Families earning $1,000/ month or less should already be covered through Medicaid and/ or SCHIPs.

$60K gross isn't much where I live. Consider that outside of crime zones, rent would be >$1,000/ month, mortgage and taxes can run upwards of $1,500/ month, groceries, gas/ commuting costs, food and utilities can easily chew up more than another $1,000 for a family (without ever eating out).

If I'm one of the 5% directly buying private healthcare, it's easily another $1,000 a month plus copays for a high deductible policy. If I've got employer-provided care, it only runs me the copays and deductibles. If I have neither and am above the qualifying level for Medicaid and SCHIPs, I can afford very little healthcare and cannot afford to have anything go wrong with me or my family.

Taking this apart further, if I pocketed and saved the the amount I or my employer would pay for insurance, I could cover maintenance medications and visits, possibly a few tests, and very minimal dental care. Provided I don't get injured, need surgery, or have to be hospitalized for any reason, I'll be fine, almost broke but getting by.

If I take the money and buy insurance to cover against the off-chance that I'll need to be hospitalized or my kid needs braces, I lose that money plus all the deductibles and co-pays. Bad deal for me, but better than going broke because of bad fortune.

In reality, most of us need relatively little care until we're older. I believe I've read that something like 75% or more of individual medical costs are incurred in the last 6 months of life. Most of those people are already under single payer, public healthcare. True, the system isn't perfect, but Medicare is there and we're paying for it out of payroll taxes.

To me, the appeal of single payer is that for what we already pay out in co-pays, deductibles, and premiums added to what we already pay for Medicare, we can have a fully-funded system at current practitioner and hospital pricing. It can only get better from there.

This is where the public option falls short. Unless it tilts the playing field by being more comprehensive, cheaper, has broader practitioner and hospital participation, and includes the 28% of the popualtion already covered by Medicare, Medicaid, and SCHIPs, is open to everyone, carries a mandate that employers offer to enroll employees as an alternative to their HMOs and PPOs, it will be a waste of time and a false victory.

It isn't just about those without coverage, it's about our right to healthcare. A right not attached to income or status.

Well, that's funny. Where do you live? You seem to be only quasi-aware that many people have long-time lost their jobs due to the economy, and they are earning just $0 per month and are NOT covered by Medicaid and/or SCHIP. So much for those earning $1000 per month receiving health benefits at this time. Think again. In terms of a public option, something would be better than nothing. And what many of us have is absolutely nothing. Have you forgotten that there are people who need health coverage who are NOT children or welfare recipients, nor in their last six months of life, nor do they have children or maybe even spouses - working or not. Have you considered that many people have fallen off the unemployment roles, including extensions, because the states they live in refuse to honor those extensions, or at least the third tier of it, if said individual earned a whopping $1000 in tax year 2008 doing temporary or part-time work? Do you realize that many of said people have no housing, no healthcare and little to no food unless somebody is kind enough to take them in?  A single-payer, public option would at least solve the lack of healthcare issue, if not the economic devastation which will likely be with us for a very long time. Extending Medicare to everyone would work, as well. Contrary to what you say, the public option does not fall short. What falls short and is reprehensible is the greed of the insurance and pharmaceutical industries that think nothing of watching people die around them, just so that they can collect the highest premiums possible, refuse coverage to those in need, and give nothing in return. With no public option, these companies will just continue merrily down the road watching the people fall around them.

I more than quasi-aware of the employement situation. I was recently on the street when my company, a retailer, went bankrupt. I have neighbors struggling through foreclosure issues, losing jopbs, and only a small fraction of my coworkers have found any job at all. Since my compnay went bust, there was no possibility of COBRA and my family was immediately qualified for the State plan (albeit with a 60-day wait). Ironically, I was only on the street for a month and I'm working with a utility company on the State's Energy Efficiency Economic Stimulus Program for Small Businesses. The shortest time I'd ever been out and I'm helping to create good paying jobs at prevailing wage. It's slow and tedious, loaded with bureaucratic processes, and I'm dying to help my neighbors. However, I am a contractor and have no coverage. My wife has taken a low-paying job which she hates in order for us to have benefits for less than the $1300/ month my employer's plan would cost me.

As to eligibility for the hard cases you cite, I suggest you help these folks out and find out what their really entitled to. These are the requirements where we are:

http://www.hrsa.gov/reimbursement/states/new-jersey-eligibility.htm

As to the public option, you should read the House committee discussion draft. It's anemic, it's a tiered system of low-cost basic and higher cost premium plans, and you would have to buy it unless you're already qualified for poverty benefits. It's just another insurance policy - not comprehensive coverage.

Single payer is the only way to go, the only way to cover an American, even those on the streets with no addresses and no clue as to where to turn for help.

I agree that single-payer is what we need. But if we can't get that, then the "anemic" public option - as you describe it - is better than the alternative, which is NOTHING. Anyway, we already have nothing. Why do we need it twice? If it is anemic, it is because of the ridiculous bipartisan stance the Obama administration has taken, and now the Blue Dog Democrats' efforts to mire up the system: why do they call themselves Democrats anyway when they think like Republicans? I believe that Obama needs to call the Democratic party together, get tough and push through what the American people need, have demanded, was one of the major reasons he was voted into office, and is a right in ever other industrialized nation.

According to what you say, you have access to a state plan after 60 days. Surely you realize that most states do not offer that, and that the average state plan is "Too bad, sorry you're out of work and there are no jobs available. Have a nice day."  It's great that you were only on the street for a month - that gives great solace to those who have not been able to find work for nearly two years.

You're being far too pragmatic, my dear.

If in the United States, practical consequences and real effects were considered to be vital components of best practice, a Single Payer system of financing our health care would have been instituted decades ago.

The intellectual and life and politics of the United States are dominated by ideologues and monied interests. As a result, practical solutions are not very popular. 

Well, it's hard to see that the Exchange alone will do much to lower costs, no matter how it's configured.  (This is putting aside talking about the public plan, for a moment).  The most it will do is present transparent information such that people will know what they're getting and gravitate to the better deal.  Statewide vs. nationwide only makes a difference to the extent that you're trying to preserve (or not) individual state mandates for what gets covered and iron-out (or not) regional variances in cost.  It won't control costs by itself.  The Exchange/Gateway is only focused on expanding coverage, near as I can tell.  But it's also only about 100 pages out of an 800 page bill.

The main ways to control cost are all in other parts of the bill, including creating an incentive towards primary care (no co-pay for any primary or preventative care), chronic disease management, comparative effectiveness research to start trimming waste, Health IT, etc.  Those are moves designed to bring costs down across the board.  Even though we talk about them a lot less, they'll have a lot more to do with controlling costs than any permutation of the Exchange we've seen so far.

Put another way -- the Exchange (or Gateway) is an improved Massachusetts model.  One thing that the Massachusetts model did not do at all is control costs -- that's the rest of either the Senate HELP bill or the House bill.

-- Well, it's hard to see that the Exchange alone will do much to lower costs, no matter how it's configured.  (This is putting aside talking about the public plan, for a moment). --

Why would we put those talking points aside?  Also, I don't see the Exchange separate from the public health insurance plan option since one lives within the other and the efficacy of both depends on the strength of the other.

-- The most it will do is present transparent information such that people will know what they're getting and gravitate to the better deal.--

I'm not an Adam Smith groupie but I do believe that efficient markets are capable of some good things.  Access to transparent information is one of the keys to an effective market - it should lead to lower insurance prices and greater access to care.  Greater access to care leads to lower costs overall.  Yahtzee!

 -- Statewide vs. nationwide only makes a difference to the extent that you're trying to preserve (or not) individual state mandates for what gets covered and iron-out (or not) regional variances in cost. --

Statewide makes me nervous b/c I think of Medicaid, which is a disaster of inequity.  Maybe I'm wrong to go there.

-- The main ways to control cost are all in other parts of the bill, including creating an incentive towards primary care (no co-pay for any primary or preventative care), chronic disease management, comparative effectiveness research to start trimming waste, Health IT, etc.  --

I understand that lowering provider and technology costs is crucial to sustainable reform.  But even with the best plan to do that put in place, we're not going to see results for at least several years.  I consider insurance costs to also be part of health care.  They're also the costs that have the greatest impact on the most people and which can be fixed the most quickly - with a very strong public health insurance plan option to drive costs down with real competition.  It's a talking point, sure, but that doesn't make it wrong.  So when I see the HELP bill work to inexplicably limit the market for a public health insurance plan option, making it less competitive and less able to drive down costs that prevent people from having access to care, I worry.

In a way, I wish we would look more to Smith's way of observing. At least then, we'd be conscious of demand-side power.

I want to see a national plan for two reasons: the inequity of wages and prices across the nation and the inequity of federal dollars collected and returned to the States. Healthcare coverage needs to be entirely independent from these factors. Once we agree that the goal is coverage for all, regardless of income or station, the pricing and care structure can be brought in line.

Just watched it... Absolutely devastating.

Wow! It was fantastic and so was Bill.

The President should call a primetime press conference and, once everyone's tuned in, introduce Mr. Potter and let him speak.

Harold, checking the "Like" tab isn't enough. I just have to say, say I LOVE your comments. Republicans "sit in the minority and solidify their cranky little base" indeed! I've never seen it better put.

"Bipartisanship" is a sick joke on every Democratic voter.

No problem there. My Congressman, the arch-conservative, Scott Garrett, doesn't even count healthcare reform among the hot issues on his homepage - not even a statement up front.

He is polling his voters, however, as to whether we should Mirandize "terrorists" (not terrorist "suspects", mind you). With such great faith in our laws and justice system, I'm sure he'll defend the just rights of the insurance industry to the end and block any attempt to deprive such noble institutions of sacred profit. After all, who are single payer advocates but terrorists threatening the supply-sider market?