Blah, blah, blah. Such empty words you speak. You don't get universal healthcare in a fascist state. Until that is cast off -- until that is recognized -- proposing fundamental changes to a luxury such as healthcare is like stopping to attend a cut finger in a roaring blaze.

Of course the problem with your approach is the employers with younger, healthier workers will elect to pay for their own coverage. Employers with older, less healty employees will opt for the public plan. That kind of plan will help GM and Ford but it will run up the cost of the public plan.

Off-topic, but I only realized yesterday that Ohio Republican felons Noe and Ney are two different people. They've got a lot of them over there.

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I am somewhat confused. Won't universal health care that disconnects health insurance from employment further shift the risk from employers to the public (read middle class) at large. I thought the whole point was about this shifting of risks.

A more cynical observer might conclude that the proponents of universal health coverage are under cover agents of giant multi-nationals.

V: You don't get universal healthcare in a fascist state. Until that is cast off -- until that is recognized -- proposing fundamental changes to a luxury such as healthcare is like stopping to attend a cut finger in a roaring blaze.

Maybe. But since fundamental change to the American state is as likely as my playing in next year's World Series, we are limited to band-aid solutions just now. They are still worth pursuing if the other option is continuing to bear the status quo.

I always liked the idea of allowing open enrollment in Medicare. Mandate coverage, let Medicare compete, and subsize people who can’t afford it through the income tax. Medicare has lower admin costs than private insurers, so for most people that alone will make it attractive. Of course private insurers will try to cherry pick the healthy people but as long as Medicare can compete under the same rules, those people will go to Medicare too.

Medical providers and Big Pharma see this as a trojan horse because once everyone’s on Medicare, Medicare will have the clout to drive down provider reimbursements and drug costs to something approaching price levels in the rest of the world. But realistically the subsidies to medical providers and big Pharma can’t continue in this country. It will crash the federal budget.

Sometimes what's good for GM is what's good for the country. American workers are at a disadvantage compared with workers in most other countries because their labor costs include health coverage. I don't know why unions and chambers of commerce aren't holding hands and singing in harmony about this.

What if the problem is that health care professionals, hospital corporations and insurance companies have been over-compensated in relation to the rest of americans since the inception of medical insurance back in the early 60s? What if the med schools put out enough doctors and nurses so that their rate of unemployment was equal to the national rate? What if pharmaceutical companies weren't allowed to advertise in magazines and on TV?

I'll bet most americans could afford health care out of pocket.

But since fundamental change to the American state is as likely as my playing in next year's World Series,

Oh no you don't! It's my girl who is going to be the first woman to play in the Major Leagues.

I'm glad that Andy Stern is part of this debate. It's at least partly the fault of major unions that we DON'T have universal healthcare. The unions actively campaigned against it in 60s, 70s, and 80s (at least) because they were afraid that it would heart their recruitment efforts (as they are in the health insurance business as well). Andy Stern taking the SEIU into this direction (and away from the other unions) is a good thing.

Oh no you don't! It's my girl who is going to be the first woman to play in the Major Leagues.

Well, if you want to nurture that ambition, you better take her to Dodgers Stadium more than you did this year, Mr. Worst Parent in the World.

Sigh. So true, so true.

Say, do you think there will be a Major League team that let's them wear pink? That would swing it, I think.

Oh, and by the way:
good news everyone!

Bwa! Tore your eyes off the page 3 girl for that little bit of all right, did you?

Need a two tier system. a cheap basic medical care for everyone and a very expensive medical care for old geezers with bad hearts who think they are too rich to die.

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shortstop: But since fundamental change to the American state is as likely as my playing in next year's World Series, we are limited to band-aid solutions just now.

Absent fundamental change, band-aid solutions are impossible. Under the present system, such changes as may occur to healthcare or any other area of resource allocation will invariably benefit only those who control the system, to the detriment of nearly everyone else and especially to those who are already mostly ignored by it.

You are correct, however, about the prospects of fundamental change. Barring the emergence of a national leader who is not beholden to corporations and special interests, and who is both humble and charismatic, and who is committed to and will espouse the fundamental principle of equality--of which there are none--my only suggestion is that you immediately enroll in and then intensely immerse yourself in baseball camp.

Looking for a few good arms and bats.

And now, must run to the great VA system for an INR.

I'd like to hear more about the overhead cost of private insurance for every dollar of coverage compared to the overhead cost of government provided insurance.

I've read the government costs pennies on the dollar while private insurance costs over twenty cents on the dollar for the same coverage. If you make government healthcare programs transparent (e.g. programs to reduce fraud and improve quality of care, programs to identify and promote the best employees) and set clear goals for performance and treatment, it would seem government run healthcare would easily cost less and provide better care.

If true, that would make it worth shifting from the complex and expensive mess we have now to a government run program that is comparatively more simple and rational and controllable.

Fred, that is already demonstrably true around the world, and here at home with Medicare.

It just takes people to remove the ideological blinders and face the facts.

craigie: Fred, that is already demonstrably true around the world, and here at home with Medicare.

Not always cheaper, depending on the system, but certainly as cheap. Better care--sure, and more to the point, for the millions of uninsured, a discussion of whether the a best insured are going to have to make some compromises under this already highly compromised system seems laughable. Person A, who has no beans and rice, is understandably not all that interested in whether Person B may have to downshift from filet mignon to porterhouse...particularly when nobody's suggesting that private supplementary insurance disappear for those who want to/can buy it.

V: ...my only suggestion is that you immediately enroll in and then intensely immerse yourself in baseball camp.

Guess you told me. Off to camp for me, then. I'll write if I get work.

Medicare seems to work just fine. Opening it up could well be the way to go. Take that a step further, what about trying some State run pilots? I don't know about other States, but PERS in California manages to keep costs in line fairly well (from what I can see anyway) I've long wondered why we don't make it an open State program that anyone could join? Add a few million more subscribers to PERS Healthcare as a separate agency and they'd have even more clout to bang the HMO's & Pharma with come re-negotiation time. ;-)

If we can piss away a half trillion dollars in Iraq, this country can afford universal health care for all Americans.

Jacob Hacker,

Any universal coverage system is going to have to stand up and explicitly explain to people that they will have to bear the costs of healthcare even if they are in a demographic group that will actually use very little of it at the present time. In your proposal, it appears to me that companies with a younger employee profile will opt for self-insurance, while those with a more elderly profile will opt for the public system.

The public and the workers already pay for the healthcare plans offered by employers- the public through tax deductions by businesses, and the increased price of the product, and the worker by their share of the policy cost.

Why is this something we want to save?

Time to do the short form- medicare coverage for all, no deductions for businesses, and businesses that want to give their employees more should pay them more with good oldfashioned taxable income.

This would bring our healthcare costs in line with those of similar nations, producing a savings equal to about 5% of our national GDP- and that ain't hay.

A more cynical observer might conclude that the proponents of universal health coverage are under cover agents of giant multi-nationals.

A more cynical, ignorant, observer. Compare us with all the other countries. We spend much more per capita, yet we lose (typically around 20th place, by decent margins from 10th place) on the following metrics:

- expected longevity (31st, 77, France is 12th with 80, Australia is 6th with 81)
- infant mortality (33rd, 6.8/1000, France is 9th with 4.3)
- percentage of life spent in ill health (20th, 10.8%, France is 7th at 8.7%)

Those are the observations. I think it would be pretty cool to live an extra three years, and avoid 16 months of being sick, and do it for 40% less money (France, again -- and I'm just picking France for the whole Conehead/Freedom-fries tie-in, there's over a dozen other good-sized countries that kick our ass on all these metrics).

Economic theory, on the other hand, suggests that free-market insurers will have an incentive to maximize their profits by avoiding likely-sick people, entirely contrary to the social purpose of insurance. They give people incentives to keep secrets, or remain ignorant, about health risks. Theory also suggests that employer-linked insurance (with the standard loss of coverage for pre-existing conditions on job change) will tend to inhibit job changes, which leads to a less-efficient deployment of labor. (Job change friction caused by non-compete-agreements is one reason cited for Route 128's failure to boom as spectacularly as Silicon Valley -- CA sharply limits the power of such agreements. See Saxenian's work for more details.)

There's a competing explanation for the horrible performance of our health care system, namely that we're fat, but we need to do more than just argue about which of these unusual American features (obesity, free market health care) is the larger cause. Against the "we're fat" hypothesis, we have the demonstrated superior performance of VA hospitals (cost and quality) and Medicare (cost, not sure if there is a quality difference).

It may happen that measurements AND theory happen to align with the interests of multinational corporations, but sometimes, what's good for GM actually is good for the US.

We need universal healthcare. A good way to achieve it is to take the burden AWAY from employers. Doing so will put employers on the bandwagon.

We need a program that covers everyone, essentially an extension of medicare.

One virtue of this approach is that employers remain a conduit for coverage, so that everyone who works (including the self-employed, who are allowed to buy into the Medicare-like program for a bargain price) is automatically enrolled at their place of employment.

Why would this be a virtue?

No, wait, let me be clear: this is not a virtue.

Tying health coverage to employment is how we got into this mess. It doesn't guarantee coverage for students, for the disabled, for people whose jobs get outsourced to India, for families broken up through death or divorce. It's a bad idea borne of our puritanical roots (if you don't work, you don't deserve health care.) It has created the patchwork of care that, with for-profit healthcare and out-of-control drug companies, is failing us miserably.

The public and the workers already pay for the healthcare plans offered by employers

Excellent point. Employees, through their value added labor, create all of the revenue that is used to pay for their employer healthcare plans anyway. The managers and investors do not add any value to any goods or services sold for revenue, so they do not pay for any of the healthcare they like to say they generously provide to their employees. Value adding employees, through their value added labor, also pay for the health insurance of their company's managers. The value adding employees would be much better off with universal healthcare because it is less expensive, provides better healthcare than private plans, and the costs are shared by non-value adding participants through their taxes, creating a larger pool of actual contributors to the financing of the plan.

I have never sent a comment to any blog I read, but this whitewashed Republican no plan needs to be shot down right away. I have a pre-existing, 'hiddedn' medical condition since I was nine. To look at me, you can't tell until it manifests, and no, I don''t want everybody everywhere having a clue; I suffer too much discrimination already. The Republicans and Democrats, at the time, truly helped every disabled American when they passed the ADA, only to have a Republican majority on the Supreme Court to eviserate it by claiming that Congressional testimony taken under oath and penalty of perjury to be 'anecdotal' and therefore not proper evidence for the record. This was conservative judicial activitism, and is revelant since this essentially eviserated the protections to 98% of the ADA. It made it legal again to fire people such as me in states such as South Carolina. In came the recession of 2001 and holding a job and finding a replacement job for disabled persons became a struggle again. Understand, I earned a B.A. in Engish with a Minor in Journalism and a core of business courses. I have worked for 5 years in a manufacturing operation, phamacuetical at that, 2.5 years of call center customer service, and numerous jobs in retail stores. The problem with this phony health care plan is if you don't work, you don't have access to health care. Presently, I am and have been taking care of my mother who has Parkinson's because I couldn't find an employer who would hire me and my siblings couldn't afford a home health care professional. By the way, my mother worked from 1968 to 1992, with the majority of that time working for a major mmanufacturing company. If it wasn't for her health insurance, we would be down the drain. Oddly enough, her company was bought out in her last years by a French manufacturer and because of French law, they must offer benefits very closely to their French employees. Viva la France!

Please think about these issues and consider that wealthy businessmen who are Republicans have been saying for at least 2 years that our health care system is broken and needs to be constructed anew, not plugged or revamped.

dr2chase, we're not that fat, not compared to the modern European anymore. Britain and even France are fast catching up.

And Americans are far more health-conscious, spending more time at the gym, eating healthy food, etc., than Brits (and likely the French). They've just discovered transfats here, for example, while Americans have been aware of them for years.

Regarding how fat we are:

http://www.nationmaster.com/graph/hea_obe-health-obesity

Their source is

http://www.oecd.org/document/16/0,2340,en_2649_34631_2085200_1_1_1_1,00.html

which is recent (2005) data. It's in Excel format, but you can read it with OpenOffice if you feel strongly about these things. It's not perfect -- apparently we are most comparable with (essentially) other English-speaking countries because of differences in methodology.

You could make a career out of studying all these statistics, trying to correct for glitches in methodology, and make sense of them all (I think that would make you an actuary). This is one of the things I expect from government that we do not get from the Bush administration. And, of course, once you have the information, it helps to use it to motivate rational action (yet another failure of the Bush administration).

OK, though on topic, I wrote the following for an ABC blog about the health insurance issue, but it never seemed to take. It would be a shame to waste (to me anyway). So for your wonderment or ridicule:

Everyone talks about how "difficult" the problem is. The only difficulty is convincing people to realize the truth that universal health care doesn't mean socialism, but simply organization. We're already paying (exhorbitant!) costs to treat everyone, but it's done in such a round-a-bout, totally inefficient manner. Dozens of countries show us how to insure everyone and do it for a fraction of what we're now paying while living longer, healthier lives - we just have to take a look at the various models and pick one.

I've been living in Germany for over 12 years - as a student, as an employee, and even unemployed - and at no time did I ever have to think about my health insurance, other than informing them of my current status. Quality of care has been good to excellent, appointments with primary care physicians (whom I'm free to pick) are possible at short notice, appointments with specialists (also freely chosen) take maybe a week or two, most dental and medication costs are covered - Americans really have no idea what they're missing.

If someone's telling you universal health coverage means socialism, find out where their money is coming from!

PS: Speaking of the organizational aspect, I just got my new insurance "smart" card (smart, because it has a chip with my data -> no paperwork), and I can now use it for treatment in most other European countries if I become ill while outside the country. If the widely diverse European countries can achieve such a phenomenal organizational feat as that, I think Americans can finally get off their butts and make a functioning system.

The more people we cover the cheaper it gets.

The more we can contribute, the easier it becomes for hospitals and doctors to set the prices they need rather than the juggling they now do to bend to the insurances.

Our system now is regressive rather than progressive. Sure you can get emergency care or immunizations if you're flat broke, but what good does that really do you if you can't treat something before it become life-threatening?

Health is more important than 'life' in this case.

Stupid mealy mmouthed Republicans and their culture of 'life' which is hell on earth.

Yo, V, we need to keep up the good fight on all fronts.

If we don't fight for this one, who'll listen to us on any other issue?

The right to healthcare is a basic right to life; without universal healthcare we cannot fight and win as we have in the past against the scourges of the ages.

And besides, without health, how can you fight for your rights? You'd be too busy fighting for your life...

Which is how the fascists want it.

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Incidentally, Hacker's post is a good illustration of how Democrats can remain clueless and irrelevant. If they start talking about healthcare reform in terms of twiddling with employer-provided coverage, 100 million viewers will change the channel to the cartoon network in disgust.

This is what happened with Clinton. You vote for a Democrat. Oh boy, the Democrat won! And then you get an endless series of stuff like the Hillary Clinton healthplan of '93, which anybody who really needed healthcare could instantly see wouldn't help them a bit.

After eight years of this, some people were fed up (me included). We can all understand when you try and fail, but too much of the Clinton stuff was not even trying, or, as with Dr. Elders, folding like a house of cards in the first mild breeze.

I don't know what inner need Hacker fulfills for KD's blogging strategy, but Hacker's views on healthcare are something I need like a hole in the head, and the Dems should take care to demand the whole enchilada instead of begging for a crumb or two to be thrown on the floor.

1. Healthcare needs to be separated from employment.
2. Access to healthcare needs to be guaranteed to all citizens and legal residents regardless of existing heath conditions.
3. People must have the right to buy additional healthcare.
4. Base health care should NOT cover everything.

Any discussion about healthcare needs to be brutally honest. Most of these discussions are not. Take the infant mortality rate as an example. The US infant mortality rate includes deaths related to premature births. The French rate does not. US healthcare spends more money and effort to save children born prematurely compared with French healthcare. This makes the US infant mortality rate and costs higher when compared with the French. This is not to say that the French system is bad. It simply points out that sometimes costs are higher for a good reason.