Ted, what does it take to receive an A? Obama was clearly Presidential and in command of the subject. Regarding Republicans, what grade would you give Boehner and McCain. Boehner is obviously an empty suit. Paulson seems to have pegged McCain accurately. With each passing day he brings less to the political dialogue.

If the Republicans' repeated statements today of their anti-government ideology did not convince Mr. Van Dyk that there's no way in this life that they were ever going to buy into the central Democratic proposals (near-universal coverage through a mandate and subsidies, strong regulation of insurance, regulated insurance exchanges, vigorous efforts to get providers to deliver care more appropriately and efficiently), then nothing is going to penetrate, apparently.
I'll point out again, to repeat what President Obama and the Democrats said a number of times today, the House and Senate bills do allow interstate sales of health insurance under stronger regulation than the Republicans want. Allowing insurers to sell nationally based on the regulations of the weakest regulatory state is a recipe for consumer disaster, as any experienced insurance regulator could tell Mr. Van Dyk. That's what the Republicans are proposing, and that's why the Dems are rightly rejecting that form of interstate sales.
Mr. Van Dyk also apparently misunderstands the Dems' reconciliation strategy. The House would pass the entire Senate bill, and the Senate with 51 votes would pass changes negotiated with the House dealing with certain budget-related issues (such as the details of the insurance subsidies). The House would then go back and pass that Senate reconciliation bill.

I must disagree. Mr. Obama in no way "impressed." I believe the more accurate description is "horrified." His arrogance was on full display, whether it was chastising Sen. McCain, bragging about how he was the President so he could dominate the proceedings if he wanted, or simply staring in mute horror as Rep. Ryan eviscerated his nonsensical claims that the Senate plan was revenue neutral.

If you support Mr. Obama's health care plan, then I suppose you came away impressed by his determination. If you oppose this government takeover of 17% of the economy, as poll after poll after poll shows that most Americans do, then you came away more determined than ever to vote all Democrats out of office this November.

Sen. Murray and Sen. Cantwell, pay attention to what happened in Massachusetts. The same will happen here if you follow Mr. Obama over the cliff.

Interesting comments. Some, as usual, do not relate to content of the article--intended to give a summary of the day's events and state of play--but reiterate the commenters' opinions on the health-care issue.

Comments also reflect the fact, as I mentioned in my article, that such events do not change minds but usually reinforce and deepen partisans' views. I specifically mentioned that Boehner's performance was weak (as was that of both Dem. and GOP nominal leaders in House and Senate). I am no fan of McCain's but he got in his points about special-interest favors in the legislation. Millions of viewers heard him discuss a subject on which Democratic sponsors of the legislation are vulnerable. That was his mission and he got it done.

It is far too soon to predict what may happen in the 4- to 6-week period to follow. At this moment, immediately after the Summit, one might think
not much will happen during the period and that the "reconciliation" strategy will be employed---with Pelosi seeking Democratic House votes in the meantime to support it. On the other hand, this is a long period in which almost anything might happen. The outcome also will be affected by the surrounding financial/economic situation a month from now. Stay tuned.

South Hill Conservative -

As Vice President Biden said during the meeting yesterday, "You're allowed your own opinion, but you're not allowed your own facts."

So please explain specificially what part of this health care reform plan is a "government takeover of 17% of the economy." What do you mean by that?

This is one of the standard GOP talking points that was exposed during yesterday's meeting as a lie. A bald faced lie.

It's like saying that because the government requires all cars to have seat belts, that somehow they've 'taken over the auto industry".

Or because they require that you wear seat belts when you board an airplane that they've somehow "taken over the airline industry".

Or because they require that meat be inspected that they've somehow "taken over the food industry."

I've been a tepid supporter of the democratic party, although I support their compassionate views of looking out for their fellow citizens. Republicans really have no credibility left because they say one thing, yet do another. If Socialist Health Care was so bad, they'd be complaining about their own health care plans. But yesterday, not ONE of them did so. Not ONE of them had a single complaint about their current government health care plan. Why? Probably because they love it. The big question is, why don't they want their own constitutents to be able to take advantage of the same plan?

Imagine if Dick Cheney were a private citizen shopping for health care in today's private market. Or imagine if you were a guy who had 4 heart attacks, you have a pacemaker in your body, and you're shopping for health care. Is there any company out there that would insure you?

I did not watch the C-Span broadcast, only the wrap-ups on both PBS and via the print media. As a result, this is the first time I learned that Washington state's great senator, Patty Murray, was in attendance--and even got the chance to speak(!) It's good to know that Washington state has such effective representation at the federal level.

BTW, even though Sen. Murray spoke relatively briefly (compared with her overly wordy congressional colleagues), she spoke powerfully and cut to the heart of the issue -- the many Americans who face the plight of the Owens family, where the 27-year-old uninsured mother died for lack of timely health care, leaving two three children. She had lost her health coverage when she lost her job. The Dems need to keep focusing on this compelling moral case for health reform, and the news media and pundits like Mr. Van Dyk need to keep pressing Republicans on how they propose to solve this horrendous problem, since they reject the Democratic solution. State high-risk pools haven't solved it in the past and they aren't going to solve it in the future.

I couldn't watch the whole thing either. But it seems crystal clear that whatever concessions are made to the R's, they will not support the bill in any form. Their talking points were repeated over and over: "step by step," "government run plan," "start over," "blank sheet of paper." Adding tort reform to the bill would not get a single R vote. As I wrote a few days ago, if the D's had the strategy and the stones to pass this legislation, some R's would jump on board to get these pet causes added to a bill that was going to pass with or without them. And then it would be "bipartisan." See how they jumped on board the jobs bill when they couldn't hold their filibuster?

I agree with TVD's point that the President should have taken hold of this issue much earlier. He, and the country, need to find a new way to work with Congress. He had the mandate and momentum last year to find that way. A Joint Select Committee would have been the way to go, with legislation before both houses by late spring. Going through three House committees and two Senate committees was a ridiculous display and waste of time, which didn't bring any new ideas to the table and lost support rather than built it. I am sorry that such an imaginative campaign has turned into such a staid and plodding presidency. (Although one can't imagine GW Bush debating his opponents face to face like Obama has.)

If the R's and the public like simplicity, here it is: Medicare for people above 55, under 25, and buy-in option for everyone else. That would be a three-page bill and could pass under reconciliation. I'm sure it's too late in the day for this for health care, but the lessons should be applied to climate change: a simple escalating carbon tax applied at the point of production or import, and use the revenue reduce the deficit.

Harris -

You have to understand that the Republicans have no compassion, in an almost inhuman way. So pressing them to fix these horrible problems with the health care system don't really apply to them. They don't care. I watched the entire show yesterday and not once did I hear the R's relate to the American public a story about one of their constituents.

The reason they are so unmoved by human emotions is that they are a wholly owned subsidiary of the Corporations. And Corporations have no conscience. They only exist to make money. The Republican Party is really just a bunch of government subsidized lobbyists for the corporations.

compelling moral case for health reform, and the news media and pundits like Mr. Van Dyk need to keep pressing Republicans on how they propose to solve this horrendous problem, since they reject the Democratic solution. State high-risk pools haven't solved it in the past and they aren't going to solve it in the future.

— Harris Meyer

(Sorry. I didn't edit fully)

Harris -

You have to understand that the Republicans have no compassion, in an almost inhuman way. So pressing them to fix these horrible problems with the health care system don't really apply to them. They don't care. I watched the entire show yesterday and not once did I hear the R's relate to the American public a story about one of their constituents.

The reason they are so unmoved by human emotions is that they are a wholly owned subsidiary of the Corporations. And Corporations have no conscience. They only exist to make money. The Republican Party is really just a bunch of government subsidized lobbyists for the corporations.

I watched the healthcare conference for several hours yesterday. It was a political spectacle. There is no common ground here. The parties are coming from polar opposite views about health care. The Democrats want comprehensive change and the Republicans want incremental change. The Democrats want the government heavily involved and the Republicans do not want the government involved.

Mostly I was appalled by all the emotional stories and anecdotal garbage. This was totally unnecessary and a waste of time. We all know our health care system has problems, so skip the tearjerking stories. The time could’ve been much better spent actually debating the issues. But that is politicians for you, especially with the television cameras rolling.

I also got tired of Obama dodging Republican remarks. I was looking forward to his reply after several questions and he would say things such as “the election is over.” Nice dodge. I did not see the Democrats accepting or even considering any of the Republicans ideas.

My prediction is that the Democrats will not use reconciliation. It is political suicide for them. It would be a major step to defeating many Democrats in the next elections. In addition, it makes no sense to pass legislation that affects 17% of our economy through the reconciliation process.

There was an excellent piece in today’s Wall Street Journal by Gerald Seib. In it he spells out the three major questions that the health care discussion needs to consider:
1. Is the goal comprehensive or incremental change?
2 Is access or cost the top priority?
3. Should the government or the markets set the standards?

These are excellent questions and they should guide the health care discussions.

In summary, I hope that Obama’s bill does not pass. It is a total hairball. And it is not the right way to solve our country’s healthcare problems. We do not just have one healthcare problem, we have many problems. It is not a good idea to scrap the current system with a new 2400 page plan. It will be much more effective and less risky If we attack each of the problems incrementally. It may take ten years to solve these problems effectively, but let’s at least make sure our solutions are effective.

Mr. Borkowski,

I read your post directed at me and began to formulate a response. Although Mr. Biden's line was cute, it should have more accurately been aimed at Mr. Reid. Mr. Reid, if you recall, stated specifically and categorically that no one was talking about reconciliation - apparently forgetting that he had done just that last Sunday.

That, my friend, is an example of making up your own facts.

Any thought I had toward engaging you in a discussion on the merits, however, evaporated with your diatribe against Republicans? No compassion, in an inhuman way? This is what passes for serious discourse in your view?

Cleary, Mr. Borkowski, true debate is wasted on you, so I shall not waste my time tilting at your bigoted and hate-filled windmill.

Taupe and SouthHillConservative, what is your plan or the Republican plan to insure the 45 million uninsured?

SouthHill -

As Taupe mentioned in the post above, there is no common ground here. People like me consider health care to be more of a right and the Republican Party considers it to be optional... except for them of course.

Thanks for not debating me. It would be a waste of our time. The Republican Party leaders are seething with anger and hatred. You can see it in their faces. They don't even need to speak.

However, Jim DeMint spoke quite clearly and said this,"If we're able to stop Obama on this, it will be his Waterloo. It will break him."

Here's Obama's response to that:
http://www.youtube.com/watch?v=0hYK5PkLdE8

It's pointless to 'debate' with people like this. I don't consider this a diatribe. I'm just quoting your fellow Republicans.

As the President points out, this isn't about him. He has Socialized Healthcare already and all of his medical costs are paid for. It's about people who don't have health care. It's about private insurance companies that are price gouging Americans and then dropping their coverage.

I don't think I'm alone when I sense with every passing day that the gigantic gâteau de merde cooked up by Obama, Pelosi, and Reid is being moved outside by the American people. Moved outside into a torrential storm that looks to wash it all away. That's the good news.

The better news is that even if The OPR Wrecking Crew manages to pass this sorry, sodden slopbucket of a bill through the tight sphincter of "reconciliation" it will only cover their cake with green cyanide frosting. And the people who are going to be served large sodden slices of this cake this coming fall will be any incumbent that voted for it. Even if those voting sit in Demowhore "safe seats" they can plan on spending a lot more money and energy to keep sitting than ever before. At the same time, they can also count of their bases of support to be less energetic and generous than ever before.

From an objectionable chunk of legislation under ordinary circumstances, the Obamacare initiative has grown over time into something so politically lethal that it makes Jamestown look like Mayberry. This last week has added something new to the death cake mix -- a double dip of tediousness.

The Healthcare Bill is not just terrible any longer (and getting more terrible the longer it becomes), it's now become terribly boring too. The nearly year long gruntfest around this bill has finally gotten to the stage of terminal enervation. To even begin to listen to Obama, Pelosi, Reid or any of their clapped-out capitol whores flatulate further on the issue is now as numbing as having a railroad spike nailed down the center of your spine. And that goes for its supporters. There was little new to say about what they were up to when they started and now, after repeating themselves into oblivion, they have less than zero to say and yet they persist in saying it.

You can be a lot of things in America and do a lot of things to Americans, but you can't bore them to death in the process.

Where's the original "excitement" of hopeful social engineering and Candyland promises gone? Faded like the Highland Mist teleported to the center of the Gobi desert.

Where's the tug at the compassionate heartstrings of America when it comes to relating for the lebenty-leventh time some sad sob-story about some family in Upper Babboon's Buttocks that were so broke they had to have do-it-yourself open heart surgery on the rusting hood of their cashed-in clunker? Vanished into gargling tales of addled octogenarians slapping pre-owned dentures into their mouths.

Where's the new dawn of blissful bipartisanship as Democrats and Republicans sing of the Brave New Morning in America now that everything from heroin suppositories to frontal lobotomies with a government-approved icepick are free, free, FREE! forever? Sunk deep into a darkness deeper than a hundred midnights down in a cypress swamp.

Oh, it may survive. It may come to pass like some spot-welded Frankenstein slapped together from the hacked corpses of five dozen dead Democrats. But it won't be pretty and it will be very, very flammable.

Much like a cake left out in a rain of gasoline.

Got a light?

Good. Let's dance!

The Obama show was as dreadful as his own personal anectdote about car insurance for one of his clunkers. Health insurance is another issue along with 'when does life begin' that is above his pay grade. The 17 Republican doctors that are in the House and Senate should write the bill. All the dems want is more SEIU workers and their dues. The dem sob stories are all obliterated by the Canadian politician who went to Florida for his heart surgery. Obama should quit smoking and blowing smoke. Obamacare should be in front of the nearest Death Panel.

@ Vince
"If the R's and the public like simplicity, here it is: Medicare for people above 55, under 25, and buy-in option for everyone else. That would be a three-page bill and could pass under reconciliation."
"Taupe and SouthHillConservative, what is your plan or the Republican plan to insure the 45 million uninsured?"

I ain't taupe or (much of) a conservative, but I think a lot of people like you are on to the Third Way the Ds and the Rs so far ignore. Here is what I have been throwing in to their giant public opinion mix-masters.

Three Criteria for a Third Way (3 for 3)
1. Single best idea of each party.
2. Each idea must have been pre-tested.
3. Result must be whole-system, i.e. coverage for all, disincentive for all not to over use it.

My vote:
Ds: means-tested Medicare for all with private supplement
Rs: Medical Savings Accounts for all (including elders)

I realized that this would take a ton of arithmetic to get it balanced neutral, but that's all it would take, unlike endless incremental experiments using Americans and their health care as lab rats.

I also would not be opposed to making some use of the knowledge to be had from the government-run health plans that our legislators already know quite intimately.

I leave to David Brooks to figure out which side would get elected if both sides got down to work and went 3 for 3.

vanderleun, your writing is certainly colorful, but completely devoid of substance. For those who object to questioning the compassion of conservatives, you certainly make their case. Real people are declaring medical bankruptcy. Real people are dying from lack of preventive care and early treatment. I'm sure you enjoyed writing it, but it's like conserva-porn, and I felt disgusted to read it.

afreeman, how would Medical Savings Accounts for all differ from health care most places in the developing world - if you can afford it, you get treated, if you can't, tough luck?

Vince -

I would start with eliminating any health care benefits for the 31 million illegal aliens currently residing in the United States, or perhaps billing their country of citizenship. If they come here illegally and get sick, perhaps their own country should foot the bill.

For the remaining 16 million (a truly miniscule number is a country of 300 million) I would say get a better job. Work hard, better yourself - it's the American way.

Of course, denying health care to the 31 million illegals would tend to drive them out of the country, making more jobs available.

Quite frankly, the biggest problem facing this country is the giant drain on social services caused by illegal immigration.

That's probably not what you wanted to hear, but it's the truth. As the Vice President said, you are entitled to your own opinion but not your own facts.

Vince, I gotta say "I'm just no feelin' ya flava, dude."

The argument for compassion is trotted out so often and for so much and so insistently that people often mistake it for the moral high ground. It's not. It's a tired and shredded trophe of the pseudo-intellectual classes that seems to be worthy only because it sounds good. It doesn't matter what the effects of the policy actual are on the populace, it only matters that it feels good saying it. And it feels even better when you can tell everybody else to reach for their wallets.

Wring out the crying towel for your fellow weepers. We're not buying this boondoggle any longer. You're not preaching morality, but fiscal and social irresponsibility. And that's the fact Jack.

SouthHillConservative, I asked you straight up for an answer without insult or posturing, and you sent me a joke. The most authoritative estimates for illegal immigrants are 11 to 12 million, although at least one estimate goes to 20 million. I couldn't find 31 million. Some of the 12 million actually have insurance.

Your suggestion that we bill their country of origin is simply ridiculous; I can't believe it was meant to be taken seriously.

For the remainder, you say, too bad, I've got mine, the others will have to do the best they can. Bravo! At last, a little honesty. Ayn Rand would say this without embarassment, and she has a following for it. I wish the Republican leaders would say it just as honestly. I wouldn't support them, but at least I wouldn't have to conclude they were flim flam men as well as lacking in compassion. I would take your comments as pretty much the definition of "lacks compassion." I don't know why you objected to that characterization. Ayn Rand wouldn't! Perhaps you have some different idea of what "compassion" means - perhaps you think of it as an aversion to suffering without any desire or responsibility to actually relieve suffering.

Like I said, your compassion is not compassion. It's a crutch you use as a club.

Good, vanderleun! Let it all out! Your opinion is exactly what people suspect about Republicans. Honesty is good for the soul!

But, to appeal to crass self-interest...what do you think of the argument that our current health care system costs more than anyplace else, imposes such large burdens on employers that they locate elsewhere, freezes labor in place and prevents its free flow to other uses because of the fear of losing benefits? Does none of this affect your personal wealth, or is irrelevant because American economic success is not relevant, or...?

I see this has alas deteriorated.

Vince, you may not know how Medical Savings Accounts work because Washington is not one of the states that has activated or allowed them. Sometimes sellers who sell without a realtor will attract a buyer by splitting the would be would-be commission. In the case of a MSA, the provider similarly splits the would-be cost of excessive use (not to say that realtors are excessive). The account holder has the option of spending the savings on optional health care, vitamin pills, gym fees, or just save it and decide later. All the pretty young things would get some, but not full, benefits for health care they don't use, so would healthy elders who now pay for all those too far into degenerative diseases for preventive care and unavoidably on drugs aplenty.

Sorry for the double would be and thanks Vince for helping me to see where I need to elaborate.

afreeman, I'm still not getting it. You set up an MSA that's funded (by whom?) for, say, $10K per year. Your first accident or serious illness will exhaust it. Then who pays? So I guess you need catastrophic insurance. How does that change the cost curve? How does someone w/ a pre-existing condition buy it? What does this do for the unemployed or low wage worker?

It seems this set-up depends on consumers to be rational, cost-minimizing consumers of medical services. But consumers don't comparison shop for medical services; they have asymetric information, decisions are made in emergency/duress situations, they have a very high emotional content. You might dump your quick-lube place if they increase price by $5, but you're not going to dump your long-time doc for a similar price increase. So at first glance I'm not seeing how this is a solution, but am willing to learn.

VinceInSeattle, good plan. Every five years the ages shift back 5 years, 30 & 50, 35 & 45, finally universal coverage after 15 years.

President Obama had good tactical reasons for this summit, but substantively, bleh. The Republicans enacted their Health Care Reform plan under Bush's watch. Their plan was and is no reform whatsoever, their ideas were implemented forcefully under Senate Majority Leader Senator Dr. Frist, a major shareholder in the Hospital Corporation of America, the largest private operator of health care facilities in the United States, operating facilities worldwide.

So SouthHillConservative, after we deport the [debatable number of] million illegals, many of them recruited as cheap labor by the same corporations working so hard against any progressive reform, your plan is GOOD LUCK? Americans are a hard working people, yet many people who thought they were covered discovered to their dismay that when the time came they were not covered well or at all, and never mind those that are out of work because of the economy. Well, that will fix the problem.

TVD, if Obama had killed the public option in a trade with the Republicans, that would have been something to discuss. Instead, like the moderate Democrat he is, he compromised at the start by not going with the liberal position of Medicare for All, and then gave away what should have been the final compromise position of the public option for nothing in return. That's not very good bargaining, and a big letdown for the liberal side. He gets a C-, because by setting up this conference he focused a Democratic party in disarray after his DNC kludged up the Massachusetts election, and we may get a quarter of a loaf instead of Frist's nothing at all.

Vince -

SouthHill isn't serious about any of this. Since he brought up the immigration issue, it's clear he's been propagandized to death about the 'illegal aliens' from Mexico. He says, "I would start with eliminating any health care benefits for the 31 million illegal aliens currently residing in the United States..."

What he's forgetting is that Mexico already HAS socialized health care. I talked to a guy from Mexico who had a very serious accident and was in the hospital for weeks and had to go through physical therapy and recovery for months. His bill for everything was $300. You take that same person in the United States with 'health insurance' from a company like United Healthcare and they would probably be dropped and would wind up filing bankruptcy. And SouthHill's solution is to 'get a better job.'

What SouthHill doesn't understand is that people from Mexico aren't coming to the U.S. for our spectacular free social services and health care. Are you kidding? Do the math. You get in an accident and your bill in Mexico is $300. You do the same in the U.S. and you're in bankruptcy.

So let's be clear, 'illegal aliens' aren't coming for our health care. The notion that our health care system is some magnet for illegals is a myth.

SouthHillConservative also states that "Quite frankly, the biggest problem facing this country is the giant drain on social services caused by illegal immigration." This is the same social services bashing that began with Reagan.

So don't waste too much time trying to convince Conservatives of anything, Vince. They've been loaded with so many lies and fears, most of their arguments are based on false information.

Still, Richard, it's nice sometimes when people are honest about motivations and intentions. SouthHill and millions like him believe health care is no problem, or a private problem. So be it. I don't think they're the majority in this country, although they may be a majority in the Republican/Tea Party. One might deduce as much from the record of the Republicans - they didn't do anything about it when they were in charge, and didn't run with any persuasive solutions, and haven't produced any to date.

But it does illuminate the objections they express to any particular proposal, and the fool's errand of "bipartisanship" that TVD fixates on. Besides the simple will to power (Waterloo!), there is no compromise or combination of proposals that will create Republican support for health care reform. They do not see it as a problem for government to solve. I do wish everyone could be more honest about this sort of thing, take the votes, and let the people decide. The Republican talking points of "step by step" reform, "blank page," etc. are totally phony - I would think more of them if they just said what SouthHill and vanderleun said. And of course I would think more of the Democrats if they would produce the results they were elected to produce without all this "bipartisan" eyewash.

Vince,

In response to your request, here's some thinking-out-loud, in that it is entirely designers' choice at this point.

A Medical Savings Account would not be separate; it would be integral to coverage "purchased however the decision was to fund basic Medicare for more than seniors--say a means tested FICA, probably with an or employer contribution, and below a certain level basic coverage subsidized , which would replace current unfunded mandate that requires the states to take care of Medicaid, if and however they "wish." Could also come with the private coverage supplemental to Medicare--the feds currently stipulate the terms of those plans-- A to H. A MSA might take care of the current wrinkle of having to pick a level from which one can only drop after initiation at age 65+.

The MS account would be like, but the opposite of credit card reward plans-- rewarding successful use of personal preventive medicine so that fewer claims are filed. Part of the arithmetic required would involve guessing at a conservative enough kickback to keep the system sustainable and then to stochastically zero in up or down similar to what insurance companies do every day--yes, just like the "bastards" in California supposedly did.

As I have told both of the parties, I do not suspect either of them to love this. It does however call their bluff on the matter being so serious that incrementalism is the only way to go, which I find totally ludicrous.

afreeman, you said other states have tried MSA's? What is their experience? What are their drawbacks? Has any other nation used them in an important way?

Vince, you are good. That is the hardest question to answer and I don't have time today, but I did spend an interesting 20 minutes with Google @ "medical savings account." The best short history is at Wikipedia. For some reason. one arrives at an outline where the US story going back to the 1990s is only linked.

I also learned that the current term is Health Savings Account, per 2008 legislation and on the HSA page at Wikipedia I saw your complaint: when MSA/HSAs are offered as substitute for conventional coverage, they attract all those who have been lowering the cost of conventional coverage. Time to wise up, is my answer.

I have yet to uncover how the states get into the game. I did see that there already is a Medicare version (again separate, I believe). And I did get as far as Massachusetts plans. Thanks for forcing me to dig.

I've always said that the President should have been out front on this, supposedly an important issue, from day 1, instead of dumping the leadership on it to Senator Reid and Speaker Pelosi, neither of whom was elected nationwide. It's a common thing I've seen in business: those "in charge" will pass it over to others, then are "surprised" that the result didn't came out the way they expected, but then they never said anything specific nor kept enough attuned to the process to assure that this would happen! To do that would be leadership, not management. I think it's too late for health care reform to happen now, as the Rs are dug in deep and united, seeing gaining a majority and being re-elected in their grasp, to heck with the good of the country. It's only when there's a significant disaster - or that the issue affects them (yeah, right, in this case) - that change will be desired.

Folks interested in real-world experiences with health savings account/high-deductible health plans might want to check out the journal Health Affairs, which has published a number of studies of HSA performance. The findings are very mixed. Here's an excerpt from a 2008 article on whether "consumer-directed" health plans change enrollee behavior:

Information seeking. In this study, we found that enrollees in the lower-deductible CDHP reported being more active information seekers prior to enrollment. However, those who were not already active were more likely to start using information on cost, health, and quality than people who remained in a traditional plan. In the second year of enrollment, we observed smaller differences among enrollees in the three plans, perhaps because insurers providing PPO coverage are rapidly expanding Web-based information resources. As the availability of health information resources continues to grow, it is likely that such differences will diminish...

Cost sensitivity. The cost exposure associated with the high-deductible CDHP appears to have made health care consumers more cost-sensitive in making health care utilization decisions. Consistent with the findings of earlier studies of cost sharing, such as the landmark RAND Health Insurance Experiment (1971–1986), consumers seem unable to distinguish between cutting back on necessary versus unnecessary care...
Patients’ self-reported behavior in this study suggests that they may be forgoing or delaying recommended care. Analysis of pharmacy claims for this same employee population confirms the finding that enrollees in the high-deductible CDHP were more likely to discontinue some classes of prescription drugs...
Although there is little difference in the level of out-of-pocket expense faced by enrollees in the PPO and the lower-deductible CDHP, risky cost-saving behavior was reported among the latter group in the second year of enrollment. Further tracking of behavior and analysis of claims is needed to establish whether this trend persists over time...
Policy implications. These survey results suggest that the impact of CDHPs is mixed. There are some early indications that health care consumers may forgo medical care in the face of greater financial risk. These patterns of utilization need to be monitored. Employers and other purchasers may need to reevaluate the appropriateness of high-deductible plans for those with high health care needs, if the results found here are substantiated by analysis of claims data.

Harris & afreeman, thanks for your notes on HSA's. I'll do some additional research when I have time. But on first glance, it doesn't seem to address universal coverage without direct subsidy and doesn't seem to do much about administrative costs. Since catastrophic insurance is still required, the insurance companies would still be involved, and would have the same incentives to deny coverage based on pre-existing conditions and the like.

But the biggest objection is that it rests on assumptions about consumer choice and markets that don't seem to apply to the health care marketplace. People may get three bids to replace their roof, but they don't get three bids for their emergency appendectomy. The patient doesn't have the expertise to second-guess the doctor - usually follows his recommendations and sees recommended specialists. The HSA model seems to be the one we use for auto maintenance and repair - we pay for routine maintenance out of pocket, with insurance to cover collisions, which are random events. Can this model possibly work for health care?