I think Republicans are succeeding at scaring people over health care again.

[anvi]

There are several problems with the process of health care reform this time, along with one considerable problem with real long-term reform.

The first problem is the conduct of the White House.  These guys are so scared to repeat the Clinton mistake of ramming their own plan through that they take a totally hands-off approach to the writing of the legislation.  They declare a few preferences and lobby for public approval and declare deadlines, but they don't set legislative parameters of their own.  The president doesn't need to present them a ready-made plan and say "stick with me or die," but he does need to set more specific parameters than have been set so far.  If this really is the president's number one domestic agenda item, he has to have more of a hand in the crafting of the legislation he wants to sign.  Congress is kicking the president's butt all over the place, and the White House, outside of begging and pleading with Congresspeople and reducing the president to the role of a mere public cheerleader, is letting it happen.  Don't get me wrong, it's good the president is out there lobbying for public support, so long as the people who want the plan turn on the heat with their own Congressional representatives.  But a president, if they want legislation, has to have a baseline for what it will include and push it with his party members, whose own success is tied to his.

The second problem is the complete lack of party discipline in the Democratic camp.  The party made their Faustian pact in 2006 by retaking majorities in both houses by supporting lots of southern conservative Democrats and Blue Dogs, and now they are paying the price of the bargain.  When Republicans held a one or two vote majority in the Senate and a slim lead in the House, they exerted incredible party discipline and, while it did backfire now and then, made them look like they held absolute power.  The Democrats, with a massive majority in the House and a virtual super-majority in the Senate, act like they have no power over their own caucuses.  You don't let your own party members give the president a full moon in public over his number one domestic policy initiative, you find ways to make the bridge creek under their feet or pledge support for them on other things as long as they come along on this one.  This is a failure of the leadership, and it sets a lousy precedent for the party's effectiveness as a whole.  The Democratic party has the discipline of a parade of cats, and the display is pathetic.

Finally, while some version of the current legislation will probably bring premiums down over time by bringing more people under coverage, which is a good thing to be sure, none of this this addresses cost inflation.  One of the major reasons that other industrialized countries are able to manage their health care systems as efficiently as they do is because the governments are empowered to negotiate prices with the suppliers, the hospitals and pharmas.  If we cannot find a way to control costs on the suppliers' end, either the way everyone else does it or in our own novel way, we will continue to be plagued by the massive costs of this problem, both through inefficient private insurers or through increased government expenditures.  But, it looks like the United States will have to go actually broke, not just hang on the verge of financial ruin, before we learn that lesson.

'Tis enough to give me the blues...

[anvi]

The point, anyway, of my long-winded post is that, if health care reform does not pass, the Democrats have only themselves to blame.  They control the White House and Congress, which means they have the biggest mandate in government then they've had in decades.  They have a considerably popular president.  They have outspent their opposition about 3-1 in tv ads supporting the plan, which has majorities of people polled supporting the basic contours of the bill they want.  If Democrats can't pass a decent plan, it won't be because Republicans said "boo!", it will be because Democrats couldn't find a way to walk in a straight line.

[anvi]

They need to sell the accurate fact that nationalized medicine will squash medical innovation. The uninsured are a small segment of the population. Why should we destroy the healthcare of the vast majority of Americans to cover 10-15 million Americans?

In the interest of accurate facts, the number of uninsured Americans is close to 50 million, not 10-15 million.  50 million people is 15% of the population, and 15% is not a small segment of the population.  When you have that many people out of the coverage pool, it raises costs for the insured, both because there are fewer people paying premiums so the generic premium costs are higher, and because when one of those 50 million people goes to an emergency room for care, the hospital has to care for them, but then passes the uncompensated cost onto taxpayers.  It would be cheaper for everyone if far more people were covered.

Secondly, it is really a myth that medical innovations in the United States are due to private industry alone.  National Institute of Heath grants are crucial for laboratories to conduct their research.  And pharmaceutical companies get massive tax credits, expensing of research expenditures and even tax breaks for direct-to-consumer advertising.  I agree that these companies are highly innovative, but they get incredible help from the government.  If you don't believe me, just look at how much the industry spends on campaign contributions to members of tax writing committees in the congress every year, and you'll see how much these industries depend on government favor.  Or, go to your nearest research university lab and ask them how they finance their cancer and spinal cord research.  The government of this country deserves lots of credit for supporting innovation in the medical industry.

[anvi]

Yes, about 7 million people in the country who are uninsured are not American citizens, but they are legal residents (that's how they end up getting counted in the census), and legal residents are legally eligible to be covered.  If you insist on not counting them (which I think would be wrong unless you are going to take a stand against legal immigration), that leaves 40 million American citizens outside of coverage, which is more than 13% of the population. 

Yes, a pretty large segment of the uninsured population have household incomes of over $50,000 a year.  But how many people are in those households?   And how many of that population, more than likely having two adults with full-time jobs, lack health insurance because their employers dropped their coverage, or because their coverage was dropped after a half year because of limitations on catastrophic care?  A pretty significant portion, I would guess, because I would not as a parent purposefully fail to purchase medical insurance for my children, because not doing so would be much more expensive for me, not to mention grossly irresponsible to my children.

And the fact remains that, when anyone from these population segments goes to an emergency room, the costs are passed on to the taxpayers and the insured.

[anvi]

He has none.  In fact there is hardly any proof that the healthcare systems of Canada or any of the European countries for that matter, are failures.  I've never gotten why people like him are so against the less well off being healthy, because that's the impression I'm getting right now. 

I join you in your bafflement.  Other developed nations spend half of what the U.S. does on health care both in absolute terms and in relative GDP, and have longer life expectancies, lower infant mortality rates and a number of other measures, while their populations are in polls much more satisfied with health care in their countries than Americans are.  So, some Americans look at everybody else, see that others are outperforming it, and then accuse everyone else of failure.  It's about as smart as watching a baseball game where team A beats team B by a score of 8-4 and saying: "wow, that team A really can't play."

I'm also baffled as to why some in this country want large segments of the population walking around uninsured and ill.  That wish defies both compassion and self-interest.  It defies compassion for obvious reasons.  It defies self-interest too, since it means that everyone will pay higher insurance premiums both for themselves and their workers, that larger percentages of their tax dollars will be spent on addressing the problem, that the workforce will be less productive because of increased rates of illness in the worker's family, and that consumers will be spending more and more money on health care costs and will therefore buy less of other goods and services.

The point: those who do not support some form of health care reform in this country are willfully self-destructive.