I responded, but I noticed that my allowable response size was much smaller than some other responses. Maybe some have higher level memberships. Anhyhow, here is my full response:

The vitriolic, ad hominem comments invoke a maxim I call TOSIAW: The Other Side Is Always Wrong, because, once a measure gets enough support to be fought out on the floors of Congress, both sides are always wrong.

The right needs the backing of Big Business, and the left needs Big Labor. these special interests broker deals that incorporate the worst of both factions, subsuming the legitimate concerns of left and right to power interests. No vested interests support health care reforms that would have been fundamentally right, and the hospital associations, insurance companies and pharmaceutical companies would have opposed them even more strenuously than they opposed Single Payer.

Single Payer was designed by and for the SEIU, which has been lobbying for it for over half a century. The SEIU represents health care workers, particularly in nursing homes. They are understandably more concerned about nursing home empolyees than about patients.

The problem is that elder care is *overly* institutionalized. Nursing homes have replaced elderly people living with their children, who (usually) love them, with warehouses where people are paid to love them. "Reform" will accelerate this shift by making those who care for their parents at home pay taxes for services they were not using.

TOSIAW works the way it does because those with genuine ideologies villainize each other while sucking up to power interests who will sell them out at the drop of a dollar. Obama, who had painted himself in a corner by promising health care reform, found that he could not reconcile the strident left with the obstinant of the right. Instead, he brokered a deal with the "amoral middle." I knew the public would get screwed when the pharmaceutical lobby, the hospital association and the insurance companies all signed off on the deal. One might as well have a police department approved by burglars.

So, what should have been done instead? A maxim from the Hippocratic Oath to which doctors pledge themselves is, "first, do no harm." Here are some reforms that end harmful interventions already in effect.

1. Gouging the uninsured. Insurance companies can require providers to charge the uninsured much higher prices than the insurance companies pay. For example, a dentist must charge $80 for a routine teeth-cleaning in order to collect $48 from his insured patient. This is called "restraint of trade" in all other industries, and was made illegal after Standard Oil was caught making railroads surcharge competitors in order to get Standard Oil contracts. No health care provider should be required to overcharge the uninsured.

2. In the case of emergency services, the provider should not be *allowed* to surcharge the uninsured. Emergency service transactions are made under duress, and are not normal market transactions.

3. No hospital or other provider that enjoys a charitable tax exemption should be allowed to surcharge the uninsured, without forfeiting that exemption. A provider that charges the uninsured more than it charges the insured is not charitable, period.

Nobody is pushing any of these reforms. A few people have pushed other reforms, such as allowing people to buy pharmaceutical products from other countries, especially when those products are made here by companies that charge our citizens a monopoly premium. However, even these reforms never gained much traction because no special interests chose to back them.

Also, while it is true that all of the industrial countries of the world have some form of government-funded health care, it is not true that all of these countries have something similar to Single Payer or the Obama compromise. For example, the Netherlands issues health care vouchers that can be used to purchase insurance or to purchase medical services directly. The government issues extra vouchers to those who have bona fide pre-existing conditions of a catastrophic nature, such as AIDS, muscular dystropy, sickle-cell anemia, etc. Dutch insurance companies are far more competitive because of this.

This approach, which benefits every Dutch citizen, pulls the rug out from under the insurance monopoly, and involves far less government intervention than Single Payer or the Obama compromise, never got serious attention because it was unappealing to all the special interests that dominate the debate.

In the end, we are back to TOSIAW: The Other Side Is Always Wrong, at least where the federal government is involved. But no matter which side you choose, your side is someone else's other side, and your side is also wrong.

Could we have had rational health care reform? Probably, if the reform were championed in a small state that was not dominated by the interests that nominate DC, or, better yet, if it was championed at the county level in a state that does not hamstring counties.

Good article!