I've got honest questions about this outrageously complex issue

Thank you for a thoughtful post. This is the sort of conversation we should be having about this issue.

I agree with you that health care is not a right, and we certainly can not afford to give everybody access to every available procedure. I think it helps to break health and medicine down into three categories: physical injuries, infections and conditions.

It makes good sense for everyone to have unfettered access to treatment for infections since they are usually contagious. I would rather Taco Bell pay a sick employee to stay home than have them handing bag after bag through the drive-through window, but since they don't pay for my antibiotics, time or doctor visit, they may not see it that way. That is one of several places where market ideology breaks down in this complex issue.

I think we should also pay for physical injuries, including heart attacks and the like, through our government, not because it is a right, but because it best serves the common good to treat such misfortune as a shared risk.

The third category, conditions, is where things get tough. Some conditions are a misfortune of genetics, others simply signs of aging, poor diet or inactivity. The cold mathematics says that expensive procedures become cost prohibitive beyond a certain age. Disabilities can limit or preclude a person from having an income to tax. Does that mean we should not pay for their care? Emotionally, everyone wants to say no, but economically it may be best to keep such expenses private and discretionary.

Regular preventive care helps minimize the costs of conditions and infections, so it is probably best worked into a public health plan.

Regulations covering health care will clearly exceed the tax code in complexity, but under the current system, we have not just complicated rules, but dozens of sets of complicated rules. Most hospitals and doctors agree that a single payer with one set of rules would drastically reduce administrative overhead.

Bobby, excellent questions, and hopefully ignorance mocking and troll bashing are going out of style anyway. There's just too much work to be done these days.

The Office of Science and Technology Policy's Open Government Initiative held a public online brainstorming session this past week at http://opengov.ideascale.com/ There I ran across a link someone posted to an excellent blog post entitled "The Supposed Difficulties of Converting to Single-Payer" where Dr. Joel A. Harrison does a good job of dissecting the arguments against a single-payer system. I highly recommend reading all of it, but Dr. Harrison sums up the bottom line as:

Many other modern industrialized nations have managed to develop some form of universal non-profit health care system with most offering comprehensive cost-effective quality care, often with far less wait than here, patient choice of doctors and hospitals, and at a lower cost.

Gradualism, given all of the above, is just a code word for keeping the unearned, disruptive, counterproductive profits of a dysfunctional fragmented for-profit health care industry that never should have been allowed to come into being in the first place (a recent phenomenon even in the U.S. basically starting in the 1980s).