Mr. Noah seems to have finally hit upon the problem with handing control of our health care to Washington. No matter which side of the political spectrum you're on, you have to accept that at some point, someone you disagree with is going to be in charge. Query, Mr. Noah, whether your enthusiasm for a single-payer system would have been at all tempered by the prospect of its being managed by the united Republican government of only a few years ago.

As always, the debate over the role of government in any sphere of life is a debate about what group of people get to make choices on your behalf. When you give government a tool that controls some significant aspect of your life, that tool can be used by anyone who can manage to form a majority coalition at some point down the line.

Right now, too many Americans find their choices in health care constrained because tax policy has made it impossible to buy health care except through insurance, and it has made it difficult to buy insurance except through an employer. For too many Americans, the possibility of switching insurers competitively is merely theoretical. But Mr. Noah's favored policies would double down on this flawed system. Today, you can possibly change the terms of your coverage by convincing your employer to switch insurers. Tomorrow, it will require convincing half of your countrymen to agree with you on the terms of the change.

Is this the future? Today, I have to compromise my health care choices with my career choices. Tomorrow, I will have to compromise my health care choices with my policy preferences on defense, on civil rights, on monetary and fiscal policy, and yes, on abortion.

This is the trade off. A health care system run by government will not be run by angels or benevolent dictators. It will be run by politicians, as flawed as they have ever been, and will always be.

There are many countries that have single payer programs, and none of them have to worry about their "choices" under those programs. Why? Because it's a SINGLE PAYER PROGRAM. Which means no matter what party is in office, the program remains the same.

My sister has lived in Spain for thirteen years now. She has never had a problem with shifting insurance companies, climbing premiums, invasive bureaucrats, shrinking benefits, growing deductibles, getting thrown out because of "pre-existing conditions" that conveniently materialize just when she or her family needs care. Why? Because Spain has a SINGLE PAYER PROGRAM. No matter who's in charge, the program pays for everything the citizens need.

Really, what is so difficult to understand about the word SINGLE PAYER?

I prefer the single payer desscribed above to the current politically run system (where insurance companies low-bid for exclusive company contracts, cutting benefits to make their profits, while simultaneously buying Republican political protection).

Serai, I think you've missed the point of the original comment. Just because a program is run by the government doesn't mean it pays for "everything the citizens need." There must always be some limit to what is provided and what is not, as health care costs would otherwise reach the point of health care demand, which is essentially unlimited if cost is no option.

In Spain, just as everywhere else there is a single payer system, the health care extended to citizens becomes a matter of public debate. There will always be issues both moral and financial. So whether we have a single payer or a public option, there will always be incentives for politicians (especially the political group in charge) to expand or limit coverage in order to appeal to voters. Those who are uncomfortable with increasing the size of government tend to point out that this is likely to lead to ever-increasing costs, as politicians are notoriously bad at saying "No." But those on the left are starting to see that the blade can cut both ways.

Regardless of what ends up being passed under the current round of changes to health care, I think it's a pretty safe bet that none of the plans available on any exchange- especially the public option if it survives- will be covering abortions after the first year or so of a GOP administration with a closely-divided or GOP controlled Congress. It's a good idea for supporters of an increased role for government in health care to understand that political considerations will drive health care and make peace with it now. One can't complain later that "This isn't how it was supposed to work!" That is, in fact, exactly how it is supposed to work.

And some of you are missing the point that the government plan at least has SOME accountability to its customers through the political process.

There is no accountability in the current health insurance industry, plus there is a profit motive that enables a major conflict of interest.They've proven amply that they cannot be trusted with this responsibility -- that great coverage for abortion, birth control, and even pregnancy was not provided by the industry voluntarily.

In the absence of a public plan, private insurance would have to be regulated within an inch of its life, to sort of begin to approach fairness to its customers. And those regulations would be the result of a political process, too.

Everybody seems to be missing the point. We are not talking about government run healthcare. I have seen in those suggestions that the government intends to take out of a management of hospitals and/or the employment of doctors. All we are talking about is whether healthcare should be funded through private insurance companies (who have not done a very good job so far) or through a public insurance company run by the government.

The "government-run" line is part of the FoxNews talking point that all Conservatives are required to repeat in every debate: Regardless of any facts.

Serai:

There are many countries that have single payer programs, and none of them have to worry about their "choices" under those programs. Why? Because it's a SINGLE PAYER PROGRAM. Which means no matter what party is in office, the program remains the same.

My sister has lived in Spain for thirteen years now. She has never had a problem with shifting insurance companies, climbing premiums, invasive bureaucrats, shrinking benefits, growing deductibles, getting thrown out because of "pre-existing conditions" that conveniently materialize just when she or her family needs care. Why? Because Spain has a SINGLE PAYER PROGRAM. No matter who's in charge, the program pays for everything the citizens need.

Really, what is so difficult to understand about the word SINGLE PAYER?

There's one serious flaw to this opinion. You're talking about Spain and this isn't Spain. The politics are different, the culture is different, and the economy is different. There seems to far too often come up the question 'why don't we have government sponsered health care like they do in the rest of the world'? First of all, this isn't the rest of the world. And secondly the government sposered health care in the rest of the world is as diverse as the people in the world.

Easily enough your entire arguement can be debunked by this simple question. How does Spain cover the millions of immigrants into their country every year? It's one of the most pressing questions when it comes to American health care, not illegal aliens rather the fact we have millions of first generation immigrants ever year and they comprise the single largest segement of the population without health insurance. It's a major issue, possibly the greatest issue in the debate, and glossing over it with 'Spain has a single payer system' is completely meaningless and useless in finding a solution.

Chrisle:

Everybody seems to be missing the point. We are not talking about government run healthcare. I have seen in those suggestions that the government intends to take out of a management of hospitals and/or the employment of doctors. All we are talking about is whether healthcare should be funded through private insurance companies (who have not done a very good job so far) or through a public insurance company run by the government.

..who wouldn't do a good job either (as their track record has shown). ;)

It's a major issue, possibly the greatest issue in the debate, and glossing over it with 'Spain has a single payer system' is completely meaningless and useless in finding a solution.

You keep saying w are "different" because we are "different". But you cite no sources or facts: Just your opinion.

I for one, do not believe we are sufficiently different, except that the United States funds its health care through private companies that consume 20-30% of the costs in administration.

I do not consider that to be a system worthy of preservation.

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You, of course, knowing that insurance companies are contributing about $1 million a day to killing any changes, and that insurance companies give about 90% of their political donations to Republicans, will go along with them and try your best to make sure nothing changes that does not benefit Republicans, because you are more loyal to the Party than to your country.

Actually the government run health care payment system (Social Security) does the job for about 2-3% overhead costs, vs about 27% for insurance companies.

The goverment actually is pretty efficient, although no Conservative is permitted to know this.

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