Health insurance is just the opposite. You pay for health insurance when you are healthy and able to work, but you build no future right to health care with your insurance premiums. If an illness or injury keeps you from working for an extended period of time and you can’t pay your premiums, you lose your access to health care at the point you stop paying your premiums.

Try getting chemotherapy when you are sick and have no way to pay and you don’t meet the severe level of poverty needed to qualify for SSI and Medicaid. You can get social security disability if you face extended time unable to work, but then you have to wait two years to qualify for Medicare. During those two years you have to find a way to pay for insurance or health care with your limited income.

To me it makes more sense to invest in “singe payer for all” which keeps my health care investment dollars in a system dedicated to maximize health care for all Americans with well documented efficiency in administering health care dollars: and most importantly to know that the investment in healthcare I am making in my healthy years will yield quality health care for me when I need it.

That whole “we weren’t at the table” whine has gotten them so much sympathy over the stimulus bill.

Why should they be at that table when they’ve got their lobbyist friends there. What is the matter with Congress (or is it Kennedy) that this plan would be written by the lobbyists. If we were okay with that we’d have voted for Republicans. [ Remember Cheney’s energy meetings were all with lobbyists. ]

I think we need legislators, including Republicans, talking this over.

it’s called lawyers and auditors.

Your characterization is more precise: the problem is health care finance. The current system rewards withholding of medical care for the many and its intensive, expensive application for the few. In the third world, that would be like hiring a top cardiologist for el presidente, whose cost would pay for fifty nurse practitioners whose care could reach thousands.

As I see it, the biggest stumbling block for both Dems and the GOP is that changing the current model requires government — acting as the representative of its citizenry, not lobbyists — to take an active role in allocating resources. They do that now, but in a manner similar to defense procurement: they fund the private sector and consequently pay for absurdly priced weapons, air and naval craft. (Some of the latter won’t even float; how ’bout them apples?)

The GOP’s public face is that further government involvement is “socialism. Priately, it’s about whose voice government listens to in allocating scarce tax dollars: select private corporations or David Brooks’ hated expert technocrat, who might spend in order to do the most good rather than generate the most profit. It’s not about socialism; its about citizenry taking responsibility for how their government spends their money. To date, they’ve relied on private companies to order priorities. Time to wake up.

Apart from health care finance, a more wide awake citizenry might demand more rational priorities from, e.g., the FDA and HHS. For example, testing for BSE, food processing inspections, food import inspections, and more critical drug trials and approvals, with shorter patent protections.

IIRC, COBRA funding survived in the Stim package. That’s a very good thing, IMHO.

Bob in HI

The model we have now generates tremendous capacity to provide care for those with (access to) deep pockets. We know this is horribly unfair, and so we come with laws intended to ameliorate the problem. Women are being kicked out of the maternity ward after less than a day in-hospital? People are being discharged from emergency departments before their condition is stable? We’ll fix that! And we got EMTALA (Emergency Medical Treatment and Active Labor Act) as a result.

This approach amounts to treating the symptoms rather the underlying problem. The underlying problem is a focus on insurance, rather than finance.

When finally get around to treating the underlying problem, some things are going to change. We will see more emphasis on prophylaxis rather than treatment, for one thing. We will likely see less effort spent on prolonging the inevitable: people are going to be allowed to die (comfortably!) rather spend weeks (or months) in incredibly expensive ICU beds.

But it’s a finance problem, not an insurance problem. Associated with the finance problem is a maldistribution problem. Addressing the finance issue should allow the distribution issue to be managed too.

I think the fly in the ointment is the fee-for-service system. The way it runs now required immense IT resources. The feds don’t necessarily want to pick up the responsibility for doing this for everybody. Indeed they have contracted out Medicare claims processing to — ta da — insurance companies.

To have single payer, you have to figure out how to control for fraud, abuse, and overcharging without having a fee-for-service system.

I’d sign up for one of the group plans where I work, but the choices are not appealing, and the information provided needs an insurance lawyer attached to explain what it really covers. (90 page PDF file written in insurance-legalese? You have to be kidding.)