You should listen to this (from last Saturday’s This American Life on NPR/PRI). I plan to tune in tomorrow for the second installment as well.

My premises with regard to healthcare reform:

A. We want coverage to be available everyone (by “everyone” we mean “almost everyone”).

B. We want cost and availability of coverage to be independent of pre-existing conditions.

A corollary of B is that we need to make participation mandatory.

Based on those premises, a major take away from the linked program is: Don’t waste time hating insurance companies. The show solidified my skepticism in at least one respect. I don't understand people who are horrified by anecdotal HMO denial-of-care stories, but who also simultaneously believe that either single-payer or a public option can reduce healthcare spending without similar anecdotal horror stories.

The program cites how, for a brief couple of years, HMOs were successful at containing healthcare costs. That was ended by the denial-of-care backlash. The more interesting point is that the evidence shows the cost-containment success of HMOs came without negative impact to outcomes. You know, outcomes, the same statistics that are used to prove that we need a public option, and the same statistics which are being proposed as the basis for “evidence-based” selection of which medical procedures to cover in the plans in consideration by Congress.

These statements are supported in the series by both anecdotes and statistics. The Dartmouth review showed that 33% of healthcare spending in the US is unnecessary, and that the impact of unnecessary procedures isn’t zero, unnecessary care is actually harmful to health. Furthermore, most of the responsibility for the high cost of healthcare is laid at the door of…doctors and patients. Not insurance companies.

The statement is made flat out: if you want to contain costs, you have to put something or someone between doctors and patients.

So, my question today is: Why do you think it’s better to have a government bureaucrat be in that place, instead of an HMO? Is it because you think that they can cut costs without denying care the way HMOs did? Is it because you really don't care about cost-containment, and think that the government option(s) will ultimately back off from denying care, costs be damned? Or is it because you think that government will use similar measures to the HMOs, but will be better at standing up to the backlash? Or some other reason?