I expect the Obama-Congress health care legislation to either fail to pass or be so attenuated that it will not remotely cover the nation's 47 million medically uninsured; to be offensive to many in its prosciptions on reproductive health services; to not dramatically curb health insurance or actual health care delivery costs; to not include a meaningful public insurance option; and, to have at most a negligible effect on the quality and availability of this nation's health care services.
A friend of 4 decades on the White House staff advises to "get your lefty friends on board because the alternatives are scary". She believes a health bill will pass and can be improved over the next several years (decades?) as it is tweaked by each new Congress. (In her world, perhaps health industry lobbyists don't exist or have no influence).
I was one of Gov. Jerry Brown's Commissioners on the California Health Facilities Commission from 1977-1982. We oversaw financial reporting and collected patient data from 646 hospitals and 1220 nursing homes. That was all of them except 7 state hospitals. (Health industry lobbyists and a Republican Governor eventually killed off the Commission in the late 1980s as it's cost data portraying an out of control health care system became increasingly embarrassing).
At one point, in 1978, a small group of state officials and consumer advocates tried to raise the $1 million it would take to have a public health insurance system put on the ballot in California. We failed to raise enough funds to hire an election firm to gather the signatures necessary to qualify such an initiative. The Governor wasn't supportive at that time but not because of any philosophical or political problem--he just didn't think it would pass in the Proposition 13 "era of limits".
Now may be the time to try again.
The spectacle of the Rep. Bart Stupak, Sens. Joe Lieberman, Ben Nelson, Charles Grassley and 39 small state Democratic Congresspersons of Washington DC holding 37 million Californians hostage should give us ample cause to "opt out" of that world. California is large enough and diverse enough to provide for its own as do many industrialized nations of similar size and much less wealth than we have.
Citizenship in this country should be a two-way street. We should all pay our fair share of taxes but in return should expect our security to be protected from enemies foreign and domestic, our children to be educated to compete in a global economy, the inevitable natural disasters overcome, and our legitimate medical needs met or guaranteed so we can be healthy enough to contribute to our family and society.
That's the social contract that we should expect. Any takers?