I don't have a whole lot of time to write this, but I'm hoping that the core questions I'm going to forward here will be compelling enough to stand on their own.  As I prepare to leave for the day, I'm listening to NPR.  I've been quite busy lately and haven't had the time to read as much as I like, but I've been trying to follow the political developments of health care reform.  It seems to me that this week we've gotten down to a new meme: "How will we pay for it?"

How indeed.  What strikes me about this talking point is that it is so radically disconnected from reality.  The reality is that we're already paying about twice the median per capita cost of comparable industrialized nations.  As far as I'm concerned, this cannot be pointed out often enough.

So, you could ask, "How will we pay for not doing it?"  Because that's already pretty damned expensive.

However, an even more interesting question is, "Why should we pay for not doing it?"  Even if we didn't reduce costs at all, but merely held steady at current levels of expenditure, by switching to a public insurance plan, wouldn't that be worth it if we were able to do so and everyone ended up with access?

Of course, there's little reason to believe that a public plan wouldn't drastically reduce costs.  Even more important, to my mind, is that it would actually represent a move to create a health care system.  Because we don't have that right now.  We have many high-quality health care providers, if by that you're talking about doctors, nurses, hospitals, etc.  But none of us can afford to pay these people directly.  We rely on the collective bargaining and risk distribution of insurance.  However, our insurance system has devolved into a government protected oligopoly of regionally dominant, rent-seeking cartels.  It is not a health care system.  It does not exist to provide health care to anyone.  It exists precisely for one reason: To turn a profit.  These companies have nothing short of a fiduciary duty to their shareholders to increase value and they do not do this by providing the best quality care at the lowest price.  That would be a competitive market.

That's not how they operate.  They operate by cherry-picking the young and healthy while Medicare picks up the tab for the most costly patients, the sick and elderly.  They operate by making sure that they never end up having to actually pay for someone's care if they can possibly avoid it.

The only people who benefit in this system are people who don't need health care and the people who don't provide it.  That's not a health care system.

When I hear craven politicians wringing their hands over cost containment, I don't care what color their dogs are.  Instead, I hear this: "You will continue to pay for this."  They're not worried about what kind of damage is being done by the status quo, because they are defending it.  The current system could not exist without its government protectors.  When you hear them bitching about the costs of reform, you know their names.  You should know who they are speaking for.  Unless you're a private insurer, it's not you.