When the Affordable Care Act was drafted every effort was made to leave intact the largest source of health care coverage in America – employer-sponsored health plans. Most working families will have no other choices than the plans offered by their employers. How well are they working?

Words. Language. Framing. Egalitarianism? How do you frame that? Is that an American concept? Is that a defining value of democracy? Do our citizens believe that we should strive to ensure that all people have equal rights and opportunities? Or is this a left-wing conspiracy that deprives people of the realization of their individual ambitions? Is it then really just about freedom?

So, the United States has “the best health care system in the world,” except for all the others. Our amenable mortality – deaths that are preventable with timely and effective health care – is the worst amongst the 16 high-income nations studied.

The authors of this article supporting competitive pricing for Medicare were funded by a grant from the American Enterprise Institute, an organization “committed to expanding liberty, increasing individual opportunity, and strengthening free enterprise.” It is interesting to read why they believe that previous efforts to introduce competitive pricing failed, but what is even more interesting is their list of proposals for action that might accomplish their elusive goal.

Having been burned repeatedly in negotiations with the Republicans, and fully aware of that the election season has already begun, President Obama stepped away from conducting negotiations over in their territory and has now released his own list of policies not tainted by compromise. Since there is no hope of passing this intact in the current Congress, releasing this proposal obviously was a political maneuver. Nevertheless, it is important to see where he stands on Medicare, if only he could have his way.

Why would health care be fiscally unsustainable when it is paid for through a government program, yet sustainable when it is paid for privately?

The Obama administration is countering Republican claims that the Affordable Care Act stole money from Medicare. They are trumpeting the facts that Medicare Advantage premiums are 4 percent lower, and enrollment is expected to be up by 10 percent. We really need to get past the deceptive rhetoric on both sides to understand what really is going on.

Much attention is being directed to Maryland’s all-payer system of rate setting for hospitals since it has been effective in shifting Maryland from a state with amongst the highest hospital costs to a state with the lowest absolute charges. Should we ignore these findings and merely proceed with the relatively ineffectual tweaks of the Affordable Care Act? Or should we adopt an all-payer system for all hospitals? Or should we change to a system of global budgeting for hospitals?

Most of us who believe that the health care system should be designed to serve patients are enraged by America’s health industry leaders who believe that the system should be designed to serve the industry. Yet who has red carpet access to Congress and President Obama? Aren’t we going to do anything about that?

This Census report for 2010 shows that 919,000 more people were uninsured this past year than in 2009. This may be considered a ho-hum statistic by those who seem to be reassured by the provisions of the Affordable Care Act since the Act would expand coverage. However, there are other reasons to be very concerned, not the least of which are the statistics on income and poverty from this same report.