So, are you opposed to any sort of universal healthcare system or just what Congress and Obama are currently trying to shove down our throats? I haven't followed the coverage closely, but I've gotten the general impression that this bill is a mess of conflicting and ill-thought out mandates that is only happening because the administration has decided we "have to have it", much like a lot of the other "must have" legislation that has been passed. Consequently, I think they really should step back and take at least 6 more months to work on it...its not like the minute Obama signs the bill everyone will suddenly become insured, so an additional 6-12 months won't make that much of a difference in the long run.

I do think that the government has to provide something. My father has sat on the local hospital board for a number of years and I have an aunt who is an administrator for 3 hospitals, so I've gotten a fair bit of exposure to the shit they deal with. One of the big reasons that costs have gone up is that hospitals ultimately still end up treating the uninsured, but because they don't get paid for it, the costs end up getting distributed to everyone else who can pay. This is further compounded by the fact that people without insurance tend to put off treatment longer, which means it ultimately costs more when they finally do go in. The end result is that we all still end up paying for "universal healthcare", even if it doesn't officially exist.

Ultimately, I think the government needs to put forth a system that provides some level of a safety net for everyone. I'm thinking basic care here, basically things that allow people to stay healthy and get adequate treatment when they get sick or injured. Private plans should still be allowed and should even be encouraged. You should still be allowed to choose your physicians, at least under the private plans; although I can somewhat understand placing some restrictions on people who rely purely on the public system. The fact is that there are plenty of doctors/organizations who will attempt to exploit any sort of insurance system to maximize their income, so some mechanisms need to exist to prevent that.

Something has to be done to cut costs in the system. Critics of Obama's plan love to point out that the percentage of insured people has remained fairly constant over the decades. That's probably true; however, the cost of insurance, both to companies and ultimately their employees continues to rise; its not unheard of for companies to see 30-50% rate increases in a single year. Unfortunately, one of the biggest costs is medicine, and the only way those costs are going to drop is if the US stands up to the rest of the world and says we won't subsidize your prescription plans. Europe and Canada won't like it, but its ridiculous that we have to pay exorbitant costs for medicines just so the more socialized system can provide the same shit on the cheap.

I'm not certain what is the best solution is, but I do think it is ridiculous that in what is arguably still the most successful country on the planet, we still can't provide a basic level of healthcare to all of our citizens. Maybe that's a pipe dream, but I think its still worth pursuing.

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I am definitely NOT opposed to any form of Universal healthcare -- and the few case studies you mention are largely the reason why. Some level of preventative care, a formalization of the system that (as you point out) we're already paying for, etc... Those things would definitely be improvements.

But. What rarely gets mentioned in this discussion, when compared to other industrialized nations, is scale and scope. First, scale:

The UK has about 60 million people packed into about 244k square kilometers. (Population density ~246 people per km^2.) Canada has 33 million people spread out over 10 million square kilometers (3.2 ppl/km^2), but if you only look at border Canada, since the vast majority of the northern portion is all but un-peopled, they really have about 31 million people spread out over only 281k square kilometers below the 50th parallel, for an effective population density of 110 people per km^2.

The US has 307 million people spread out over 10 million square kilometers, for a population density of only 31 people per per km^2. Even if you exclude the mostly-unpopulated bits of the Western US, you still have a density of about 38 people mer km^2. About 3 times less dense than even Canada, and 6.5 times less than much of Europe.

So before we go ANY further, tell me how we provide universal coverage on this scale with a cost structure even CLOSE to that of our foreign cousins? The infrastructure costs alone are so vastly larger to maintain a health care network, that costs have no alternative but to be higher than elsewhere on the planet. So looking at the costs per capita to provide healthcare to all of Cuba, and extrapolating that outwards is just bad math, aside from being bad public policy.

Now, if you look at where costs are injected into the system, what are the largest costs we encounter? Pharmaceuticals, Insurance and Legal expenses are the top 3... actual patient care is somewhere below those.

Fixing problems number 4-10 might be good populist policy, but it's horrible fiscal planning. I've said for years that I would be the first standing in line to support universal healthcare if we:

1) Implemented tort and liability reform, and eliminated lawsuits on commission. (Noting that we are ALSO the only industrialized nation on the planet that allows lawyers to file class-action lawsuits on commission instead of charging set fees independent of the outcome of cases.)

2) Implemented patent and distribution reform, and removed the artificial barriers to healthcare materials that most of the rest of the world enjoy.

3) Banned the patchwork of state-by-state regulations on malpractice and insurance coverage that currently make fiscally impossible for (for instance) neurologists to operate in Ohio without the backing of an enormous outfit like the Cleveland Clinic. Or that require insurance policies to cover things like hair transplants and tattoo removal (ala Connecticut).

Until we've fixed THOSE things, providing universal healthcare to all citizens is a recipe for fiscal disaster. And, with the current bills, the CBO and most other government agencies who analyze budgets agree with me on that point!

The system is already largely broken BECAUSE of governments. Until they fix the problems that they, themselves, have caused, the new proposals will simply introduce more problems. Fix the 3 things above, and then I'll happily accept a new tax or a restriction on some choice to level the playing field. All we're doing now is costing everyone more money while keeping a myriad of artificial, and destructive, constraints wrapped around the jugular of the delivery system.

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I actually only got to read this comment, not the original post, as I am a little scattered right now, but..

*standing ovation*

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