I just returned from the annual conference of the National Health Care for the Homeless Council, where the link between medical bankruptcy and homelessness was made more clear than ever.

Which raises the question: Will the health reform we get end the “Only in America” phenomenon of medical bankruptcy? Just asking….

I am not usually the one to write about individual horror stories.  I will have my usual statistics and facts later in this diary. But one speaker’s story summed up so much of what is wrong Only in America.

Let me tell you the story of Joe Benson:

However, seemingly out of the blue, came one, and only one, analysis that claimed McCain’s health plan would actually cover more than half of the nation’s 47 million uninsured, and two million more than the Obama plan.

Could it be that everybody else, including the wellknown non-partisan experts at the Kaiser Family Foundation  and The Commonwealth Fund  were wrong?

Thanks to Julie Rovner of NPR for connecting the dots of this phony Astroturf analysis:

1. The analysis is by Minnesota-based HSI Network LLC.
2. The lead author is Roger Feldman, University of Minnesota, health economics professor.
3. Feldman is longtime advocate of so-called “consumer-driven” health plans, the name given by its advocates to the free market fundamentalism described above.
4. Feldman’s frequent academic and writing partner is fellow U. MN professor Stephen Parente.
5. Stephen Parente is also a co-owner the HSI Network LLC. the company that that did the pro-McCain report.
6. McCain economic adviser Douglas Holtz-Eakin cited Stephen Parrente as a co-author of the McCain health plan.
7. QED: Left hand, meet right hand.

If you want to be pro-McCain so be it.  Just stop lying about it and claiming to be independent, when you obviously are not.

Will any academic associated with the McCain campaign have their reputations intact by the end of this campaign?

No.

This is what Republican nominee John McCain had to say about health care reform in his acceptance speech last night: 

My health care plan will make it easier for more Americans to find and keep good health care insurance. His plan will force small businesses to cut jobs, reduce wages, and force families into a government-run health care system where a bureaucrat stands between you and your doctor.

1. As Ezra Klein puts it: Spoken like a man who, on the one hand, has never used an HMO, and on the other, has never been off government health care a day in his life, and is healthy enough to run for president at 72. 
2. Also, it is of course, just another outright Republican lie; acutally two lies: On the one hand, McCain’s plan does not even make a pretense of trying to reduce uninsured or underinsured. To the extent it makes any claims, false as they are also, it is about cost control.  On the other hand, Obama’s plan does nothing to force people into a government plan.  Remember his is the plan among the Democrats that does not have mandates for adults.  At best, it tries to offer a public option for those that cannot get covered in the private for-profit sector.
3. Still it is a good example of how even after pre-compromising and offering a “respectable moderate” plan that keeps the private for-profit insurance companies front and center, the Democrats will still get attacked as if they actually had proposed Single Payer.  If you are going to take the heat, at least offer the benefit.  Sigh.

 Meanwhile, this article in todays Washington Post suggest that as governor in Alaska, Sarah Palin has been a knee-jerk free market fundamentalist with a typical misunderstanding of the reality of “competition” in the health care sector.  Basically she wanted to do away with “certificate of need” regulation, ostensibly so free market competition could lower costs and increase access, which just happened to coincide with the interests of some of her big donors.  As it failed to work (paging the Dartmouth Atlas) she created an advisory panel, packed with some of the same special interests.  When even they suggested changing course, she over ruled them.  I guess like Bush/Cheney, we would not want to listen to any, you know, experts.

So what else did you take away from the Republican convention?

“But the numbers are misleading, said John Goodman, president of the National Center for Policy Analysis, a right-leaning Dallas-based think tank. Mr. Goodman, who helped craft Sen. John McCain’s health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care.)

“So I have a solution. And it will cost not one thin dime,” Mr. Goodman said. “The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American – even illegal aliens – as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care.

“So, there you have it. Voila! Problem solved.”

[snip]

According to Mr. Goodman, only people who are denied care are truly uninsured – everyone who gets care is effectively insured by some mechanism. “So instead of producing worthless statistics that people fling around in vacuous editorials and pointless debates, the Census Bureau should produce meaningful numbers, identifying all of the sources of funds people will draw on if they need medical care,” he said.

I can only begin to count the 22,000 ways per year this statement wrong:

1. Studies estimate that there are about 22,000 deaths per year due to lack of health insurance. There are 11 million Americans with chronic physical illnesses like heart disease, diabetes and asthma are not getting the medical care they need because they don’t have health insurance. The uninsured have higher rates of stroke and cardiovascular disease deaths. The American Cancer Society found that uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage. Overall, the United States has the highest rate of so-called “amenable” mortality among 19 OECD countries; that’s 101,000 fewer deaths per year if we were as good as the average of the top three. But forget studies and just think for a moment. It matters if you got the mammogram last year, or get “treated” in the ER for untreatable metastatic breast cancer today. It matters if you if get your lipids checked and started on statins five years ago because you have coverage, or get “treated” in the ER for your fatal heart attack today. Apparently that is too hard to understand for some alleged health policy experts. Let me be a little bit more clear. This attitude by John McCain’s health policy advisor and by right wing Republican idealogues is not just delusional, it is homicidal. They are justifying the deaths of tens of thousands of Americans. That is the equivalent of seven 9/11’s per year, year-in and year-out.
2. Hospitals are getting killed financially in part because of the dumping of care into emergency rooms. They are closing ERs all over the country because of this. Meanwhile wait times in the ER are up even for the critically ill. This is not new news. Everyone who knows anything about health care in the country knows this. Except John McCain’s health policy advisor. They literally live in their own world, but not the one we live in.
3. And let’s not forget that half of personal bankruptcies are linked to health care costs (admittedly the studies on this predate the mortgage crisis; though of course right-wing free-market fundamentalist privatization and deregulation led to that disaster too). Of course that includes lots of people “with” health insurance from the same private for-profit health insurance companies that John McCain wants to really turn loose. Republican family values means more family bankruptcies… and more preventable American deaths.

Okay that is just three argumentsfor why these folks, as previously demonstrated by top economic advisor Phil Gramm’s mental recession and whiner comments, are completely out of touch with reality.

No doubt you have more! Let’s hear from you… 

P.S.: I should note that the full newspaper article included pathetically mild rebuttals by the Center for Public Policy Priorities in Texas and from Families USA.

PPS: h/t to Texas Tom for bringing the Dallas News article to my attention.

I will review where we have been, are, and are going. And why speaking personally I support (more and better) Democrats, but also why even in the face of the “poilitically feasible” argument, we need to keep fighting for real national care, which means single payer.

As previously discussed, Obama opposes mandates for adults and as the AP says:

…aims to achieve something close to universal coverage by making insurance more affordable and helping struggling families pay for it.

The platform makes a rhetorical movement in the right direction:

The party now declares itself “united behind a commitment that every American man, woman and child be guaranteed to have affordable, comprehensive health care.”

My interpretation is that Obama moved his language closer Clinton’s language in general to a more explicit goal of universality, but without any explicit incorporation of individual mandates. This all has to do with what their relative positions were during the primaries, fall-out from the Obama “Harry & Louise-like” advertisements against mandates and the Clinton/Krugman disappointment with Obama over all that. Obama’s plan was rightfully criticized for not even trying for adult universality, though their criticism of mandates forcing people to buy private insurance had validity too.

Unfortunately:

Under any system in play, most people would still put out money for [to buy] health insurance [from the same private for profit companies] as they do now, but they would get help [government tax payer public subsidy to the private for profit health insurance companies] when needed.

That was a common feature of the plans put forward by Obama and Clinton in the primaries. But she would have required everyone [used police power of the state to force people to give money to the private for profit insurance companies] to get insurance while his plan makes it mandatory only for children.

As reported:

Advisers to Obama and Clinton both told the party’s platform meeting they were happy with the compromise, adopted without opposition or without explanation as to how health care would be guaranteed.

Yeah there is that little detail… how, with neither mandates nor actual universal national guaranteed, everybody in, nobody out, coverage and care.

In return for the guarantee, activists dropped a tougher platform amendment seeking a government-run, single-payer system and another amendment explicitly holding out Clinton’s plan as the one to follow.

A few comments on that:

First, it is interesting that the Wyden/McCain approach of getting rid of the tax subsidy for the purchase of insurance through employers, popular among some, does not seem to have been at all in play here. Single Payer was at least part of the discussion. That is because we actually have some grassroots and activism. Hurray for us.

Second, note the use of the deliberately misleading shorthand description of “government-run, single-payer system” which falsely leads the average reader with the impression that your doctor is going to “government run”. In fact, under single payer, the service delivery side (doctors, clinics, hospitals) remains completely private sector. What is guaranteed is that you and your family DO have access and INDIVIDUAL CHOICE of doctor, clinic and hospital. More real choice then you have now with the insurance companies. As we have learned since 1994 with the so-called HMOs and MCOS is that it is private for-profit insurance model that leads to loss of access to and individual choice of doctor.

Thirdly, well okay, we did not have the votes in this committee to get single payer endorsed today. The fight goes on.

And here are some reasons why the fight for real National Health Care needs to go on:

An Obama White House will propose whatever it will propose, but they are signaling (shouting) that they are very open to whatever/anything that can pass congress.

Hopefully regardless of what comes out of the White House and out of the Senate, and whatever pull there is to the right from AHIP/Pharama/For Profit Hospitals/Republicans/etc…. that there will also be a serious pull to the left/single payer side from the House with Conyers’ HR-676 being the leading bill there. That is one reason single payer advocacy has to stay in the game, to get as good a bill as we can passed in the short term.

My prediction is that some sort of “reform” will pass in 2009-2010.

If it leaves the private for profits in place, then it will fail, for some mix of four reasons: Not only will it not achieve universal coveragte (all people) or comprhensive coverage (all needed care vs. too many excluded conditions/services, private companies still playing denial of care games), but it will wind up being too expensive in total out of pocket costs to individuals (premiums, deductibles, copays, uncovered conditions/expenses, coverage refusals/denials of care, still go bankrupt if actually get sick), and it will not control costs nationally (e.g., percent of GNP going to health care).

Which leaves for 2012 and beyond the question of who is blamed for the failure?

Is failure going to be (falsely) interpreted politically and publicly as being due to failure of entire liberal model of (incomplete) public reform? In which case the right/conservatives/republicans win and we go backwards to a pure private for-profit model (Giuliani, McCain).

Or is blame correctly assessed as being due to the failure of having left the private for profits in place (and even haved forcibly subsidized them via mandates)… and therefore that the need is to get them out of the game and finally going to single payer national health care.

That is the other reason single payer advocacy needs to stay in the game. To get the a real solution passed as soon as possible.

P.S.:

For those who are interested in this subject there are two new great books just coming out this week:

“10 Excellent Reasons for National Health Care”
Edited by Mary O’Brien and Martha Livingston

“Do Not Resuscitate: Why the Health Insurance Industry is Dying and How We Must Replace It”
by John Geyman

While the beltway and people “who knew better” did little after 1994, it has been Single Payer advocates who continued more then anybody to do the hard work of actually building a grassroots infrastructure and support.

As Jon Cohn admitted:

You can see it in the press coverage, as reporters, myself included, hype the work of lawmakers like Senator Ron Wyden, who has been pushing a bipartisan bill that would give everybody private insurance. Meanwhile, almost nobody bothers to interview Representative John Conyers, even though his single-payer bill has 90 co-sponsors–not enough to earn it passage, perhaps, but surely enough to earn it a place in the conversation.

Actually HR-676 now has 91 co-sponsers, having added one more just this past week.

HR-676 has been endorsed by over 417 union organizations in 48 states including 107 Central Labor Councils and Area Labor Federations and 33 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO,MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA & AK).

It has the vigourous support of the largest Nurse’s Union (CNA/NNOC), and the largest Nurses professional association (ANA). And the National Association of Social Workers.

It was endorsed last year by largest physician specialty group, the American College of Physicians which represents Internists, and in a recent editorial in their professional journal (.pdf).

And of course Physicians for a National Program (PNHP) with organized activists in most States.

It has been recently endorsed by the U..S. Conference of Mayors.

Oh yes… HR-676 has also been endorsed by the Assembly of the Urban Caucus of the Episcopal Church, General Board on Global Ministries of the United Methodist Church and the Presbyterian Health, Education and Welfare Association of the Presbyterian Church (USA). And most recently Unitarian-Universalist.

We have explained why as a matter of policy it is a mistake to take Single Payer off the table and to ignore John Conyers HR-676.

So, just maybe it is not a good idea to ignore us or tell us shut up. We have explained why it is wrong as a matter of strategy, politics and real coalition building.

None of us wants there to be no real reform (even if it is a first step) in 2009-2010!

But do not ignore us.
Do not tell us to shut up.
Do not tell us to go away.
Do not ask for our support after the fact.

So here is a deal… You include single payer advocates at the table from the beginning, you leave single payer in as an option, and I (speaking just for myself, not necessarily PNHP as an organization) won’t insist on it as the only option. This is just the beginning of the fight with AHIP, Pharma, the for-profit hospitals… there’s no need to take any of our chips off the table before real negotiations even begin. Let us organize and fight together?

But as a one of those who has supported the obvious need for some sort of “universal health care” since I was first learned about the issue as a college and medical student in the 1980s, and only came to single payer per se recently, I have a few of my own points to make:

1: Strong or Weak?

Ironically, we single payer advocates are apparently so weak that we should be dismissed out of hand and not even have a seat at the negotiating table? But then again we are also strong enough to be warned not to wreck “doable reform”?

It is the Beltway sensible moderates who have worked hard to ignore the actual presendce of single-payer grassroots and to exclude its advocates from the table, not the other way around. And frankly, it is tiresome to be dismissed upfront (and then be blamed for not participating or getting on board).

We are the ones who actually have a real grassroots movement. The single payer proposal in Congress, HR-676, has more signed-on co-sponsors then then any other “universal health reform bill.” It has a higher percent of the House then the Wyden bill has in the Senate. HCAN could have included single payer advocates as part of their mix, could have included support for HR-676 “Improved and expanded Medicare for All” as one option still in the mix of possibilities to be promoted; in their language and in their “poll”; etc.). First they exclude us from the table, then they call us rejectionist zealots after the fact.

I first encountered this back in 1992 after Bill Clinton was elected with our support, and they actively kept single payer advocates from the pre-inaugural economic summit. Similarly we were kept out of participating in the closed door development of the Clinton health plan during 1992-1994. More recently there was the so called Citizens’ Health Care Working Group, where the citizens part supported single payer but the establishment organizers made sure they were ignored. Similarly during the early part of the primaries, during the Clinton listening tour in 2007, citizens for single payer were a majority at many of her gatherings, but were actively ignored. Most recently, leading up to HCAN, there have been numerous conference call by the “Unity” group at which single-payer advocates are told to be quiet and “get over it”. At a Health Affairs sponsered press conference in D.C., ostensibly for discussing just the candidates Obama and McCain plans, other folks from AHIP, Wyden, etc., were in fact also invited and spoke. Nobody from Conyers office or single-payer groups was invited ahead of time.

Unlike those with $40 million K-street campaign-cycle-only Ads, we are the ones who have been working at the real grassroots level to inform the public and health care professionals since the last pre-compromise plan went down in flames (not due to us) in 1994. WE have made progress, as noted by the recent survey published in the Annals of Internal Medcine showing a 59% of U.S. physicians would be in favor of a single payer system, up 10%.

2: Strategy of Pre-Compromising with the Insurance Companies?

No matter what “Reform” is proposed the opposition – AHIP, Pharma, the for-profit hospitals, and free market fundamentalists will start off by opposing it. We don’t see the advantage of pre-compromising before the negotiations even begin. I prefer to keep all my bargaining chips until the real negotiations begin.

3: Politics and Overton Window & Framing?

Putting aside for the moment that we are correct as a matter of pure policy; just as a matter of politics does it make sense for us to shut-up? There is the Overton Window argument.

For those who do argue for pre-compromised mixed plan on the basis of political expediency/feasibility, is it not really better for them to also have folks arguing from their left? Is it not a good thing to have some pull from left, while they are also being fought from the right by AHIP and free market fundementalists?

Is this not part of the success the right had? What was crazy talk in the National Review in the 1950s, and a political failure with Goldwater in 1964, becomes the “success” (tax cuts, supply side, deregulation, government is the problem) of Reagan/Bush.

More recently we see the example of same-sex relationships as a case of moving successfully the goal posts. Crazy talk that becomes acceptable in compromise fashion (civil union; state benefit rights) and slowly (but surely?) marriage. Historically we can think of ending slavery, and the vote for women. There were always folks calling for half-way compromise. But the more the side that seemed more “extreme” but in fact had truth and reality on their side won in the end.

For those who prefer, and think that one wins, by framing a policy as a clear moral message, the single payer approach also offers the better way. HCAN starts off by saying that the for-profit private insurance companies are the problem, but then goes on to keep them as wasteful distorting middlemen. Rather then deliberately pre-compromising and keeping keeping the identified problem in the mix, we say who need them, get rid of them. It is similar to the confusing and mixed message the ever so clever moderates came up with of paying for SCHIP expansion with cigarette taxes. A simpler message with moral clarity is what Single Payer offers.

4: Perceived Political Feasibility Aside, Which Reform Will Work?

PNHP’s role and goal is to advocate for the the actual best plan, the one that can actually work to provide coverage that is not only universal, but also that is comprehensive, affordable to individuals and families, and also acheives system wide control of costs. Single Payer, as embodied by HR-676, Improved and Expanded Medicare for All can do this.

The U.S. already spends as much as Europe and the other developed countries do on it public sector health coverage; they provide universal; we are already in effect paying for it, but don’t get it. Keeping the for-profit private insurance companies in the mix allows them to continue to game the system (e.g. skimming the healthy and wealthy; dumping the sick, poor, old on the public system). Continued subsidizing of the wasteful for-profit private insurance companies forgoes $350 savings billion per year. Administrative waste is a natural byproduct of the private insurance firms that would retain a central role under HCAN’s plan. Private plans’ overhead is 12-fold higher than under NHI; the excess is squandered on marketing, underwriting, utilization reviewers and profits, and for the billions paid to executives. And the multiplicity of insurers envisioned in the plan precludes paying hospitals a global, lump sum budget; such budgets would save additional billions by obviating the need for most hospital billing and much of the internal accounting needed to attribute hospital costs to individual patients and payers.

Alas, HCAN’s proposal duplicates key elements of health reforms that have passed, and then failed, in multiple states: Massachusetts in 1988; Oregon in 1989; Tennessee, Minnesota and Vermont in 1992; Washington State in 1993; and Maine in 2003. In each case, rising costs scuttled the reform effort; none had a durable impact on the number of uninsured. The 2006 Massachusetts law, which incorporates many of the features of HCAN’s plan, is already threatened by rising costs, despite offering skimpy coverage and leaving many uninsured; indeed so far the increase in coverage in the new Massachusetts plan is among to poor who get public coverage, and the effect if any of mandates and regulated private coverage has not been seen yet. And Massachusetts, with its low rate of uninsurance to begin with, and a large fund devoted to care of the uninsured, offered the optimal conditions for trying such a plan.

Single Payer is the one that also control costs! CBO and GAO have previously scored single payer as most economically feasible. So has Lewin on numerous State single payer proposals. So not only does single payer provide care that is more universal and comprehensive then the other reform proposals, it does so with greater cost saving then HCAN or Obama or Wyden-Bennett or McCain. We are correct as a matter of policy and economics.

5: Who Wins “I Told You So” After the Next “Reform” Fails?

It is also a matter of who gets to win the “I told you so” argument after the next reform passes, and if it fails as Single Payer advocates believe it will. At the very least we want to be sure that after the next reform does pass, that if it fails, the next step is forward to single-payer (“see you left the private for-profit in as wasteful cheating unneeded intermediaries”), and not backward (“see government tries to reform things and it went badly”) to market fundamentalism. This is very important, since something is likely to pass after the 2008 elections and I fear for what it will and will not bring.

6: We Are Not Spoilers!

How dare others, especially folks not actually working in health care and for those who are underserved, call us spoilers! Like many other single-payer activists, I already work in the frontlines of providing care to those who are uninsured and underinsured. Many of the PNHP’ers and other single-payer advocates that I know have as their real full time day jobs just such work. And guess what? We could be earning a lot more if we worked elsewhere. Unlike the K-street lobbyists and full time corporate supported think-tanker’s, we are mostly volunteers doing this in addition to the work that pays the bills. Supporters of HR-676, both grassroots, and the 90 co-sponsers in the House, are ALSO the same folks who have always been at the forefront of all the immediate short-term reforms and fights such as those for SCHIP, Medicaid expansion, saving the Medicare from the privatizers, etc. We are hardly rejecting the good/mediocre for the perfect. It sure as heck was not us who shot down the Clinton proposal, even thought they thought they a had a pre-compromised deal with AHIP, in 1994. And frankly, despite some claims, it was not CNA or other single payer advocates who shot down the Schwarzenegger Rube Goldberg-kludge of a plan in California last year. Indeed, case in point, it was the ridiculous economics of that plan which killed it, even though, once again, Lewin had scored California single-payor favorably.

I can’t speak for any individual other then myself, but at the very end of the day I won’t be the reason a half-decent reform does not pass. But, meanwhile, I will fight for it to be at least three-quarters decent instead. But meanwhile “god forbid” we should actually argue for the actual best policy at the beginning.

Oddly in the Jon Cohn article it is Andy Stern who is cited as asking for our grassroots support to make a differnce. This joiner of every compromising coalition there has been (including with WalMart and AHIP), may not be the best spokesperson for calling out single payer advocates. He has his own separatist and exclusionary agendas with regard to some single payer advocating unions such as CNA and many AFL-CIO affiliates. Actually several SEIU locals have endorsed HR-676.

The real problem is not that Single payer advocates are unwilling to support HCAN. The real problem is that Single Payer advocates have been and still are being actively excluded from all the these other efforts. It is nice that they have gotten around to co-opting our message after we laid the ground work for them with years of hard work. Although they are using our message that the Insurance companies are the problem, even if they are too invested in pre-compromise to follow through to the conclusion. Maybe if they would be more inclusive of us upfront, we could indeed work jointly, equally, together as true partners.

$40 miilion dollars is being spent by K-Street professionals to tell the American people that the disaster of the U.S. health care system is due to the for-profit private insurance companies. That is a good thing, right? Heck, when I first saw the print Ad I thought it WAS a single payer group. It is single payer language about the failure and evil of the for profit private insurance companies. But then they chicken out on their remedy. David and Don’s critique below are completely correct as a matter of policy. But since HCAN is not really making a call to action, policy is not what this is about.

What it really is:

Where is the money coming from and why is it going to this campaign that does not actually have a specific call to action? The official message from on high is that HCAN is grassroots. Yup $40 million bucks, top down pre-determined pre-compromised message by K-Steet establishment. Nicely done professional Ads. Paid staffers sent out on-message from central office. But we are told its grassroots. So says Ezra Klein. So says David Sirota (who really should know better). Well HCAN is many things. It is a lot of money beng spent with our message that the for-profit private insurance companies are the problem. But grassroots it obviously is not! Sheesh. These are grassroots!

What it really is, is about building mailing lists and fundraising and get-out-the vote for November. It is a $40 million investment in party organizing. Think of it as the Democratic messaging counterpart to the National Rifle Association. In addition, the campaign is going to take advantage of MoveOn.org’s massive data files to reach out to like-minded supporters and officials promised to work in Democratic and Republican districts alike. “We’ll have an organizer in the district of every Blue Dog Democrat,” said HCAN campaign manager Richard Kirsch of the conservative Democrats. I guess that is all good. But it would be nice if for $40 million dollars they supported something without pre-compromising.

What it could have been:

What is weird, is that they seem to truly believe that the message that will resonate with the American people is our single-payer message that the insurance companies are the problem. That is the out front message to pull people in. Co-opting our message. To get people’s contact info and donations. Brilliant. Glad we could help. You are welcome. 

But… gee… all that money, and no real call to specific action, except to compromise and take single payer off thetable without even a fight. Now, imagine if they did everything the same, but also included in their $40 million blitz an option ask Americans to on call their Congresspeople to sign onto HR-676.

Imagine. Yes we can.

1. Is it Universal? Does it cover all people? This would seem to be pretty basic, insofar as all other developed countries do it.  But just being, or claiming to have, universal coverage is not enough.  It is a common error to claim universality and then let it go at that. When thinking about a so-called health care reform proposal you must also explore how the proposal deals with items 2, 3 & 4:
2. Is it Comprehensive?  Does it cover all needed conditions, prevention, treatment? What care is included under the proposal? What care is not covered? And given the way the for-profit private insurance companies actually operate in the real world, one has to ask what is REALLY covered: does the health proposal allow insurance companies to deny medical treatment, diagnosis, referrals recommended by a patient’s physician because of cost? Does it stop insurance companies from refusing to cover patients with pre-existing conditions or rescinding policies for people when they get sick?
3. How much is it going to Cost Individuals? Is it affordable year-in and year-out.  How much does it cost you and your family if you are not sick?  Can you afford to get sick.  What is the total cost of the system to you and your family including taxes, premiums, deductibles, copays, uncovered conditions/expenses, denial of care/coverage refusals/claim rejections.  What is your total out of pocket costs?  If you get sick are you going to go bankrupt?
4. How much is it going to Cost Overall? What is the cost to the system, to the country, for example as a percent of GNP?  How does it control costs. How is it paid for, and who is paying, all the pieces, direct and indirect?

Too many folks fall for the trap of hearing “reform” or even “universal” and don’t realize that it is not really Universal Coverage, IF that Coverage is really “coverage” because it leaves you with too much legitimate care not actually covered, leaves you and your family with bankruptingly high out of pocket expenses when somebody does get sick, and the total system costs keeps rising as percent of GNP. 

Any real reform has to do all 4.