Thanks for the link. Would you be interested in seeing a copy of a letter I received from my Republican Congressman on healthcare? I sent him a scathing reply. Especially his inflammatory statement "millions of Canadians flee to the U.S. to escape healthcare bureacracy in Canada". I asked for his sources and if he couldn't prove this statement, to please remove it from his form letter. I mean "millions"???, "flee"??? what does that mean, except to incite fear and an emotional response? Grrr....

The big irony of the Democratic Party proposals, to my mind, is that what Congress actually seems likely to pass isn't going to do much to challenge the hegemony of the insurance industry. To start with, it compels 45 million people to become their customers, and forbids them to say, "No, I can't afford what you're selling, it's too expensive"—which is the single strongest force against rising prices. It even has the government spending money to subsidize the purchase of insurance, though only after the coerced buyers have paid out a ruinously high share of their own incomes. There may not even be a public insurance alternative; but in any case I'm confident that if there is, the insurance lobby will prevent its actually offering them serious competition. So the whole proposal looks like a classic example of government regulation for the benefit of the regulated industry, and at the expense of the customers.

And it carries on a long-established pattern of regulation that drives insurance costs up. It's competition that keeps prices low. But most people get their insurance through health benefits that give them only a handful of choices. People can't buy insurance from providers in other states, even when they could save substantial amounts of money by doing so. Comprehensive insurance policies are mandated to include coverage of all sorts of things that many of their customers might not want or need; in many states, for example, a single man can't get insurance that doesn't cover prenatal care. It's technically possible to buy purely catastrophic coverage with a high deductible, and pay regular medical costs out of pocket . . . but such plans aren't offered by most corporate systems of employee health benefits, and given that health benefits are tax free and salaries and wages are not, taking a pay hike instead of benefits and buying your own insurance is hardly ever a winning option. It's rare to see anyone proposing an approach to health policy that would do away with this overcomplicated mass of special interest legislation . . . and given the massive hostility that John Mackey received for his August 11 column in the Wall Street Journal, that's not surprising.

But I recommend that column to you, for a set of concrete proposals in a different direction, aimed at actually reducing reliance on insurance companies and enhancing the power of market forces to bring prices down. David Goldhill's piece in the current Atlantic, "How American Health Care Killed My Father," is also worth reading, though it's much more coercive than I really favor. I actually believe that Obama was right when he said during his campaign that if you made health insurance cost something that people could afford, they would want to have it; a shame he's turned against that and accepted mainstream Democratic proposals to make people with modest incomes buy insurance that they can't afford . . . proposal, I might add, that started out as Republican proposals, supported by people like Romney and Schwarzenegger. Even so, Goldhill has some worthwhile points about the actual economics of health care.