I put this post on my "regular" blog, but since nobody ever goes there, I'll repost it here.

I've been following the discussion on health care reform with great interest. Some argue that we should push for a "single payer" universal health care plan, others argue that we should push for a "nose in the tent" incremental approach. Here's my take on it.

In my view, it's a risk vs. reward question. I start from the premise that the current system is the problem. The only "people" it really works for are the insurance companies and, increasingly (as more diseases are treated by drugs), the pharmaceutical companies.

Given that premise, what are the risks of pursuing an incrementalist approach? In my view, the biggest risk is that, if we win, we simply perpetuate the problem - in perhaps a slightly mitigated form, but the current system will still be in place, helping the fewest number of people at the greatest cost. In that sense, "winning" is virtually indistinguishable from "losing" -because the risks of losing with an incrementalist approach are that the problem is perpetuated, and the reward of winning is that the problem is perpetuated - except that if we "win," we'll be complicit in that perpetuation.

What are the risks of pursuing a "UHC" approach? Well, if we lose, the system is perpstuated. That risk is absolutely cancelled out by the fact that it's the *same* risk as persuing an incrementalist approach.

But what are the rewards of pursuing a "UHC" approach? It fixes the problem AND provides the opportunity for a paradigm shift in both the way the Democratic party is perceived by the working class AND the way we as a society view government's value in solving problems.

We need not argue that government can solve *every* problem, but we can, and should, argue that government can, and should, have a role in solving problems that affect ALL of us.

In short, we won't be much worse off if we lose (and in pure partisan terms, I'd suggest we'll be better off if we lose on a UHC approach than we will be if we win on a incrementalist approach), and we'll be far, far better off - both as a country and as a party - if we win on an UHC approach.

I say we go for broke.

And, yes, I used that expression on purpose. Because if we lose on either approach (and even if we "win" on an incremental approach), more and more people will be pushed into bankruptcy by medical bills, and the execrable Bankruptcy "reform" will insure that they will be even madder about it than they are now. The difference is, if we lose on UHC, they'll have a much clearer idea about who to blame for it, than if we either win or lose on incremental approach.