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The real problem is this: these bills are cobbled together in secret by congressional staffers, then earmarked in secret, and turn into Christmas tree bills. If you want the support of the American people on this oh great Demos, try this: Put a bill together in public, list the benefits, list the costs to the average American and let us vote on it in a national referendum. Otherwise, it's Hillary II as far as most people are concerned and that = DOA. Be statesman like and do something for the good of the country for a change OR give us the Congressional health plan! For ALL Americans.

I am in medical devices not the hospital, but since they are our customers (for profit and non-profit) I have learned a lot on how they operate. One of the problems is that each department is run by a doctor as a fiefdom. Some hospitals have more central control then others, but the head of the department is always powerful. So take a product that can be used in the ED, PICU, NICU and CVOR/CVICU. You do not sell to the hospital, you sell to each department. A hospital can have manufacturer A's device in the ED, manufacturer B's device in the PICU and manufacturer C's device in the NICU. Meanwhile the CVOR/CVICU decides to go without. Hospital purchasing has to inventory parts and disposables (often ones that expire) from 3 different companies and buy in small quantities. The devices all need different quality control procedures, personnel have to be trained on three different instruments and patients in different departments receive different levels of care. The same thing applies when it comes to information systems, making electronic records far more difficult to implement and maintain.

It is not a question of fraud or excessive salaries (good luck defining that) it is an enterprise that ignores efficiency because they have no incentive to care about it. I am not talking about efficiency at the expense of care, the idea that quality costs money is outdated: ask Toyota. Increased quality can and does drive down price. What they need are some decent cost accountants. So while the current system is not exactly fixing this problem, a universal health care system (even through private insurers) would cement us into the status quo of a broken system. Individuals shopping around is what drives out inefficiencies and lowers costs. But you can't shop until you can compare.

I used to live in Sweden (>30 years ago) and found the state-run health care to be pretty good, in spite of some draconian rules as to which hospital I was required to go to (based on my address) -- that has since been disbanded. However, there was also a private sector of health care which I could use, and did from time to time, and for which I was required to pay (needless to say, my tax money went to the state-run system). It was fine, and frankly, I think that a multi-tiered system would work in this country, too.

After all, isn't more desirable to have healthy, and therefore more productive people, in our society? Ah, yes, it's probably a difference between those who wish to exclude and those who wish to include.

bokonen asks "bsimon, given that information, how is it fair that I and others like me get whacked, while richer people can afford inclusive plans? "

I don't know that it is. When I was self-employed, I chose to take the risk & went without coverage. Now that I have a spouse & child, I work for a company that pays me less, but pays for my healthcare.

As far as what richer people can afford vs. what you can afford, sometimes thats the way it is. Hey, I'd like to be rich too, but I have to budget for what's important to me & can't always buy whatever I want.

I know that everyone assumes that because it is a government, or government-mandated program, universal coverage will by definition be messy and wasteful. Does no one recognize that there is plenty of waste and unnecessary spending in the private sector as well?

muD, what has your experience been working in (I am assuming) for-profit health care? Are the premiums paid put always put to efficient use, or is there skimming, overbilling, excessive salary cost - as in almost every other industry, to one extent or another?

and Demos, in re: sticker shock, I agree... but if we were able to bargain with Big Pharma (the way the GOP specifically disallowed) and able to take out some of the advertising costs of both the pharm and insurance industries, that could be a savings too.

Also, there are other savings beside the tax cuts which could come into play. For example, we have spent billions, possibly over a trillion dollars so far in Iraq...

Demos, I am currently self-employed, and am paying @$400/month for my insurance. (as a point of reference, this is >10% of my before tax income.) When on a company plan, that was roughly $60/month.

bsimon, given that information, how is it fair that I and others like me get whacked, while richer people can afford inclusive plans?

also, from what I have heard, the state "universal" plan in Massachusetts (where I live) is going to be considerably better than "crappy, minimal coverage."

My point is that health care is NOT yet another way in which the rich / poor gap in this country should be made manifest, unless you are willing to concede that material success is really all that matters when determining the value of a person's life.

The founding fathers, who were admittedly a group of rich white men, seemed to think otherwise in listing "health" as one of the "inalienable rights" with which humanity was "endowed by the creator."

Health care in general is something the Democrats can use to beat up the Republicans. Universal coverage specifics is what Republicans use to beat up the Democrats. While large numbers of Americans want more affordable coverage that cannot be lost, everyone of them has a different idea of how to go about it. If you propose a plan that doesn't include their idea of how to fix it suddenly the guy without a plan starts to look good. Better no plan than the wrong plan.

Any plan for tax dollars to support universal coverage will bankrupt the country unless reforms dealing with efficiency and quality are also put in place. Now that I work in medical devices I see how hospitals operate. I never imagined such temples of inefficiency could stay solvent. And it is all in the name of "care" which sadly isn't always very good. Until people can shop around costs will never be contained properly. And by shopping around the health care consumer has to be able to compare price and relative quality. One without the other is worthless. So while I am pro universal coverage I'm against any plan that doesn't tackle the cost and quality of care issue. It's not that I mind rewarding bad behavior, it's that I mind bankrupting the country.

As far as I know all the candidates plan to fund UHC using the tax cuts for millionaires/billionaires set to expire in 2010.

Some would happily blow that money in an Iraqi quagmire without blinking or accountability but will howl loudly about spending it on UHC for the citizens of the USA.

'What better way to 'prove' the inefficiencies of big government than to grow the government & appoint incompetent, bungling cronies to run it??'

bush will be out of power soon, so that doesn't have to happen. under clinton, both FEMA and the Veteran's administration were models of efficiency.

One very important limitation of these poll questions is that they don't give any hint of the size of the taxes that would be required. Most of us have no idea what our health insurance costs, because we get it through an employer and only pay 20% or so of the premium, or we're in a government program like Medicare or Medicaid where, again, the government picks up most of the tab.

If fixing the problems in our health system were easy, we'd have already done it. Unfortunately, any real world solution is going to take a lot of money - and it's like buying a cell phone, the bills will keep coming every month, forever and ever, amen.

That doesn't mean we shouldn't do something, but we have to all understand that there's going to be real sticker shock involved. I suspect that when poll respondents understand that the tax increases aren't going to be $5 per paycheck, but something noticable, then the support numbers may change (unless supporters of whatever plan is under consideration do a very, very good job of selling it).

drindl writes
"It's all a matter of whether the organization is run by competent, experience managers -- or incomptent, bungling cronies."

What better way to 'prove' the inefficiencies of big government than to grow the government & appoint incompetent, bungling cronies to run it??

Right now In Medicare Part D, we have a system where privatizing ends up costing taxpayers more. Every single company that participates is paid significantly more for delivering the same services than Medicare is. It's absurd -- a bribe because they won't participate unless they are guaranteed high profits. What is free market about that? That's holding taxpayers for ransom.

And there is nothing inherently less bureacratic or effiicient about a transnational corporation than there is a government -- that's just rightwing tripe and propaganda. It's all a matter of whether the organization is run by competent, experience managers -- or incomptent, bungling cronies.

HokieAnnie writes
"Getting laid off from your job shouldn't mean the loss of your health insurance. People are chained to jobs for the health insurance, afraid to take career risks such as starting their own business."

Exactly. It is idiodic that health care is tied to a job at all. It is idiotic that my employer is burdened with covering the health care needs of me, my family & all the other employees & their families. Health care should be up to the individual - not up to that individual's employer. If I want crappy, minimal coverage, let me buy into a gov't provided insurance plan. If I want better 'gold standard' coverage, let me pick a private insurance company - in other words, put the free market to work - if private enterprise is so much more efficient than gov't bureaucracies, the consumer will flock to private insurance. But, most importantly, detach employment from health care coverage.

I find it interesting that Obama and Hillary's plan are very similar to the plan that Edwards laid out Months ago. The only difference is that Edwards plan is bolder. My opinion is that any plan the Democrats put forth will have to be cut in some way to get it through the Congress with at least some Republican help. With Edwards he can put his plan to the congress and then comprimise on some issues so that it passes and everyone is happy.

I also wanted to point out that the belief that the federal government cannot run a healthcare system is false. Medicare is an extremely well run program. They run much lower administrative costs then do large HMOs. Now don't get me wrong Medicare has some problems too (like not using electronic billing which would save millions of dollars). And the prescription drug benefits needs to be reworked so that Medicare can negociate their prices, but otherwise the system works very well.

Getting laid off from your job shouldn't mean the loss of your health insurance. People are chained to jobs for the health insurance, afraid to take career risks such as starting their own business.

Many employers sense this and as a result use with to gain the upper hand.

The question will become; Who pays the taxes and how much more will they be? Many Americans don't have faith that sending their tax dollars to be spent by Congress and government bureaucrats is such a great idea.

Perhaps Congress should demonstrate more restraint and a higher respect for the American taxpayer's dollar. After regaining our trust we might be more likely to support an investment in a healthcare system.

I think it's more accurate to say that nothing has been done, by Democrats at least, because the Republican party controlled Congress for 12 years and has held the White House for more than six.

The tactic that Republicans will adopt in addition to decrying tax increases will be to paint any universal system proposed by Democrats as a massive, inefficient bureaucracy that gives subscribers less control over their health care options.

Can we have a bit more information on the different plans the candidates of either party are proposing?