The problem has never been the insurance companies.  You can cite all the stats you want, but the bottom line is that these organizations are run by people. It is the people not the organization that are the problem.  The owners, decison and policy makers for these organizations and other health care organizations have a stake in the current system. It is thier livelihood and it expands their wealth and power.

Until you change the game you'll get more of the same.

A single payer option changes the game, but you can change the game in other ways. Elimiinating fee-for-service and pay-per-pill is the real goal because then the for-profit system rewards behavior that improves people's health.

Of course insurance companies are not the entire problem, I agree. However, the increase in for-profit insurance companies and the influence of Wall Street on the industry has disproportionately increased costs with no corresponding benefit in the delivery or quality of care.

Insurance is wildly profitable because the business model is to collect as much in premiums as possible while paying out as little in claims as one can. James, are you familiar with Post Claims Underwriting?

Once we establish health care as a human right and as such, pay for it together and dispense it universally, we can also address eliminating fee-for-service and pay-per-pill as other countries do.

There is no reason whatsoever for health insurance to be a for-profit business, and many, many reasons that it should not be.  

The short verson is we're doing so few of the things that will lead to us being healthier as a society, and we *haven't* been paying for it, that now we need to start.  The savings are down the road, but the needs are immediate.

Let's stick to diabetes.  Every day, someone goes to the emergency room (the most expensive place to receive care), or has a drastic intervention including amputation, hospitalization, or being treated for heart failure.  In too many cases, this was preventable.  Diabetes can be treated with regular primary care (pretty cheap) and insulin (also cheap).  The patient who needs the expensive intervention does so because they didn't have cheap primary care for the previous ten years.  If we make primary care affordable and available now, we don't see that savings for another ten years when a similar patient *doesn't* need that expensive intervention.  (It should go without saying, our incident rate of severe complications from diabetes is substantially higher than a country like Japan or France, where primary care is affordable and accessible.)

In the mean time, though, we can't *stop* paying for the person who didn't have access to primary care 10 years ago and needs a foot amputation today.  So we can't just move money around -- we have to continue spending for the investments we *didn't* make while we also spend to make health care better and cheaper in the future.

To be clear, the money needed for the House bill is 6% of our total health care spending each year.  The tax increase is 2% of our total health care spending.  That's a pretty damn efficient deployment of money if so little can make such a bloated system so much better.

No offense, but "insulin is cheap"?  Have you priced it?  The rate that shows as the negotiated prices for WA Medicaid on the handouts from our pharmacies are over $400 per month for each of the two insulins my husband uses and that's on top of the costs of syringes, testing supplies and the costs of disposal whatnots that aren't even covered by Medicaid.  Maybe this is just poverty speaking, but $800/mo isn't "cheap".  Someone effectively kicking my husband in the rear in a way that would have gotten across the message "hey, I mean it - lose weight, eat right - and just for the record and your help, here's what "eat right" means - and get adequate exercise (as defined by the following)" then he MIGHT have avoided diabetes or at least not have been the complicated and tangled mess of diabetes complications he is now - where they started realizing how bad his health really was about the time his first GP here in this city finally did an a1c and FORCED him to get his blood sugars under control upon realizing it was almost twice the goal for an a1c.

Screening is an issue too. I've spent a lot of time on Reservations and otherwise around IHS, but I know that screenings are a problem with many insurances (and esp. with public health, Medicaid and in some aspects with Medicare).  With IHS, for the longest (and I'd bet in pockets this still happens) people would find out they had diabetes when the doctors went looking to find out why they'd just had something amputated or why they were being put on dialysis.  This shouldn't be happening at all except as a really rare exception and definitely not as anything relatively common. Preventive medicine works part way, but screening still has to be in place because prevention doesn't prevent all cases of anything.

But education is a good part of the problem.  Docs can't leave their "education" of patients at things like "eat less and exercise more".  Just what in the blue blazes does THAT mean?  Stop at one double quarter pounder and park in the second row of cars?  (I have relatives who'd say that qualifies...)  And did they even check to see if the patient was over eating or under active in the first place?  Just because a patient is overweight doesn't mean they're automatically overeating and sloth-like.  I once got the "eat less and exercise more" lecture until I was eating some really dangerously small amount and still jogging daily - and my doctor STILL didn't want to admit that the problem even MIGHT be a medication known to cause weight gain as a side effect. So education has to be complete AND it has to be the right education for the issue at hand.  Not all doctors, even right now, are good at that, esp. not where weight is concerned - too many see the (pun not intended) one size fits all answer and refuse to look further.

I do agree ultimately that a lot of the problem now is inefficient spending.  Any time something is treated sooner it typically costs less because it's had less of a chance to cause complications - and it's better for the patient too because those fewer delays and (if applicable) fewer complications mean less suffering.  Ultimately, a more efficient health CARE system is win-win - unless you're an insurance company...or someone who doesn't want to share their doc with "common folk".

Michael, most the important medical research that is done is funded by the National Institutes of Health, which is to say, our tax dollars.

We spend double per capita what other countries do, and we're rated 37th in the world by the World Health Organization for the quality of our healthcare.

At least 60 percent of every dollar spent on healthcare in the U.S. is funded by taxes. So we're already paying for universal, single-payer healthcare, we're just not getting it.

The 45 million uninsured is an old number. The latest estimate is 49 million, and 14,000 Americans are losing their jobs and their health insurance every day.

O.K., so if illegal immigrants are 15% of the uninsured, that would come out to something under 7 million people. What about the other 42 million?

Michael, I would be interested to hear if you have ever travelled abroad and experienced a healthcare system in another industrialized country?

I have, and I must tell you, the American non-system does not compare at all favorably.

Michael, a few things come to mind:

1. The insurance companies which take a way 30c of every Health Care dollar certainly do not contribute to medical research, do they? Well, that's one big issue we are talking about here, so lets agree to eliminate the middle man. We got a major cost reduction right there.

2. As Carla pointed out, a a breakthrough medical research (as well as a much of the other science) is done to large extent at universities and research institutes  and is founded by National Science Foundation, National Institute of Health, and similar tax payer founded entities.

Even when private, these institutions have educational, scientific and humanitarian mission, they are partially funded by public science grants, and are not run for monetary profit of their owners. Scientists who work for them have decent salaries but far from extravagant, so you can't explain their work by either a personal profit motive or a profit motive of their enablers.

This still leaves a possibility that a private speculative investment capital which normally goes into the highest return investment areas may be to some extent diverted to other investment areas. This is a valid concern.

However, there are few questions and observations to consider before making a premature, ideology-based conclusion:

(1) Where would the capital go? - after all, there will still be a huge global market for medical innovation, and the US part of it will be just made larger for about 50 Million people;

(2) Could it be that diversion of some of these speculative capital to the healthy food production, healthy life style industry, green industries, prevention, fitness industry, medical efficiency innovation, etc. would be in fact a better use of it?

This especially in the light of the previously mentioned facts that a profit-seeking capital, which historically was responsible for delivery and commercial exploitation of the medical discoveries, was not responsible but for a tiny fraction of the important medical advances.

actually, in the U.S., most of the biomedical research comes from private industry. Since 2003, the NIH was responsible for 28%-about $28 billion-of the total biomedical research funding spent annually in the U.S., with most of the rest coming from industry.