If so, I'll definitely be voting for someone else come primary time.

Goolsbee's moral hazard argument--"people tend to use things more frequently when they are free"--is a crock. Anybody interested in a sceptical view of this theory should read Malcom Gladwell's "The Moral Hazard Myth" at www.gladwell.com. In short, it says that people don't consume health care the way they do other goods (e.g., Pepsi). Do the most extremely wealthy and heavily-insured decide to stay at the hospital because it's free? People only schedule doctor's appointments because they're ill. And when constrained by cost, people are just as likely to choose against necessary treatment as they are superfluous treatment. By skipping preventative care and screening due to cost (Gladwell's example is a suspicious mole), much more expensive treatment is required down the line.

Goolsbee's next point is how much a single payer system would impact our doctors' bottom line. If that's the case, then why do most continue to accept Medicare patients? Moreover, if compensation abroad is so poor, then why do most Western countries with universal systems have more doctors per capita than the USA?

As for the increased cost to other countries if drug prices were lowered through a national system, I'm quite willing to continue subsidizing lower prices for the developing world, but not Western Europe, South Korea, Japan and other countries that have as higher or higher a standard of living than us. I'm not sure I believe the current pricing policies of the pharmaceutical companies are valid anyway. Formerly, their argument was that the obscene price of new drugs was necessary to recoup the cost of R&D. With the latest cancer drugs, however, they've taken an interesting new approach: intrinsic value pricing, i.e., if the drug's a lifesaver, the price is whatever the market will bear.

Of course health care will always be rationed to some degree or another. But who would you prefer make the decisions: the government, whose at least somewhat accountable to the public, or a company devoted to maximizing profit for a small group of shareholders?

The one thing Goolsbee is right about is pooling for risk. But why limit it to states or regions? The bigger the pool the greater the dispersal of the risk, which means a nationwide pool could provide insurance at an even lower cost.

BTW, Goolsbee, I used to have a shitty car, too. An old '75 Dodge Dart that never ran when I needed it, and actually managed to cost more per annum in repairs than payments on a new one. I looked abroad for a better solution: a Japanese Honda Accord that's now 17 years old and still runs better than most of Chrysler's new offerings and at a much lower cost per mile. So why should we want to continue trudging along with a system that costs almost 2 1/2 times what the rest of the industrialized does on healthcare, yet delivers a shorter life expectancy than the average in the Western world?

Sorry, but you are out of touch with Medicare and how fragile the support of Physicians is for it. There are a great many providers who now do not accept new medicare enrollees as the reimbursements are less then the cost of services.

An AMA survey, released last month, showed that most doctors -- up to 77 percent -- would limit the number of new or existing Medicare patients they would accept if the cuts are made.