The author assumes that making a radical switch to the sort of universal health care systems provided for in Canada and Western Europe is a non-starter, because powerful factions will resist it. So, he reasonably suggests, let's tinker with it.

But does tinkering ever work?

Does it get an alcoholic to sobriety?

The American Revolution wasn't an excercise in tinkering. The adoption of our Constitution wasn't an exercise in tinkering. The creation of Social Security wasn't an excercise in tinkering. The Civil Rights movement wasn't an exercise in tinkering.

Just because there are powerful interests arrayed against radical change isn't a persuasive argument for not working to achieve such radical change. Do the naysayers have a hotline to the holy?

My hunch -- the reason Hillarycare failed in '94 is that the Clinton administration assumed the public wouldn't buy going for broke so they decided to tinker, and they spent so much time tinkering with themselves that they devised a system that could be easily ridiculed.

Better a bare-knuckle fight with the insurance companies. You could easily peel off most of the opposition of their employees by offering a generous two-year buyout while they sought other work. How many of them really aspire to have the words etched on their gravestones: I denied benefits?

Most doctors would be delighted not to have to battle with insurance companies to approve a treatment.

Keep it simple and sell, sell, sell.