regulations has costs too. It's just that in the market, sometimes the benefits of regulation are not enjoyed by the people who have to pay for them. You are half correct when you say incentives incent. What really happens is that good incentives, and only good incentives, incent. And the fact is, revising the tax code would not create good incentives for consumers to buy insurance, nor would some magical group of capitalists spring up suddenly to sell it.Contrary to what Sean thinks, businesses first provided insurance benefits on their own as a way of increasing "compensation" in the context of wage controls during World War 2. I suppose one could argue that without wage controls businesses simply would have increased salaries. But aside from the fact that one cannot run a wartime economy without regulations, capping salaries helped control inflation, which is something that the economy needs to avoid during a war. In short, business wanted the regulatory caps and then in their capitalist style they looked for ways to get around them when it suited their individual competitive needs. The reason that this became so widespread was because in a wartime economy it is very easy for things to spread very widely very quickly.Since health benefits were part of the overall package, if business (in general) had decided to cut them and operate like they did on a pre-war basis, they would have had to make up the cut in salary, don't you think? The economy took off from the war and after the war. They was no labor glut. However, it happened that health benefits were a rather cheap thing to offer. So it became standard and business loved it. The reason that business doesn't love it any more and the reason that they are unable to simply stop giving these benefits and have the worker/consumer take care of them himself is that the underlying costs of medical care are increasing far faster than wages are in general and far faster than business can control. When you talk about incentives and individuals, you are giving very poor marks to how American business acts with what are, in fact, the same incentives. American health insurance from the business person's point of view is all about individual incentives. Those rising co-pays and out of pockets that you have been seeing this last decade or two are precisely from business constructing those utilization incentives that you claims don't exist now because employees get their insurance handed to them by someone else. You must be very wealthy indeed if changes in your insurance plans have not directly impacted your pocketbook relative to the amount of health care you use.The consumer doesn't understand what is going on; I will grant you that. They think that the insurance companies are raising rates on one hand and ripping off doctors on the other (and this when they are not simply denying benefits altogether). But insurance companies (and this is true about any kind of insurance whatsoever) simply is a vehicle for distributing risk and passing on the underlying costs. It's just that the underlying costs are out of control.If there was a way to "incent" the individual any more than we do now to be prudent with their benefits, between us insurance companies and American business we would have figured it out already and we would be ramming down the worker's throat.Business would love to get out of the insurance benefits game and they would love to pass 100 percent of the thing off to the consumer. But consumers would not be able by themselves to pay for insurance. Why? Because at least with businesses there is some semblance of risk pools. A company with sick workers pays higher premiums than a company with healthy workers. There is at least some redistribution of risk within the company. But if you take that away, than only well people will be able to afford insurance, even if you reduce the tax burden to zero. As underlying medical costs keep going up, you are not talking about some free market consumer adapting by being prudent. You are talking about people choosing between medical care and, say, food. If we were to say that business would then have to increase salaries to cover the general COLA of medical care, then business is simply back providing insurance benefits indirectly, without the business expertise (and discipline) that they can use to influence utilization.This is how it really works.

Unagidon--Well, since you already know how it really works, there may not be much that I can add to the discussion ;-) Nevertheless, I will follow up on one thing you said that I agree with, and lament. Big business often does not mind regulation, and in far too many cases actually courts it, to prevent others from entering their market. On the other hand, I've yet to meet a small businessman who has anything but disdain for government red tape.

I'm sure you could add to the discussion. I'm talking as an executive in the business and am always willing to listen to other people's insights.Small business people don't like red tape in theory. But a lot of it benefits them too.

"But consumers would not be able by themselves to pay for insurance. Why? Because at least with businesses there is some semblance of risk pools. A company with sick workers pays higher premiums than a company with healthy workers. There is at least some redistribution of risk within the company. But if you take that away, than only well people will be able to afford insurance, even if you reduce the tax burden to zero. "I've wondered for some time if there wasn't a way to simply take the currently-uninsured and configure them (somehow) into risk pools. Would that be possible? Practical?

As a follow-up to my previous question: aren't there examples of non-employer risk pooling out there? E.g. the Knights of Columbus, the Lutheran Brotherhood?

There are lots of risk pools as you have described. But the question I would ask as a private sector insurer is "whose risk pool"? We could concoct a risk pool of the 30 million uninsured that would probably have a lower cost per person than most people would be able to get on their own, but this doesn't address the problem that many many people simply could not afford to pay for it anyway. Health care costs have risen and are rising so far so fast that risk pool configurations, tax "incentives", "consumer driven" schemes etc. by themselves simply cannot solve the problem through "free market" mechanisms by themselves, whatever the worshippers say or believe.

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