Country Doctor

I haven't really said much about health care reform. I am not an expert on the various proposals, I don't really have the time to become an expert, and accordingly I don't have the depth of knowledge to get into the weeds of the various proposals, some of which are designed to make health care work; some of which are designed to preserve industry growth for doctors, pharmaceutical companies and insurance companies; and some of which are cynically designed to scuttle a bill.

That being said, however, American health care right now is a disaster for working Americans, despite the claims that American medicine is the "best in the world." American medicine is the pinnacle, in the sense that it is the most sophisticated for those dealing with disease. But that focus comes at an incredibly high cost that deals with medical emergencies at the margins, but is terribly inefficient when it comes to preventive care and care for the unprivileged masses.

Laying my views out on the table, the best of all plans would be a single-payer plan. Nothing else comes close. Unfortunately, that's not going to happen.

The next best plan is a plan with a public option, although in its current formulation that option just creates a government-owned insurance company. And any plan without a public component is a scam; a governmental role is the only way to ensure the provision of health care and manage cost. Everyone knows this, despite the scare tactics and insular self-interests of those who have dollars at stake in the current system.

But if the public option plan is the only viable plan that offers progress - and it is - the plan must not pander to the medical-pharma-insurance complex. Some found it shocking that the American Medical Association announced its support for the House plan. However, the AMA's support really shouldn't be a surprise at all. The House plan does very little to control costs. So the AMA is thrilled by such a plan. But, while such a plan is a boon for the AMA - whoopie, guaranteed growth! - it is a failure for the average American.

As a fundamental matter, American workers should not be tied into jobs just because of employer-provided health insurance. It's bad policy, and bad economics. It creates inefficiencies and unhappy employees, strains the budgets of small business, makes American products more expensive and less competitive with foreign products, creates incentives to move industries overseas, and creates more perverse incentives for retail businesses to avoid providing permanent positions, stacking their payroll with part-time employees to whom they don't provide health care insurance. Among the results - lower quality work from unhappy, uncommitted employees who stuggle to get in enough hours to make ends meet, who still face the risk of economic catastrophe from an ill-timed injury or sickness.

"Conservatives" argue that a goal of universal health care is socialism. That's ridiculous. Rather, it is, or should be, part of government's basic duty of providing security. Securing a basic level of health for Americans is, at its core, about justice, fairness and sound economics.

Perhaps it is time to rebrand health care reform as "Health Security". So-called conservatives, to the extent they pretend to consistency, argue that one of the few acceptable roles of government is to provide security. It's time to drive home the point that this is what the debate is all about. American children, American workers, our parents and brothers and sisters and friends, all deserve a basic level of security, the knowledge that when they need care, they won't be left without needed medication or hospital care or a visit to their doctor; that when their child gets sick, they can get them medical care and maintain their dignity and self respect.

The current health care system, which is rooted in employer-subsidized private health insurance, is a failure for those who don't have access to it, and an albatross around the necks of innumerable Americans who are trapped in unhappy working conditions, a hinderance to entrepreneurship, and an anticompetitive burden on American business. The status quo discourages risk-taking ventures that form the backbone of capitalism; it encourages low wage, part-time employment instead of full-time employment with full benefits. It makes workers less productive and less committed to their employers. It makes our products more expensive and less competitive against foreign products and encourages the (almost complete) shift of our nation's manufacturing base offshore. The current system makes us less stable and less competitive as a nation, and less moral as a people.

Health security is the most fundamental security issue Americans face on a day-to-day basis, and to continue to deprive a subset of Americans of that right is fundamentally un-American, and beneath us as a nation that likes to claim that we are comprised of the most generous people in the world.

At the end of the day, I don't care where I see the cost for the plan; if per capita costs are controlled, who cares (or, who should care) if it is paid for out of "taxes" rather than as a paycheck deduction? But the plan must be built around providing necessary care while managing costs, reducing the inefficiencies of the medical-insurance complex which is currently built on ensuring maximum profit rather than insuring basic health.

Do I believe lawmakers can be grown-ups and do health care reform right?

Who writes the campaign checks?