Anyone want to beckon me down from the ledge on this one?

No, but I'll stand beside you on that ledge...

The way I view this is that single payer healthcare is inevitable. It will take time and energy to win like women and black americans getting the right to vote, etc.

But hopefully, like electing our first black president, it will come sooner than we imagine, and we will become more unified by working to further a shared ideal/value in the process.

"I don't want the same people who rescued people after Hurricane Katrina--i.e. the government--providing my health insurance."

This is a GOP talking point and hardly commensurate. Healthcare is not some disaster to be prepared and have waiting for a big day. Healthcare is an ongoing issue and we pretty much have all the tools we need. We just need to use them more efficiently. Scraping money off healthcare costs to pay shareholders and marketing costs are unnecessary expenditures. Those vultures need to find another place to roost.

Single payer is good, but don't get hung up on the structure of the system. Most systems can be *made* to work with the right incentives and regulation. Look at Germany: It is NOT single payer but it works equal or better than any system anywhere. There are many different approaches, and many work very well:
http://en.wikipedia.org/wiki/Health_care_system

Universal health care coverage is the end goal we are after, as well as affordable and quality care. It will take several rounds of reform to get it all right I think. But let's not forgo the first round just because we don't reach the promised land right away. Dems have been trying since Truman for national health care. We need to start somewhere. Let's push to get the best bill we can this time, and then once in place, it can be expanded and improved.

Also, some kind of public plan is necessary to compete with the private ones and keep them honest. Bob Reich wrote about that a few weeks ago and he is right. It will keep costs down, and disprove all the rightwing propaganda against "socialized medicine" -- if it's so bad, why fear it as a competitor?

Passing single payer would require an overwhelming popular mandate and a massive demonstration of political will -- neither of which exist yet. The insurance and pharmaceutical industries directly employ over a million people and have an iron grip on Washington.

Even so, I think it's premature for you and LisB to step off that ledge. We don't do dramatic paradigm change well in this country; absent an economic or health catastrophe (neither of which knock wood have occurred), change will as the result of a gradual shift to more progressive values. That is the realization behind Obama's plan and may explain his single-payer comment (though I wasn't aware he made it.)

The way I look at it, any plan that provides universal coverage and achieves a significant reduction in health care costs would be a breakthrough and well worth celebrating.

Germany, Switzerland and the Netherlands have achieved both goals using a system that combines private insurance with strict regulation and a strong social contract. In Germany, health care expenditures run 10.7 percent of GDP. That's one percent higher than Canada and 2 points higher than the UK, but a full 4.6 percent -- nearly $600 billion -- less then the United States.

The Times, in its Economix blog, recently featured a series of posts on health care by Uwe Reinhardt. His post on the German system is worth reading. To me, the money quote is here:

In Europe, as in Canada, that social ethic is based on the principle of social solidarity. It means that health care should be financed by individuals on the basis of their ability to pay, but should be available to all who need it on roughly equal terms. The regulations imposed on health care in these countries are rooted in this overarching principle.

Yet another example of someone expressing bitter disappointment because Obama's doing what he said he'd do or not doing what he said he wouldn't do.

One thing that should have been clear from the campaigns was that no matter which of the three Democrats with a chance won, there wasn't going to be a move to single payer. It wasn't in any of the three campaign-prop plans and, as a result, there was no mandate for it generated in the election.

The Hillaristas and the Obamabots (note equal time given to derogatory epithets) spent a ridiculous amount of time arguing about mandates because that was the only significant difference between their two plans, both of which were just campaign props and neither of which was going to bear much resemblance to whatever we got. Not one of the three plans them considered single payer an immediate option (though Edwards did indicate that if his public entity drove the private companies out of business, he wouldn't shed any tears--a bit of candor that's not helping us much right now).

It was never in the cards and, frankly, the "progressive" single-payer fetish is, and always has been, IMHO, yet another example of a policy generated by ideological preferences and dogmatic faith assumptions rather than reality.

Out in the real world, there are single payer plans that work well and there are single player plans in the world that don't work well--at least not if patient satisfaction is the touchstone guide. All of them do seem to do a decent job of cost containment, but the cost containment measures taken by particular governments are the main source of dissatisfaction.

But, as pointed out above, there are public-private plans in countries in Europe that American lefties usually point to as models for how things should work that work quite well. And there is at least one huge, ungainly, money-burning, care denying, public-private system that is an ongoing, growing disaster that's killing people and threatening the viability of its owner's economy.

I'm indifferent to how we get there as long as we get there. I am gravely concerned that Congress will keep us from getting there. But given the varying success levels of the different systems in Europe, I don't know for a fact that single-payer will necessarily be better and, more importantly, I have no earthly idea how we could possibly implement one in a reasonable fashion.

Who's going to do the work? Are we supposed to just nationalize all the private health insurers? Nationalize part of them and let the rest die? Will we hire their employees into the new system en masse, or will throw them all onto their state's growing unemployement rolls and require them to take the civil service exam if they want in to the new government plan or will we create a class of bureucrats who are exempt from the civil service system?

Where will all these new federal employees work--in the newly nationalized Blue Cross-Blue Shield buildings across the nation we'll be buying or will we build all new buildings and buy all new systems? Where will we come up to the cash to pay for all these assets we'll be expropriating (the Fifth Amendment presumably won't be repealed)? How will we integrate all the different records into one big system overnight?

My point is that whether we did it through some short, sharp, shock transition to socialized medicine or some glacial creep to it that could be undone by a change in administrations or control of congress, converting what we've got now to single-payer system looks to me like prescription for a bureaucratic and economic trainwreck whose backlash (yeah, mixed metaphor, deal with it) could set liberalism back thirty years.

Fight on for single payer if you want. But, in my view, the more useful, and utterly necessary, fight that people should be directing their energy to is making sure Congress does go to a true, workable public-private system rather than killing off the public entity and hooking the private insurers into the public's jugular.

Yet another example of someone expressing bitter disappointment because Obama's doing what he said he'd do or not doing what he said he wouldn't do.

Yes--finally somebody has me pegged. It's got to be frustrated to read posts like mine, but I'm really glad you took the time to respond like you did. I realize I'm late--very, very late--to the health care conversation, and I'm just trying to sort out

- the difference between where we're going and where we need to go,
- how urgently that difference needs to be eliminated, and
- what I need to be doing now, if--thirty years from now, once I've finally figured out what happened in the early 2000s--I want to be able to sleep at night.

You and everyone else have helped me tons. Thanks.