Long Live The King 52


Who should King Barack Hussein Obama go after when we are done gutting private health insurance companies and turning their mostly middle class employees out on to American streets?

How about pharmaceutical companies or those evil government contractors?  Why not the petrochemical industry followed by food manufacturers and then General Electric?  There are some financial institutions who could still use a lesson in manners after the TARP-funded gluttony they just threw in our face.  If we tried hard enough, I bet we could spin up enough populist rage to kill all the companies we allowed to get out of control over the past few decades though short-sighted government policies, lack of meaningful regulation and pathological voter disinterest.

I say we start with King Corn.

Then again, unregulated private companies have long been a blight on the American landscape in one way or another, so it seem to me that the answer isn’t to shut private health insurers down anymore than it was to shut those other industries down when We The People finally tired of their privations. The answer is to harness corporate America via consistent regulation and make them provide for our common needs by enforcing those common sense rules like every other modern industrialized nation has done or is currently trying to do.

Encountering many of the same problems we face today, most universal health care systems around the world went with a public-private hybrid more often than simply replacing private health insurance with a national single payer plan.  In fact, the legislation being crafted on Capital Hill right now has many of the same properties as some of the most successful medical systems in the world.  It is far from perfect, but it seems to make a good faith effort at reforming our system into something much more equitable and sustainable than what we currently have, even with Blue Dogs and Moderate Republicans involved.

I still wonder why Medicare-for-All isn’t gaining traction with the American public when it aims to solve the same problems as what is “on the table” in Congress, especially when Medicare itself is so popular on the left and right.   Perhaps advocating a heart lung transplant as the only course of treatment when diet and exercise might do the trick is a bit extreme for most Americans.

I have many concerns with House Resolution 676 as it is currently written.  Not only does it fail to address the underlying fact that Medicare is unsustainable as it exists today, the legislation also requires that every provider of medical services in the country that would be covered under the plan be public or nonprofit.  Look at Section 103 of the bill for the exact wording, but let me repeat the summary of that section for those who missed it two sentences ago.   Not only does HR 676 kill the private insurance companies that many Americans still support to varying degrees, it requires all medically-related companies covered under our new single payer system become public or non-profit entities within 15 years of enactment.

That fact alone makes it a non-starter for most Americans who are not safely ensconced on the Looking Glass Left.

There is serious doubt the government could pull off national single payer in any form much less as written in the Medicare-for-All bill.  Beyond the poorly constructed legislation itself –  which basically waves a magic wand and hopes the assumptions of wholesale replacement of the existing system will work despite many objective objections – the lack of performance of the US government at just about every level for as long as I can remember gives me serious qualms with throwing all our health care dollars into one leaky basket. Our most successful national efforts in recent years have been small private efforts funded with public dollars. Funds put into research and development or nonprofit social causes have had huge returns for each dollar invested.

The inverse is not true.

Bigger budgets in government lead to more corruption and not less. The Defense Department is one example but there are many others.  All are riddled with piss-poor contract management leading to wide-spread fraud, waste and abuse of public funds that has led to an unprecedented lack of faith in the US government on the left and right.  The health insurance system we have is bad enough as the operating budgets are scattered among dozens of entities with differing strategies and tactics. Put it all in one place and it becomes easier to loot the system. Look at the Medicare link above as an example of the single largest insured population in America getting snookered daily by medical providers and drug companies, no matter how much the people on Medicare like it.

Medicare and the rest of the government health programs have been around for decades and have gotten steadily less sustainable with the exception of the military health care system. It is not a money thing with Medicare, though, or an ideology thing.  Medicare spends plenty of cash and members of both parties love it, but it remains unsustainable because it leaks like a sieve and flows out into the broken foundations of our health care system to combine with all the rest of our myriad of symptoms, flooding the federal budget with red ink.  The ten-year cost projections from HHS don’t look promising, so Medicare remains a fatal flaw in our current system that must be addressed.

America can take excess profit out of health care and not kill private insurance companies in the process.

We can implement strict health insurance regulation, set expectations for a minimum allowable plan with a set price and draconian enforcement of those standards. We can fix our existing system using smart strategies that seek to reconcile private businesses with public interests. Maybe this initial legislation leads to a nonprofit health insurance system as being the only sustainable method of paying for universal health care in America.   Something more like the Dutch or the Swiss system. This would also cure our Medicare problem because we fixed private insurance to the point that it could be trusted with the public needs.

We could also create an sustainable “public option” that brings together all the various and sundry public plans (Medicare/Medicaid, SCHIP, TRICARE, VA, federal workers, etc.) into a single Americare public insurance plan with significant medical delivery infrastructure in all fifty states via the military and VA.  It would combine cost centers to achieve huge immediate savings and would eventually lead to a significant bargaining position to bring down overall health provider and pharmaceutical costs with nearly 100 million Americans as members when one includes small businesses, the self employed and the uninsured.

If private companies find a fair and equitable system is not conducive to a profit-driven board of directors, then I suspect most will go into a new line of business or they will become non profits.

This would maintain the public-private hybrid we currently have by using government regulations to eliminate or reduce our worst problems in order to create a sustainable medical system and would be supported by most moderate conservatives and independents who agree the system is desperately in need of significant reform.  A reformed medical system of this nature would be one that everyone in America supports and defends against private interests in years to come instead of just the liberal wing of the democratic party.  We get the ends we require without using a single payer solution that many Americans don’t seem to support in its current form.

At any rate, President Obama has done exactly what he campaigned on with regards to this particular subject, which is more than most presidents can say over the last four decades.

I wish Barack had advocated for a more innovative solution to the problem instead of leaving it up to the democratic caucus. I believe he could have gone straight to the American people and built support for an efficient and effective strategy that might not have included a single payer solution, but would have been a straight kick in the ass to the private insurance industry and serve as the first positive step forward in decades for health care reform.  Going to Congress on this one ensured the process would lead to something less than ideal.

Same thing he did with the stimulus debate.

Health reform more properly belonged as part of that debate because of the role it plays in our crumbling economy and ballooning debt. The military should have been in there as well. I think a lot of people on the left and right were looking for Obama to be bold and progressive and innovative, but not necessarily “liberal” as his base would define it.  Barack’s learning curve is in full view as the administration continues to set unreasonable deadlines for these complex and interrelated issues. It makes conservatives feel like he is trying to pull a fast one. The same way it made liberals feel when Ronnie and Newt and George Junior did it to them over the last three decades.

By building on his brilliant campaign strategy and using the gains he made with moderate republicans and independents, the country could have spent the last six months talking about what a New New Deal and a Greater Society might look like with President  Obama signing legislation at the end of the summer that was overwhelming supported by both houses and parties as well as the American people.  Kind of like this landmark bill, more than fifty years past. Our last real moment of political unity in America.  On second thought, I believe this was the last time we saw such political unity in Congress.

I think passing systemic, significant and sustainable health care reform can be the next unifying theme to bring a fractured nation together.

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52 thoughts on “Long Live The King

  • matyra

    Jason, your blog’s going to take me awhile to digest. But one thing I wonder about and would hinder Medicare For All is that Medicare has a simple image problem.

    • Jason Everett Miller

      Actually, seniors on both the left and right love Medicare, so I think its image is just fine but for some funding issues and projected outlooks.

      A slightly different positioning on this one and I think Medicare could have been used as the basis for forming Americare as the public option against strict regulation of private companies and medical providers to take care of the commercial side of the house. Fix Medicare by combining it with all other government plans and extend it to everyone who can’t private insurance while at the same time regulating the commercial interests that keep the system unstable and unsustainable.

      I think that strategy would have been a winner for progressives and it would be all over but the crying by now.

  • Bwakfat

    hmmmm.

    I say we kill the corps, yes. They should only have a citizen lifespan if they enjoy citizens rights.

    Prolonging a wrong does not make it right.

      • Bwakfat

        Never say never, Jason. A novelist isn’t what I’d call a slam dunk argument, especially Sinclair.

        We also used to kill corporations after 75 years. It’s an idea whose time has come, again.

        BTW, off topic, but thanks for looking out for the folks in DC. That was mighty decent of you. If you are ever in CT, I’ll be happy to look after you and yours.

          • Bwakfat

            Thanks!

            =D

            Florida is mighty hot. Interesting new avatar look. Is there a story involved?

          • Jon Wisby

            The avatar is of a (then) 15 yr old girl named Tash from the south of Cornwall. Her mother wanted some exterior shots for her modeling portfolio, so we went down to the cliff side of the beach. The lighting was iffy and this shot wasn’t great, but I loved the composition. I worked on it in photoshop for years with no decent results. Then I went crazy. Voila!

        • Jason Everett Miller

          I wasn’t speaking of the novel, I was speaking of the situation.

          Wide-spread corruption and dangerous conditions in the meatpacking industry that led to massive public health issues. We fixed it by creating the FDA, not the Uncle Sam Meatpacking Division of the Department of Agriculture.

          While there have been (and continue to be) many problems with corporate America, I don’t believe killing companies after 75 years is a solution to the issues that remain as much as a crusade against things solved in better ways. I think the essentially conservative nature of the American people, in its actual sense of favoring gradual change, will ensure such a Bloody Sunday never comes to past.

          As a fan of evolution over revolution, I am certainly glad about that. I will certainly give a shout if we ever do our northeast road trip. We’ve been dying for a real lobster roll and have to come though CT to get there!

      • San Fernando Curt

        Jason, here’s the process with that: Egregious practices or practical catastrophe prompt regulation, regulation becomes routine, those regulated lobby for changes easing rules in the name of commerce, Congress pressures regulatory agencies to do so (and don’t give me the song and dance this can’t be done administratively done; humans can’t fly, either). Finally, we have deregulation, or nonregulation. Process repeats.

        Corporations shouldn’t be shamed or punished. But human nature prevents pure capitalism as much as it confounds the feeble precepts of Marxism. Corporations, and the business practices that propel them, should be regulated. Or the default template is pure greed.

        • Jason Everett Miller

          Exactly right, Curt. Rinse and repeat. I hope we can find some way to break the cycle before we destroy the planet. Maybe Generation X can be the one that starts a new paradigm as we take over the reigns of leadership in public and private institutions.

          • San Fernando Curt

            I know there was a time when Generation X – because they had a catchy rubric? – was the FedEx messiah of the new millennium, a generation of storied promise that would cure all ills, answer all thorny dilemmas. Time comes, time goes. The youngest members of GenX are long out of college; the oldest are in their mid-40s(!) If they were going to make a noise, they would have done so by now. Face it: Generation X is the Silent Generation of the New Millennium.

          • Jason Everett Miller

            Perhaps you are right, although I would suggest that as a member of Generation X, moving silently into positions of power and changing the institutions from within is a better strategy than storming the Bastille with flowers in your hair.

            Such change actually has the potential to last rather than having to fight the same battles over and over for the next forty years.

            We are also late bloomers. Many of us only recently started paying attention to politics and what’s been going on around us. Not saying it is right, but it is the truth. The 1990s were largely a lost decade for Gen X, but that doesn’t mean we are through yet and the Millenials are even more involved than we are now.

            Maybe you are right, but I wouldn’t write Gen Xers off just yet. The Boomers need to get out of the way before we can do anything of substance and that might take another decade or more.

          • San Fernando Curt

            Wow. Sorry. I would’ve guess you ‘Boomer’. Look… Let’s see if we can turn this around. Lemme make nice. Y’know. I mean… Gen X. Man. Hootie and the Blowfish. Brooke Shields. Yeah, man. That’s what I’m talkin’ about. Kelly Ripa. What’s not to like about Kelly Ripa? Am I right?

            Are you sure you’re not age-shavin’ a little bit, here, Jason? C’mon. We’re adults. Pruning off a few years? Maybe getting into that Just For Men – for that touch o’ grey along the temples?

            Wow. OK… Guess I’ll take my Dead Kennedys eight-tracks and leave now…

          • Jason Everett Miller

            That is the first time I have been confused for a Boomer, but I am actually only 39. Ouch. I usually get pegged in my late 20s, but I guess maturity is good as well.

            I am more reeling in the years than shaving off the years these days. I embrace every one of my wrinkles.

          • San Fernando Curt

            Look, Jason. I still transpose the Teddy Roosevelt thumbnail on your name. That ages anyone. I just turned 55 in June, and I’m told I don’t look a DAY over 53. So there…

          • Jason Everett Miller

            Ditching TR as my icon seems to have lost some context for my comments and blogs for those who don’t know me very well. I have somehow become a thug and a repug rather than the unique and endangered animal I truly am. :O) Who listens to ducks anyway?

    • Don Key

      “They should only have a citizen lifespan if they enjoy citizens rights.”

      Great idea, Bwak!(And that lifespan should be tied to the uninsured- they’d be onboard with HC reform in a heartbeat).

  • Carey Rowland

    Well, you said, Jason: “Not only does HR 676 kill the private insurance companies that many Americans still support…”
    but that’s not consistent with what Fred and the other public option advocating TPMrs have said about it, and what the Urban Institute report presented, so I’m wondering…who is being realistic here? Will this legislation kill the “private insurance companies” or not?

    Because I happen to believe that medical patients should retain an and “option” between the public plan and the old maligned private one.

    • Jason Everett Miller

      HR 676 is not the public option currently being considered in the senate. That is the Medicare-for-All plan that I linked to and is currently still in committee in the House I believe.

      As far as I can tell, it is now a debate between some sort of system as I outlined above with a reformed Medicare taking a prominent role in insuring the uninsured or uninsureable or a nonprofit collective like Sallie Mae or Freddie Mac that would function as a coordinator of privately delivered plans serving the same purpose.

      In either case, I think it is a better first step than putting in a single payer system for all the reasons noted as well as for the reason you added – Americans don’t like to be told what to do, even for their own good.

  • Bwakfat

    We fixed it by creating the FDA, not the Uncle Sam Meatpacking Division of the Department of Agriculture.

    Funny, some meat-packing magnates may have called it just that.

    =D

    I tend to agree with Bernake in that there need to be ways to dismantle “too big to fail” in just about every industry there is. I heard the head of the anti-trust division of the justice dept. on an interview on NPR say that Congress needs to “tweak” the anti-trust laws. I agree. If a company is a defacto monopoly, I don’t see why we have to prove that there was collusion, just break ’em up.

    We did it with MaBell, as I recall.

    OT–Lobster rolls can be good here, too. But really, I’d treat you to a New Haven pizza. They are the best in the world.

    (shuffles feet)

    Well, we think so.

    • Jason Everett Miller

      I tend to agree with Bernake in that there need to be ways to dismantle “too big to fail” in just about every industry there is.

      Totally agree.

      I think when we are done regulating health insurance we need to turn our sights to the media and energy and transportation and every other special interest dominated monopoly still operating in America via mergers and acquisitions that should have never been approved based on our existing laws.

      Health reform is only the beginning of what must be a government-mandated renaissance in American business before it kills us all.

      OT – We love a good pizza, too. :O) Isn’t New Haven the place with the burger joint that is two hundred years old?

    • Nebton

      Absolutely with the “too big to fail” bit. I’ve said it before, and I’ll say it again. Too big to fail == too big to exist.

  • Frog Leg

    Interesting post.

    I’m not sure that the 1964 Civil Rights Act is the best model however. This was hardly a case of the nation coming together. It was bitterly fought on both sides of the aisle. Resentments about the bill lingered for decades.

    A better (albeit much more boring) model for what health insurance reform should be is the 1986 Tax Reform Act. This was a mammoth piece of legislation which made significant changes, directly to the tax code, but indirectly throughout society. It was also a truly bipartisan Act, with people from both sides making real sacrifices and coming to a consensus on what had to be done. It may not sound that significant, but the 1986 Act really transformed American business, even though the ways it did so (such as the changes to depreciation deduction) would put you to sleep.

    Right now there is too much emotion on both sides. Perhaps making the debate more boring would aid in doing so.

    • Jason Everett Miller

      The vote for the Civil Rights Act was overwhelmingly in favor of passage in both parties, no matter the route we took to get there or the battles involved. More than fifty years later, the act seems to have taken us in the right direction, even if many other laws made those gains mostly moot.

      • amike

        Took an assassination to get it passed however. Very few Presidents get the chance to operate when the opposition is shell-shocked–the opposition in both parties, I might add.

        Few Vice-Presidents turned Presidents had the clout and savvy to use such an opportunity. Before LBJ, Teddy Roosevelt. Who else?

        • Jason Everett Miller

          Truman, maybe? I suspect LBJ’s time in the senate was more responsible for his political acumen with Congress than his time in the VP’s chair.

          I guess my main point is that despite the specific circumstances, America has occasionally come together to do some marvelous things, usually over a series of years and initiatives. I think this is one of those times where we can do so again because so many people on both sides of the aisle are being damaged severely by the status quo.

          All it takes is proper positioning, which democrats are horrible at these days. I am a fan of evolutionary change over revolutionary change. Changes that come from the former seem to last while the latter simply leads to more bloodshed and bitterness.

          • amike

            Truman, yes and no. He also came to the office at a time of political shell-shock. We remember him fondly for a lot of reasons–not the least because he balled out the music critics for picking on his daughter, Margaret.

            He accomplished a lot by executive order–for example beginning the process of desegregating the military. But the republicans beat him up pretty bad…Taft-Hartley legislation began the process of eroding unions, for example. He also lost when he tried nationalizing the Steel Industry. And those nasty Dixiecrats…We should call the modern Republican Party the Dixiecans. I was 7 at the time of the 1948 election cycle. I just barely remember a
            poem from that cycle.

            Truuman’s in the White House,

            Gathering up his votes,

            Dewey’s in the Garbage Can,

            Gathering up his Oats

            Maybe some other old geezer remembers a version which makes more sense. My parents (Republicans through and through) were most distressed when I brought that bit of doggerel home from the playground. My Uncle Norm thought Dewey was too liberal so he voted for Norman Thomas. Go Figure.

            Your point on democratic positioning is right on. It’s harder to position when you have no center yourself. I tossed out Will Rogers on another blog. I might as well plagiarize him now, too. I (like Will) belong to no organized party. I’m a Democrat.

    • Jason Everett Miller

      PS: Not to say that “boring” legislation doesn’t have its place as well, but most big gains are made through this method and takes years to actually implement. Even desegregation in the military started under a democratic president and was finally implemented by a republican one.

  • dickday

    Jason, we need a new model when we look at a number of systems in this country in my humble opinion.

    Health Insurance should be run by non profit corporations. The for profit model DOES NOT WORK within this arena.

    On the other hand the contractors must be for the most part for profit corporations. Somebody has to manufacture MRI machines and hospital beds.

    Good discussion here Jason.

    • Jason Everett Miller

      Which is why I think HR 676 didn’t gain much support. The cure was almost certainly worse than the disease for most Americans.

      Properly regulating the industry would almost certainly lead to a nonprofit health insurance paradigm in America, all without the need for a single additional dollar in government spending nor the need for drastic measure or partisan battles.

      I believe most people agree on the problems with the system and would be OK with fixing them permanently and letting the chips fall where they may, which for us would look more like Switzerland or Germany than like Canada or Taiwan.

      Glad you stopped by!

        • Jason Everett Miller

          PS: You didn’t have to read far since the second paragraph sets the context of the piece, which is a position makes the title and opening paragraph an obviously satirical poke at the Looking Glass Left and how their All or Nothing ultimatums are seen by many moderates on the left and right.

          • OldenGoldenDecoy

            I know what…

            . . . ol’ Bluster Butt can do with that looking glass . . .

            ~OGD~

          • Jason Everett Miller

            Thanks for illuminating commentary. Anything useful to add or are you too busy admiring your reflection?

          • miguelitoh2o

            Your disallowance of the power of a vocal grass roots movement for real change in your endless pursuit of ‘evolution not revolution’, belies the very real impact such movements have on legislation emerging from Capitol Hill. Your arguments seem designed more to stymie change than to promote it at whatever pace.

          • Jason Everett Miller

            In contrast to your caricature of my opinions, which most people at TPM seem to get rather easily, I am a huge fan of the power of the grassroots of both parties. Problem is, the grassroots doesn’t seem to be involved as the ideologues duke it out non-stop over this issue.

            A little more actual grassroots involvement and the “public option” would already be a given as an essential part of health care reform. As it is, you’ll be lucky to keep a public option since it has been hailed as the “compromise position” that will lead to single payer eventually.

            One argument after the other, the single payer crowd has lost the forest for the trees yet somehow that is my fault or the Blue Dog’s fault or anybody but the movement’s fault to properly position their solution against the solutions being offered by other groups. Your “vocal grassroots movement” led to 400 people in Upper Senate Park. Sorry if I find those methods to be less than effective.

            Perhaps I missing their brilliance, but a “vocal grassroots movement” without direction and leadership, as seen with the single payer crusade continuing to offer All or Nothing solutions, is doomed to failure.

          • Jason Everett Miller

            More of that partisan swing, huh? In case you missed it, I am a republican, so I would say they could more properly be called your Blue Dogs, though I doubt anyone in Congress could be called a hero.

          • miguelitoh2o

            I make the comparison as you seem to be pretty much in step with their tactics and goals.

          • Jason Everett Miller

            If the Blue Dogs use my reasons and “tactics” then find no reason to quarrel with them over this particular issue.

            Once again, my thoughts on reform are more in line with the public at large than your own, so I would suggest that I am not required to convince anyone of anything. Further, many of my preferred solutions appear to be where the legislation is heading, so I am not really in the business of apologizing for being right about the type of bill that would come to Obama’s desk.

            It will have a robust public option built on a nonprofit model that accounts for the uninsured and uninsurable. I hope it fixes Medicare and Medicaid while they are at it, but have yet to see anything that addresses those programs.

          • brewmn61

            “the movement’s fault to properly position their solution against the solutions being offered by other groups”

            What “solutions” are you talking about?

          • Jason Everett Miller

            HR 676. It is known as “Medicare-for-All” or simply the “single payer” plan in the discussions above.

  • PseudoCyAnts

    Jason, I’m in a little late with this response, but I want to address your statement about:

    gutting private health insurance companies and turning their mostly middle class employees out on to American streets

    I am not a big fan of single-payer, mostly for the conservative/libertarian view that it is not a proper governmental function, and the government has shown itself in the past to be a poor, wasteful administrator of non-essential governmental duties. I part with the usual arguments against however, when they reach over into impairing the free-market, Capitalism and Free-Market are not synonymous. They are oppositional concepts in many ways. The Insurance Industry does not work under free-market paradigms. Instead it operates much more like a numbers game racket.

    Over the past many decades, Insurance Corporations have created a vertical market, and now cover all the bases. In the Health Insurance Industry, the same Corporations handle employee insurance packages, individual/family insurance plans, HMOs and PPOs. Their parent corporations also cover business liability insurance plans, as well as Medical Malpractise Insurance. As to the latter, this entails much more than M.Ds these days. Almost all medical service providers higher up in the food chain than just grunt techs need insurance; nurses, physical therapists, phlebotomists, pharmacists, EMTs, etc., need to get policied up, or risk losing every tangible asset that they own in a liability decision against them. The same parent insurance corp. offers coverage for all of this and more. They have every base covered.

    Once the bean-counters realise this, Insurers suddenly lose all motivation to curtail insurance costs, because the corporations take a percentage of the handle, so it’s in their best interests to increase it.

    In the late 70’s/early 80s, health insurers started pushing managed care as the proper way to curtail medical insurance costs, because medical providers were prescribing far too many unnecessary procedures for their patients. Of course, the insurers ran the PPO’s and HMO’s, and health insurance costs kept spiraling upwards. Then they went after the Medical providers directly, by upping their malpractise premiums exponentially, claiming that ambulance chasing attorneys and their gold-digger clients were cheating the system with deep-pocket arguments given to gullible juries. Individual states across the US capped pain/suffering settlements, yet the malpractise premiums kept climbing upward rapidly. Pain/Suffering caps hurt the young and poor disproportionately, because settlements are based solely upon what the injured person could have earned lifetime, at their present career. An 18 year old kid working his/her way through the University at WalMart, only got WalMart wages factored in for the settlement. Settlements for debilitating injuries often would not even cover proper professional home-care for these plaintiffs.

    Finally, the AMA and Health Insurers have begun to seek rational tort reform, and stop allowing lawsuits being filed in instances where the medical provider properly followed standard, recognised procedures/medications/treatments. This should have never been a tort from the git. If I go to an orthopaedic surgeon, because I’ve torn cartilage in my knee, I should not expect to be made good as new. A piece of my insides is going to be removed in an arthroscopy. If the surgeon cuts on the wrong knee; hell yes I’ll sue him, but otherwise, I should be happy with any improvement.

    Health Insurance Providers have become anti free-market entities; unnecessary middleman leeches, that siphon away monies which should be used for medical care, into their own subsidiaries; and into their own coffers.

    • Jason Everett Miller

      No argument from me about any of this, PCA, and thanks for stopping by.

      I would only add that like the meatpacking, telecommunications and banking industries before them, we can bring the health insurance companies to heel without killing them. It will take massive regulation and enforcement, but I think that it is a better first step than single payer for all the reasons you noted.

      I guess my biggest disappoint beyond the way Obama handled this one is the fact that democrats most able advocates are stuck in a single payer groove that is not even being considered and unlikely to make it out of the House. I would have loved for them to have switched gears or been better prepared going in, so we didn’t lose the chance to have their voices involved in crafting the final legislation.

      I think we will get something that moves us down the path we need to go.