There are a lot of *practical* things which could be considered as ways to reduce the burden of healthcare costs to individuals/families and to the economy as a whole. For example, we could eliminate the current regulatory regime which makes competition in health insurance a state-by-state affair rather than a national market. We could look at expanding the number of medical schools to increase supply of physicians, and we should definitely be increasing the number of nursing schools. We could look at the assignment of roles in medical practice--for example, could the role of nurse practitioners be expanded? Should we create a new class of super-nurse-practitioners? What can be done with the application of "lean" methodologies to hospital and physician office management? etc etc

Barack Obama, though, despite his reputation as an intellectual, does not seem to me to have the kind of analytical mind that would be interested in digging into such issues or even directing others to do so. Rather, he is a man of glib verbalization, interested in getting his name on a healtcare bill more than in its actual effectiveness. The same characterization is true of many if not most of our Congresscreatures.

Someone recently observed that getting elected is Dionysian, whereas actually governing is Apollonian.

I don't pretend to know much about the health care system. I do know a few simple things from personal experience. For example, Americans often wait just as long as citizens of countries with so-called socialized medicine. My father, with stage three cancer, waited three weeks before he could have a liver biopsy, another week for the results, delaying his treatment for over a month. Meanwhile, in Scotland, my former grandmother-in-law received immediate cancer diagnosis, treatment, and wonderful hospice care.

I also know that, with the exception of opening up national competition, David's ideas would distribute health care along the same lines as food. The worst services provided by the least trained (the McDonalds Clinic), and then maybe something slightly swankier overseen by someone with a degree (the Olive Garden Clinic), and then small, specialized master treatment (the little Italian place with a year of reservations already booked).

Simply put, I think all Americans should demand the same from medical treatment and education. The best regardless of class status. A baby should not be punished because his parents don't have money.

I agree with David. I'd also like to see tort reform, which would remove much of the rationale for defensive medicine.

Matt, I'm sorry about your father, and pleased that your former grandmother-in-law was treated quickly and well. But I'm not sure either is typical of the systems.

LB...don't think we're communicating here. I'm not suggesting that degree/certificate requirements be eliminated, rather that:

1)We increase the capacity of medical school system to generate physicians, rather than allowing it to be constrained artificially...arguably now being done in order to keep prices up.
2)We do a better job of thinking out which kinds of procedures need to be done by people of what skill level. To use your own analogy, the "little Italian place with a year of reservations already booked" does not require certified chefs to do the dishwashing, or even to serve the tables. This is not a class issue but a division of labor issue.

If the Air Line Pilots Association, rather than the FAA, had authority over pilot certifications, what would happen to pilot salaries and airline ticket prices? I think the answer is pretty obvious.

The actual debate here is about whether the government's present acrobatics will resolve the problem of spiraling health care costs and shrinking access--or make it much worse. ***And there's really no debate about that***.

You can accuse your opponents of not being willing to enter into a serious debate, or you can be dismissive and contemptuous toward their arguments, but I'm not sure that you can do *both*.

Umm, Peter, they aren't my "opponents." They are *our representatives.* Yours and mine. And if you've been reading this blog, you'll know my efforts to communicate with them have met with laughable dismissiveness-as have the efforts of many, many other Americans. More to the point, if you've been reading a properly broad set of news sources, or even just listening to what's been coming out of congressional and presidential mouths, you'll know that I'm hardly making a controversial point about who is willing to debate what in Washington.

And surely you don't want to suggest that there can be any debate about whether a bill no one understands (not even its authors), one few even intend to try to read (see Arlen Specter), and one whose supporters are pushing through as fast as they can in an effort to prevent disclosure and debate, is going to be a positive good for the country?

Finally, let's not diminish this to an internecine spat about whether I argue in a manner that meets your standards. As our president recently said, "this is not about me." In fact, I think it *is* about him. But it's definitely not about me.

Erin,

I think that I may have misread your post. By "there's really no debate about that," I understood you to be suggesting that it was not open to debate (i.e. it was manifestly clear) that the government's policies would be ruinous. Instead, I think that I now understand that you were deploring the lack of serious debate surrounding the policies. Correct?

Peter -- I mean both. I don't think there is a meaningful debate about whether this bill is what American needs (instead, we see far too much conflation of "need for health care reform" with "need for this particular huge spending bill"). I also don't think it's up for debate whether it is viable to race to pass huge costly legislation that no one understands and that few legislators can even claim to have made an attempt to read. Some may think it is, since we've been doing it quite a bit lately. But I think it's just factual--not debatable--that this is grossly irresponsible behavior.