I've said on this forum before that I consider myself a libertarian, not a progressive/liberal. I use the small l because I don't come close to passing the litmus test that seems to be required to dare use the capital L. I point that out because I am basically very sympathetic to the power of the free market system (Capitalism is a form of the free market system now mostly obsolete in a post-industrial society but is still commonly used to equate to a free market). I rarely if ever buy into the "evil corporation" rhetoric. Corporations do not exist to provide for what even its own board of directors perceive as the public good. It exists to generate a positive return on investment to its owners - whether proprietary, privately held, or publicly traded. That's its purpose for being. In a functioning market, the market system generates greater wealth for its owners and employees, greater innovation, less waste, and lower costs than any competing system in existence. I lose my big L rights because I acknowledge the natural pressures of a free market system require government regulations to mandate behaviors that are in the public interest but contrary to profit motive (pollution, worker safety, and so forth). So, no, I don't buy the story that our health care problem can be laid at the feet of private health insurance companies. Within the existing market structure, they are doing what they can to fulfill their mission to their owners.

The trouble is that, from any objective standpoint, the whole health care market is broken - not functioning. Doctors and hospitals aren't truly competing for patients, attempting to provide better service at lower costs. The patients are really shopping for healthcare so there's no incentive to compete for patients. Patients don't directly pay for much of their health care consumption. The costs are born by pools of potential patients paying into an insurance program of which the patient is but one member. These pools are, by and large, made up of the employees of a single employer. This has its roots in a WWII era wage freeze which, combined with a severe labor shortage owing to the war effort, caused comapnies to get more creative in attracting applicants. That's why your employer picks your coverage, not you. Other pools are defined by government agencies (medicaid, medicare) or you have pools of 1 (me buying insurance for myself). Too many pools of insufficient size, too little choice for coverage by the patients, too little competitive market pressure for health care providers... inherently broken system. It's not irreparably broken, but any free market solution would necessarily entail removing employers from the equation - creating something more along the line of auto insurance. Unfortunately, that's not really going to address the whole issue.

This is because the problem of health care provision is compounded by a problem within the pharmaceutical market. Most other industrialized nations have some sort of single payer health system. Prescription drug costs are tightly regulated, and those regulations are based upon production costs and market size - where they're based on any sort of market rationale at all. As a direct result, the U.S. of A. almost singlehandedly funds the overwhelming bulk of all R&D costs within the industry. Added up, this burden is easily the largest single form of foreign aid the United States has. Canadian drugs are cheaper because WE paid for all the R&D while the Canadians are only picking up their share of production costs.

Consequently, even if some mighty genius finds a way to fix the broken health care provision market (preferably by divorcing employers from the equation altogehter), the overall healthcare market remains broken. Viewed globally, the health care market as currently defined compels the United States to adopt a single payer model if only to force the burden of pharmaceutical R&D to be more justly shared by all developed nations. Corporations are international. Healthcare demand is global. A provincial approach to the problem is inadequate. We can't get away with legislating that pharmaceutical companies doing business in socialized medicine nations are banned from doing business here.

I agree with the suggestion that single payer is the only response. I disagree that the root of the issue lies with U.S. health insurance companies, but would more readily attribute it to the market pressures created by pharmaceutical companies attempting to do business within a socialized marketplace. If the rest of the world was to abandon socialized medicine, we would have the option of a free market solution. Since that's not going to happen, some action has to be taken to end the cost shifting from socialized nations to ours. I'm not smart enough to come up with a practical alternative that would force the socialized nations to shoulder their rightful share of the R&D burden short of socializing our own system, so I support a single payer response. No capital L for me, I'm afraid.