The Policy That Dare Not Speak Its Name

I'm sure I'm not the only reader who noticed the juxtaposition of two front page stories in Sunday's New York Times dealing with health care. The first article cited a new Times-CBS poll showing that 72 percent of Americans favored a government run health plan comparable to Medicare, which would be available to everyone.

The second reported on a rogue radiologist at a Philadelphia VA hospital who botched 92 prostate procedures.

The right will doubtless go to town on that one, as what we can expect of government-sponsored medicine. I'll have more to say about the VA in a moment, but first let's consider the poll findings.

The poll is relevant because Congress will soon decide whether to include the so-called "public option" in the Obama health reform bill. As drafted by three House leaders and unveiled last Wednesday, the 852-page bill would include a government-sponsored, Medicare-like public plan.

Republicans and the health industry have been kicking and screaming that this is socialistic. But the poll suggests that defenders of the public plan have nothing to fear politically, and that Republicans are in danger of getting on the wrong side of a popular issue.

However, that's only the beginning of the story. The reform package, as drafted by the Obama administration and the House leadership, is dubious legislation even with the inclusion of a public option. Basically, it leaves the two worst aspects of the system intact. First, private insurers will continue to dominate. Second, most people will continue to get their insurance through their employers. Given these two bedrock realities, there is no way that the bill can make serious inroads on cost without cutting back on care. The high cost of the approach is already causing key legislators to back off. The current system wastes huge sums, but because it is so fragmented the money flows to profit opportunities and not to the most cost-effective forms of health care.

Also, as my American Prospect colleague Paul Starr warns, a mixed system with a public option effectively invites the most expensive and hard-to-treat people to opt for the public plan, while private insurers will seek to insure the young and the healthy. This is a familiar problem known as adverse selection. The private insurers will then smugly point out that the public plan is less "efficient," when in fact it simply will have a more costly population. The only way to avoid this problem is to have everyone in the same universal plan--what's otherwise known as a single-payer plan.

The public option is a not-very-good second best--because our leading liberal politicians lack the nerve to embrace the one reform that simultaneously solves the problem of cost, quality, and universal inclusion. The policy that dare not speak its name is of course comprehensive national health insurance, or Medicare-for-All. I try to avoid using the term "single payer," because a technical, policy-wonk phrase not understood by most civilians has become insider shorthand for national health insurance. Let's call the thing by its rightful name. Medicare-for-All is something regular people understand.

The Times-CBS poll is evidence that this is what more than two Americans in three really want. Most voters have not followed the nuances of how the public option in the Obama plan would compete with private insurance. The poll simply indicates that voters want access to a straight-up, Medicare-style plan to be available to one and all. In past polls, when Times-CBS pollsters ask whether people favor national health insurance, responses generally favor Medicare-for-All by margins of about two-to-one.

In the current debate, liberals find themselves fighting to keep the public option alive, so that some form of efficient, publicly-run health insurance will stay in the mix--but knowing that it is embedded in a reform package that is far more costly and inefficient than it should have been. Instead of validating the common sense and reformist demands of ordinary Americans and identifying the insurance, drug, and corporate elites as the obstacles to real reform, too many of our liberal leaders from President Obama on down hope to co-opt business elites with a convoluted scheme that undermines the efficiencies of a comprehensive and universal system. And just wait until it gets watered down further in order to retain the support of these same elites. A plan that all of these groups would endorse would not be worth having.

So what's the matter with our politicians? Why are the people so far ahead of their elected leaders on this one? One reason, as usual, is money. The combination of the insurance industry, the drug industry, the American Medical Association, the hospital lobby--all of whom oppose Medicare-for-All--represents a huge amount of political spending. It takes a brave politician to face down all of these industries, even though the people are on the side of real reform. The AMA's position is especially shameful, since the professional societies that represent most actual physicians favor national health insurance.

The second reason that liberal politicians wimp out on single payer is that the self-styled realists in this debate have decided that Medicare-for-All, even if it's the first-best system, is too hard politically. But think about it. Has the administration picked up one Republican vote by supporting the present system plus a public option? Hardly. The current House leadership bill, offering a mixed system, with a robust public option, a requirement that employers provide good insurance or pay a tax, and that insurers not discriminate against pre-existing conditions, is just as heavy a political lift as national health insurance--and far inferior policy. So why not just go for the first-best?

The advocates of Medicare-for-All have become something of an embarrassment to the liberals. The White House forum on health reform on March 5th, which boasted a diverse range of viewpoints, including representatives of the Business Roundtable, the health insurance industry, the drug lobby, as well as a broad spectrum of business, labor and Congressional leaders, left advocates of Medicare-for-All banging on the door. None were included, despite requests for invitations.

When Sen. Bernie Sanders recently arranged for five prominent advocates of national health insurance to have a courtesy meeting with Senate Finance Committee Chair Max Baucus, the story was newsworthy because the political elite usually pretends that this viewpoint doesn't exist, much less that it represents the desires of two Americans in three. The mainstream media have also colluded in the general effort to keep the single-payer option out of the limelight. The organization FAIR recently published an important study in its heroic magazine, "Extra", titled "Media Blackout on Single-Payer Healthcare."

Indeed, the Sunday New York Times-CBS poll didn't even offer Medicare-for-All as a free-standing option. It took the Obama position as the left edge of the debate.

As for that rogue doctor at the Philadelphia veterans' hospital, quality control is not what it should be throughout our fragmented system. And the oases of public medicine are particularly starved for resources. Yet studies consistently find that on average, the VA does more with less than its private sector competitors. Phil Longman has written the definitive book on the subject, "Best Care Anywhere." Here is a summary.

In this case, the offending radiologist, Dr. Gary D. Kao, was actually a contract employee and not a VA physician.

Only by having a comprehensive system can we marry quality, cost-effective care, and universal access. One of these days, a national leader will have the nerve to embrace national health insurance and fight for it. Until then, we will keep paying more money for less care, and liberals will defend reforms they themselves scarcely believe in.

Robert Kuttner is co-editor of The American Prospect, and senior fellow at Demos. His recent book is "Obama's Challenge".

Comments

[racetoinfinity]

A few politicians like Sanders and Kucinich have the guts to stand up and say that Medicare-for-all is the only rational and effective plan. They also have the guts to say that healthcare is a right, not an opportunity to enrich some fat cats.

[jmpurser]

You can sign Senator Bernie Sanders' petition here:
http://sanders.senate.gov/petitions/index.cfm?uid=7fd59f2e-88e1-477a-8eaf-762a5b050809

[FreddieVee]

A TV ad that I saw today said that if the "Health Care Option" is passed, 119,000,000 Americans will leave private health insurance and then we will have no choice.

So, let me see: If we exercise our choice to use the "Health Care Option", we will have no choice. So having a choice means we have no choice?

That's like saying, "Because we chose Senator Obama for President, we had no choice."

FreddieVee

[jmpurser]

First, why do you want "choice" in who your insurer is? How about a choice of who your doctor is instead? And most Americans get the health care insurer their employer uses so "choice" is already a myth.

Second, the "public option" will neither be available to the public nor optional for those who are on it. Most Americans will be forced by the IRS to buy insurance policies from commercial carriers. You will get to choose who drives you to bankruptcy.

[WellTickleMeWillie]

I think it is fairly obvious if you are awake that the health denial insurance industry and their bought and paid for Congressmen (mostly Rethugs but Dems as awell) are behind plans that either lock out public health care entirely or if included, insure it's ultimate failure. A "reformed" health care system w/o a public option is fundamentally lipstick on a pig. A "reformed" health care system including an optional public option with lots of restrictions, is designed to fail from the gitgo. The later makes it easy for the health care denial industry then to say I told you so, Folks, the 7 out of 10 of you who support a public option, we are being bamboozled and defrauded. Only a single payer health care system that includes EVERYONE will improve care and reduce costs and they know it. But the $25 million dollar health denial industry CEO's don't want you to have that system b/c well they would be unemployed and out-of-business. But unemployment for them would mean they would have lots of time to enjoy their yacths, palatial estates and private jets that you already paid for when they turned you away or paid very little of your medical bills. It's another Bernie Maddoff scheme to defraud the publc by giving the impression but not really providing for your health coverage.

[jmpurser]

The "public option" is the lipstick on a pig approach. It's a con job put up by President Obama so Americans wouldn't notice that he took single payer (the only real health care reform plan we've discussed) off the table.

In health care President Obama is NOT on the public's side.

[darker]

YES, a government­-sponsored­, Medicare-like public PLAN IS NEEDED
after years of private insurers PROFITEERING, scamming and robbing the public until
theyre bleeding to death financially. This has got to stop.

WE CAN'T AFFORD REPUBLICANS any more.
Their privatization is killing the country.

[jmpurser]

Agreed! You can sign Senator Bernie Sanders' petition for single payer here:
http://sanders.senate.gov/petitions/index.cfm?uid=7fd59f2e-88e1-477a-8eaf-762a5b050809

[larry278]

Re: VA treatment errors, close all VA hospitals; have the VA pay local & regional hospitals for caring for veterans. Even if a VA hospital is brand new, it is behind the times. The VA is a hide bound agency which is incapable of changing. The VA's methods are at least 15 years behind methods used by medicine & hospitals outside the VA system(?). Look at how the UK gives medical care to its veterans.
If the USA gets universal health care-there will be no need for VA hospitals & out patient clinics. Let veterans be treated where they live in local facilities by local practitioners.
The VA hospital system has been broken for a long time; there is no way to fix the VA's hospitals.

[droftim]

Let me understand this: You want to close down the highest quality/lowest cost health system in the United States that consistently gets high ratings from its patients?]

I think that you are the one who is 15 years behind.

The Best Care Anywhere - http://www.washingtonmonthly.com/features/2005/0501.longman.html

[LeftRight]

You have no concept of the VA, do you?? While I will admit that in major metropolitan areas the VA is understaffed, the service that is provided by the VA is among the best in the USA!!!

[FreddieVee]

The latest polls shows that Americans want Obama to concentrate on the National Debt at the expense of stimulating the economy. Why isn't every Democrat with access to the media screaming that allowing the economy to slip further, decreases tax revenues and increases the National Debt?

Every Democrat should out California and say, “They cut spending, but the spending cuts just caused more layoffs, and with more people out of work the tax revenues decreased, worsening the state's deficit".

"Debt is Debt" whether the debt comes from increases in spending or decreases in tax rates. Here's a hypothetical example: If there were Americas in three parallel universes and one (USA-1) balanced their budget, one (USA-2) kept taxes the same as USA-1, but increased spending by one trillion dollars and the last one USA-3, kept spending the same as USA-1, but cut taxes by one trillion dollars, then both USA-2 & USA-3 would run a one trillion dollar deficit.

Thirty years ago, there was not that much difference between the results of the very different philosophies. Tax cuts aimed at the middle-class and lower tax brackets increased direct spending and stimulated the economy. Tax cuts aimed at the wealthy stimulated the economy because they would start or expand businesses in America creating jobs. But today, the Republicans skew tax cuts toward the wealthy, and the wealthy invest in new businesses or expanding existing businesses overseas instead of investing in jobs in the USA.

FreddieVee

[deebles]

To object to single-payer health insurance, or Medicare-like health insurance, or socialized health insurance, or any other term for what is actually just non-profit health care, requires arguing extreme positions on either side of a non-existent argument. It is rather like arguing that the non-profit postal system is sometimes slow--it is, or that because it is non-profit you can't choose the biggest, brightest envelopes. Both arguments are based on personal attitudes which have nothing to do with the fact that our postal system works. Take the very real fact that our for-profit health insurance companies could not survive without the government subsidizing their mountain of bills and rejection forms and what exactly is your position? Nothing will ever satisfy two extremes of any position therefore the position itself becomes pointless, and the argument in between becomes nullified by aimless, though self- satisfying rhetoric. Self-satisfaction and We The People do not a more prefect union make. The issue is do we or do we not believe that every American is as "entitled' to health care as they are to their Get Well cards?

[robiwan]

But will you admit that even under the most efficient system (single payer,) healthcare for every man, woman and child in the US will cost about 2 trillion dollars a year. Divided equally between 170 million wage earners (full employment) results in $11,000 per wage earner?

[jmpurser]

No, I won't admit to those numbers at all. Where do you get them? And where are your offsetting numbers for the emergencies that don't happen because they have adequate health care and the extra years of working instead of disability or death because again, they got adequate health care?

No, you numbers mean nothing.

[robiwan]

Then give me numbers for what it will cost to insure every man, woman and child in the US per year in a single payer system. Put up or shut up.

And by the way. $11,000 is not a bad number when adjusted for what we pay in taxes for medicare/m­edicare/VA­, income bracket, and kids per household.

I am on your side. I believe in single payer, but I will not play your rainbows and ponies for all game about the costs. Even under the cheapest way to do this which is single payer, healthcare is expensive.

[deebles]

To argue cost in concrete numbers for a non-existent system is the most useless position of all; therefore, I didn't consider it worth mentioning. What you are doing is projecting the cost of rebuilding the burned-down barn as a reason to never build any barn at all. Rather pointless if all you want is a dry horse.

[vanmungo]

Your numbers are from Pluto. Here are the real numbers:

"Over sixty percent (60.5 percent) of health spending in the U.S. is funded by government. Official figures for 2005 peg government’s share of total health expenditure at 45.4 percent, but this excludes two items:

1. Tax subsidies for private insurance, which cost the federal treasury $188.6 billion in 2004. These predominantly benefit wealthy taxpayers.

2. Government purchases of private health insurance for public employees such as police officers and teachers. Government paid private insurers $120.2 billion for such coverage in 2005: 24.7 percent of the total spending by U.S. employers for private insurance.

So, government’s true share amounted to 9.7 percent of gross domestic product in 2005, 60.5 percent of total health spending, or $4,048 per capita (out of total expenditure of $6,697).

By contrast, government health spending in Canada and the U.K. was 6.9 percent and 7.2 percent of gross domestic product respectively (or $2,337 and $2,371 per capita). Government health spending per capita in the U.S. exceeds total (public plus private) per capita health spending in every country except Norway, Switzerland and Luxembourg."

(Source: Himmelstein and Woolhandler, “Competition in a publicly funded healthcare system” BMJ 2007; 335:1126-1129 [1 December] and Woolhandler and Himmelstein, Health Affairs, 2002, 21(4), 88, “Paying for National Health Insurance - And Not Getting It.”)

[droftim]

Why are you putting the entire cost on the government? Why wouldn''t we do what they do in Germany? If employers contributed all the money they are spending on employee healthcare today to a national healtcare fund and we added the amount that the government is now spending on various programs, the additional cost per person wouldn't be minimal. Some economists estimate that the total outlay to deliver care to every US Citizen would be less than what we as a nation are spending today.

[robiwan]

Then give me numbers for what it will cost to insure every man, woman and child in the US per year in a single payer system. Put up or shut up.

And by the way. $11,000 is not a bad number when adjusted for what we pay in taxes for medicare/m­edicare/VA­, income bracket, and kids per household.

[jmpurser]

You have no right to tell anyone here to shut up.

[freshnotbitter]

I just went to my mailbox. Today I had not personal mail but I had over one pound of useless paper in my hands. Do you want to know why? Because the Congress now telling you that they cannot afford health care for their constituents have voted to give corporations subsidized mail.

corporations do not pay the same rates you do for mail.

that is why you get junk mail.

Oh, and of course, the post office is an example of how private industry runs business better than the state. Especially when the state subsidizes the private sector. then they really blow away the public sector.

[jmpurser]

Single payer is not socialize health care. They are not two terms for the same idea at all. Single payer is also not "non-profit health care".

Please stop confusing the terms.

[freshnotbitter]

The criticism of Obama's health plan is that it would spend a trillion over the next decade (100 billion per year)to insure 16 million people who do not have insurance today.

Those figures don't really add up but even if they did I wonder why Congress go so picky suddenly.

The department of education, which does absolutely nothing, has an annual budget of $67 billion.

I wonder why congress isn't foaming at the mouth to get rid of the department of education?

Canada doesn't even have a department of education and they are far ahead of us in terms of performance.

[legalclubs]

I saw the VA hospital story and universal health care story and also thought this would provide much fodder to the right. I also know many veterans and have two in my direct family -- they avoid the VA hospitals and use private insurance for superior service and quality. This is a sad comment on government run healthcare.

[freshnotbitter]

The editor in chief of the National Review, a Buckley Conservative was on C-Span talkiing about health care and he was actually quite objective.

People called in and instead of arguing with them and making himself out to be a liar he noted that the outcomes at VA were good overall and that the variance in anecdotal information (actual reports from people who used the system) seemed to vary based on location of the facility.

As far as I know, that is correct.

For some reason, probably due to "anglo-cultural" biases, Americans are not able to discuss social issues intelligently. Instead they think one is supposed to use the "adversarial" process that the English law was based on and which picks a winner between two incorrect sides.

The NY Times knows very well that they are distorting the picture with their VA horror story but if it is argumentative it is ok.

[Manx]

When he was in Illinois, Obama advocated a single-payer system. On Jan. 25, 2007, in a speech to Families USA Conference, Obama said: "I am absolutely determined that, by the end of the first term of the next president, we should have universal health care in this country. There's no reason why we can't accomplish that."

Well, so much for rhetoric.

I thought Obama would be the standard-bearer for real health-care reform but boy was I wrong.
Just when we need a bold leader, we got a weak, bland politician. With Obama, I no longer hope for audacity.

[Coinyer101]

Someone needs to make them take an up or down vote on single-payer, so people will know who NOT to reelect.

[Coinyer101]

Like I been saying. Single-payer or we just may as well wait til 2010, or until we get enough progressives to pass it, and a President willing to give SP advocates a seat at the table.

[Spiritgirl2]

Great article! But we need to admit a few truths:

(1) Media celebrities, pundits, and the MSM only use the talking points that the right wing want promoted and none of that points toward Universal Insurance unless it is in regards to Socialized Medicine!

(2) The AMA (much like the Catholic Church hiding the priests) does not allow the records of bad doctors to be made public, so these bad actors far from acknowledg­ing/accept­ing punishment continue to screw up - it's usually just at different hospitals where their records are not known!!

(3)Health-care in America is all about business! How much profit can be squeezed out of the insured so that the CEO's & shareholders can make more and more money!!!

At some point we the people are really going to have to take a stand and fight the powers that be for what we want - because these people will never concede a thing! And until we really start holding Congress accountable (by voting them out of office) for their actions against the American people, we the people will continue receiving the short end of the stick!!!

[robiwan]

One more truth. Even running at its most efficient, we will need to spend about 2 trillion a year on healthcare for every man, woman and child in this country. We have about 170 billion wage earners.
That's about $11,000/year per wage earner.

[freshnotbitter]

Spirit girl you get the "Freshpo's Pick" check mark.

BTW, I remember when Obama was being questioned for perhaps having too crowded an agenda. The NY Times suggested he put health care off until next year.

Naturally nothing will get done next year because it is election year in congress and nobody wants to go up against the opposition (inisurance) advertising dollars on TV

So, the nY Times was never in favor of health care reform. The result is that our country will go the way of the nY Times and other dinosaurs who could not adapt.

[hark]

Excellent post. Good arguments.

I look at the public option as the last chance we will ever have to solve the health care crisis. Whatever comes out of this process is the last time we're going to do reform, unless the public option is included, and given a fighting chance. On an even playing field, it will prevail, and the private insurance industry will be reduced to gold-plated plans for the rich and fringe supplemental coverage within a decade.

But if the public option isn't robust enough, if it is blocked from drawing a cross-section of Americans, it will blow up as Mr. Kuttner explains. If employers are required to maintain the main form of coverage that the American people now have - which is ridiculous, because employers can't afford it for much longer - all the sick people will flock to the public plan and it will eventually be scrapped as a dismal failure, when it fact its fate was engineered.

But I don't expect the Democrats to hold out anyway. I don't see a public plan at all. And there goes the health care industry, gobbling up the economy just like the financial sector. By 2050 health insurance premiums will exceed the median income of the American family.

[vanmungo]

But the official Democratic version of the public option--the one just proposed by Rangel and Waxman--is not only NOT robust, it's an outright scam!

Unlike the nonprofit, single-payer plans in place in Canada and Europe, this "public option" would charge premiums and impose deductibles; unlike them, it could not accept government funding (after the initial infusion), and so would have to be self-sustaining. Moreover, it would likely be saddled with the oldest, sickest, and thus most expensive cohort, and would have to offer higher fees than Medicare--so no cost savings, none of the cost efficiencies of a single risk pool; it would be competing with 1,300 private HMO risk pools, which would aggressively market the youngest, healthiest, and thus cheapest and most profitable cohort.

This is consumer fraud that fails to loosen the HMOs' dysfunctional vice grip on this isystem.

Public-option plans have been tried in several states, and in every case they have failed to reduce costs or increase coverage. The only PROVEN way of accomplishing both goals--based on a half-century's track record in Europe and Canada--is a nonprofit, single-payer approach.

For a detailed analysis of the pitfalls of the public options, please see the following:

http://www.commondreams.org/print/43440

http://www.pnhp.org/facts/singlepayer_faq.php#public-option

[lwaxanatroi]

HuffPost's Pick

Do admit: once Medicare-for'-All is enacted, employers will drop their insurance plans like hot rocks. This will be good in the long run for our economy, but it will suck for a while for a lot of people who will see themselves as losing something precious. That may be the doctor they've grown to think of as theirs, or a job within the insurance or insurance-­processing industry. There will be a big shakeout as we all settle in to the new reality of American health care. Someday the people who passed that legislation will be seen as heroes, but I wouldn't bet on statues being built to them in the first five years or so. This means it will take tremendous political courage to vote for the kind of comprehensive single-payer system that this country, this economy, truly needs. One thing we can do is keep the pressure on; let your representatives know you won't be happy settling for anything else. As Kuttner rightly points out, a sliver of a public plan sandwiched in with all the private ones just means that's where the sickos end up. One talking point: I'm a pretty healthy 62-year-old and I'm being turned down by insurer after insurer, even for high-deductible, expensive plans. If private insurers choose not to insure everyone, then they deserve to be supplanted by an insurer that will.

[Awake-and-Sing]

Great post!

Who here has actually written their Representative, their Senators and the White House on this issue THIS year -- not just talked about it, but done it?

I have and I hope you all have or will today.

Time is of the essence.

[socalgal38]

You are basically right with the exception of the part about losing the doctor that they have grown to think of as theirs. Single payer is not going to restrict who you see for your doctor. The other exception is that it will take 5 yrs to settle in, as soon as it goes into effect you will see more companies start to build their company, wages will rise, employement will ease up as well. It might be 5 yrs down the line for the Republicans to accept the concept this as a right for all Americans.

[freshnotbitter]

You are being fooled by both sides because both sides are controlled by elites.

Parameter 1 - universal coverage. Any SS# not able to prove on its IRS 1040 that it has private insurance simply pays 15% of his AGI (last line 1040 page 1) as a premium and is insured in the public option. Job done, finished, over.

Parameter 2 - affordability. Privates can't say public option competes unfairly and at the same time argue it attracts sick, poor, etc. We have medicare because the privates refuse to cover the aged. Here is the reconciliation of the two: The privates continue doing what they are doing; the public option is real public health care which can use state clout to reduce costs with automation, auditing (absent in the VA horror story above due to fragmented public option system), prevention, manipulation of deductibles with no deductibles at public clinics, etc.

This big fear that the public system will appear inefficient is unfounded. Reason: At the end of the day the public option will wring inefficiencies out of the system that make it a shining example of how it's done.

Oddly, both sides are fighting against the above.

The single payers say no dice on hybrid system and the elites are happily agreeing with them.

Single payers are under the illusion that Congress would dare to cancel 100 million + insurance contracts overnight. Think, people.

[vanmungo]

It's not a matter of canceling 100 million contracts overnight. Under HR676, the system would be phased in over a five-year period.

Second, if Congress declared profiteering in the health-care field to be illegal, there could be no new contracts. The old ones would be allowed to lapse, and if the companies could no longer cover them, people would have Medicare for all. Besides--under Medicare for all, which will guarantee better coverage without premiums or deductibles, nearly all people will gladly stop paying their extortionate premiums on their own.

You are misinformed on this subject. See the FAQ at www.pnhp.org

[droftim]

Why doesn't anyone ever mention that fact that employers are already cutting back on coverage and raising copays and they will continue to do so no matter what Congress does?. Private industry has already concluded that the model the ideologues want to protect is in fact unsustainable.

http://www.nytimes.com/2008/11/15/business/15insure.html

We will soon be at the point where the only people with full, employer-paid coverage will be government workers ...and that of course will continue to be taxpayer funded.

More and more of the nominally insured will be like those in Massachusetts who cannot use the insurance they have because the copays are too high. Remember, 62% of 2007 bankrupts listed medical bills as a signifcant cause of their problems -- and three-quarters of those people had insurance "coverage".

Insurance does not equal coverage and coverage does not equal care.

[jmpurser]

That would be true IF we ever get to universal coverage via a "public option". I seriously doubt that will happen. In the mean time we'll be paying for both the world's most expensive health care solution AND paying taxes to cover all the sick and poor on the public system.

If we went with a Universal Single Payer Health Insurance system run by the Government then I believe it would fall out a lot like you envision. Some chaos, then cheering for the heroes who delivered it.