Rotwang seems to have a completely garbled message, partly, it would seem, because he is ignoring basic economics and partly because he seems not to realize how crappy private health insurance has become.

No one, let me repeat that no one, lives "in the comfortable womb of good private insurance." No such thing exists any longer. Wealthy people can afford to pay out of pocket for an indefinitely long time and members of Congress provide themselves luxurious health benefits, but the rest of us are already at risk, even those who have the semblance of "good private insurance."

The opponent is not the merciless economist (god how I hate to ever defend economists), it is the utilization review analyst, usually a nurse, who will deny your care for a poorly completed form as quickly as for the fact that it is quack quack quackery from Quacksville. Ironically, the UR analyst also has crappy health insurance.

This is not a new phenomenon to anticipate under a new government health plan (tightened to the bones by the anti-tax crowd), it is what we have had for 40+ years and it has been getting worse every year. When, 40 years ago, your doctor or your parent's doctor asked you to sign a form allowing him to receive assignment of your health insurance payment, you or they should have said, "Hell no, I will pay you and deal with the insurance company myself." That would have delayed, if not blocked, the UR analyst development.

That water is way past under the bridge. And, THAT is why we need single payer. Single payer can free competent health care professionals to perform their services without the constant insolence of UR analysts, who should, collectively, be relegated to one of the lower rings of hell.

Now, having said that, that only scratches the surface of Rotwang's nonsense. As Rotwang well knows, societal decisions are based on allocation of scarce resources. The scarce resource in this instance is not health care, it is economic power, otherwise known as money. Despite our individual desire otherwise, there is a point where society cannot put more resources into health care. To do so takes resources away from other vital matters. I personally think we could easily take $1-200 billion a year out of the military budget, maybe more, and spend it on health care. But, I do not have the clout to make it happen.

When we max out on our willingness to pay, all other health care finance decisions are zero-sum between health care beneficiaries and vendors. For example, in my long ago job in public health finance, we were concerned that fast growing costs for certain elderly would be spent in the opportunity cost of immunizations and other relatively inexpensive but very effective health care for children.

The low hanging fruit in the health care pie is the excessive overhead of insurance companies (including all those UR analysts). The next, not quite as easy to get at amount is the profiteering by nursing homes, hospitals, pharmaceutical manufacturing companies, medical appliance companies, and others in the health care production function. Yes, that includes physicians who, understandably, make up the most bizarre excuses possible for their extraordinary pay relative to other similarly skilled professionals. Then, there is the matter of what to do with momma (or pop); the very existence of the entire nursing home industry reflects a disgraceful failure of the family.

All of that comes before deliberate rationing. I say deliberate, because we have had de facto rationing for quite some time.

I hope Rotwang does not repeat this sort of column. I have long been a fan of his, but scare mongering is no more attractive among progressives than it is among the right.