I still haven't seen a plan that outlaws employer provided health insurance.

I think Edwards comes closest by admitting that a single payer system might eventually evolve as the most efficient choice. The thing that kills me about all three of these is how they've spent so much effort triangulating against the insurance lobby, health care providers, drug companies, and the GOOPers terrified of "socialized medicine." None of them are addressing the near hyperinflation in underlying medical costs, as if insurance reform is the only possible avenue of action. Nobody's really tackling the question of why medical costs (not just insurance) have skyrocketed much faster than the rest of the economy for the last couple of decades.

As a result, these three plans merely tinker around the edges, although they do present some worthwhile ideas (pooling, IT improvements, best practices, etc.). The fundamental problems remain unadressed.

And thanks for the link. ;-)

--Socialist With A Gold Card

I have been living with this dream for a long time because I have worked in healthcare for over 30 years. I have had many jobs and career paths that did not require me to take care of sick people (that is a whole different story).

Among those jobs were working for 2 different hospital associations in the area that contracted for hospital supplies, services and equipment. I learned a bunch about bidding out to pharmaceutical companies, manufacturers and wholesalers, among many other types of vendors. While at these institutions, I learned about hospital lobbying at the state and federal level. During my first stint at an association Medicare went to the prospective pay system based on diagnosis/procedure. That was a revolution in hospital finances and changed the purpose of the "medical record" which then became a billing tool.

Later I worked for several insurance companies as a case manager. And while there I learned about huge companies that are "self insured", moving money around to pay large claims that would be hitting. I learned how to educate the family that I was the 'case manager for the insurance company', they are the case manager for their loved one. I would often give them the "magic words" that could open doors when dealing with the claims department or in trying to get the many referrals needed from the Utilization Dept. This was before they started monitoring our calls.

I worked for several "Independent Physician Associations" (IPA) that was basically a group of physicians being offered to insurance companies so they did not have to go out and contract with each of them individually. There were a couple that got into the HMO business and then I learned about writing those wonderful insurance plans that we all get to study to see what our copays will be and how many physical therapy visits we get a year. I saw the bean counters get real greedy, 'keep inpatient days down'.

One company I worked for was into selling policies to individuals that had a nasty pre-existing clause that most people did not understand until they were sick. While my department did not deny care, we were certainly pressured by the "California office" to find something in the medical record that they could use. I did not last very long at this place.

Somewhere I learned about the insurance "brokers" that got their percentage when selling a policy to an employer, working with the HR folks. They are a sleezy bunch.

I then found myself doing Quality Assurance/Performance Improvement and Compliance with a local hospital. How does one legislate quality? With a bunch of forms and reports all requiring some RN to review charts, collate data, spew out reports, and discuss in committees (administrative overhead).

In between some of these jobs I worked in home health, another time in durable medical equipment, medical waste disposal, hospice.... Not to mention being a patient at times and fighting the battles with the hospitals, doctors,and insurance companies.

So I see the mess we are in and have some ideas of how to make it all better. But there are so many making so much money right now, the lobbyists for all of them are still to powerful. We need campaign finance reform so our politicians cannot be bought. The major employers in the US need to rise up and insist that healthcare be taken off their shoulders in order for them to compete fairly in the global market (otherwise they will keep shipping the jobs overseas). The uninsured or under insured need to make their voice heard.

The healthcare reform the candidates are posing sound like ways to evolve our current system. I believe it will take a revolution to overturn the status quo. Is that revolution near?