This is as much about political realignment as it is about health care.

Health care reform will pass. It will pass along a party-line vote. It will pass without the end-of-life counseling provision, and it will in all likelihood pass without a public option (even Paul Krugman seems to have moved on from the public option in today's NYT piece about "Swiss-style" care).

In crass political terms, the critical pieces are these:

- The 46 million (or a good chunk of the 46 million) uninsured will have access to health care.

- There will be a community-rating process so that people with preexisting conditions can buy insurance, and there will be restrictions to prevent "shedding" of sick people from the rolls.

- There will be subsidies to allow people who can't afford insurance to get it.

Would single-payer be more efficient? Of course it would. Is it politically possible? Of course it isn't. It appears that the same may be true for the public option, as meritorious as the public option is.

But however the thing shapes up, there will be some form of health care reform, because there are 46 million potential voters out there, and as long as it can be done in a way that doesn't scare off the other voters, it will happen.

Which is why the GOP is pulling out all its stops against health reform. They are afraid of seeing 46 million voters cemented to the Democratic party for years to come.

And the insurance companies? They're just angling for the best possible deal they can get out of this. Which is why the public option appears to be in such trouble right now.

But public option is/was the pivot not only of meaningful health care reform, but of the realignment you speak of. That is precisely why the interests that profit from the present dysfunction will throw everything into the fight to defeat it. They appear to be succeeding. A "Swiss cheese reform" will prove so chaotic, confusing and ineffective, certainly for the remainder of Obama's first term, that it will become a Republican selling point in 2012. Such a system may indeed work well in Switzerland--a small country where it has been in place for decades if not generations, but implementing it in the politically fragmented and economically floundering United States would be a nightmare. A public option "single payer" analog would be clean and simple by comparison.

Agreed. And the failure of the most charismatic leader this side of Kennedy to get a public option in the normal heathcare plans (in addition to the existing ones for children, the really poor and the elderly) will kill the idea for another decade or so.

Let us look a little more closely at the 46 million without coverage. About 25% of them are illegal aliens. Another 25% are young people who have jobs which offer coverage but which they decline because they don't want to pay even nonimal amounts for health care, thinking they do not need it. Another 25% are people who are between jobs or who otherwise qualify for Medicare or Medicaid but for some reason do not sign up for the programs. That leaves about 25% or about 9 to 10 million people who have fallen through the gap. So we want to upend 20% of the US economy to meet the needs of 3 to 4% of the total US population? If we want to meet those needs, is there not some way to address this?

"Let us look a little more closely at the 46 million without coverage."

Okay let's look more closely. Where do you get these figures?

"Such a system may indeed work well in Switzerland--a small country where it has been in place for decades if not generations.."

Nope, only about 15 years. See T.R. Reid's documentary, Sick Around the World, for more on how the Swiss system developed.

The Swiss system is social insurance like in Japan and Germany, voted in by a national referendum in 1994. Switzerland didn't have far to go to achieve universal coverage; 95 percent of the population already had voluntary insurance when the law was passed. All citizens are required to have coverage; those not covered were automatically assigned to a company. The government provides assistance to those who can't afford the premiums.

Social Security was a 1 percent tax when initiated. It is now 12.5 percent.

If we had politicians who knew how to balance the budget and reduce our national debt, and we had some good examples of where governement has been efficient in the use of taxpayer resources ( Hey, let's forget all about those $2,000 toliet seats) I might feel a little better about giving Big Brother, I mean the federal government, more power, and more of our tax dollars.

How big do we want our government to become? Seriously. Is there an end in sight?

But voting in universal coverage when 95% of 8 million people are already covered is still a different matter from mandating coverage when around 65% of 300 million people are covered. And the kind/quality of the preexisting coverage is important. I won't hazard another guess about Switzerland, but both the availability and the quality of health care coverage have gradually deteriorated over the last couple of decades for most Americans. We have to address those issues as well as simply recording people in the "covered" column, if we want to turn this mess around.

"But voting in universal coverage when 95% of 8 million people are already covered is still a different matter from mandating coverage when around 65% of 300 million people are covered."

Yes, but think of it this way. With only 5% of its population uninsured, the Swiss people thought it was such a crisis that they voted in a referendum to institute a system that made sure EVERYONE was covered. In the USA, with 16% of its population uninsured, there is a huge effort to foil any reform at all.

Hmm. Government isn't always very efficient, but by the measure of many companies it is a veritable model of transparency and efficiency. It's the usual difference between systems of government. Companies are authoritarian systems (at least the medium to large ones), which can be efficient if the culture, leaders and goals match up. As with all authoritarian systems, they tend to derail from time to time. Democratic governments never get the best solution in place, because they have to please the nutters too. But they are more stable.

We're in the position of trying to reform the French monarchy and its finances in 1789.

Incidentally, I've seen somewhere in the last few days that Kruger's Swiss parallel is also misleading in that Swiss health insurance companies are, by law, nonprofit rather than profit organizations. Haven't attempted to verify that.

'Incidentally, I've seen somewhere in the last few days that Kruger's Swiss parallel is also misleading in that Swiss health insurance companies are, by law, nonprofit rather than profit organizations. Haven't attempted to verify that.'

My understanding is that they are nonprofit on their basic health care coverage. They can make profits on their supplemental coverage.

just to insure the Illegals and Lazy.

Seniors Vote.

Democrats may get a few things, things which can be taken back once Democrats are long gone from Power.

Where did CocoMarie get her numbers? She made them up out of her head.