Jay,

You are about to touch the third rail so you might want to be careful.

The uncontrolled and unsustainable growth in government-financed health care is THE problem. Seeing that Congress is unable to run in a responsible manner the portion of the health insurance market it funds perhaps Congress should get out of the business altogether.

Or do you believe in unicorns and magic beans? The Democratic party apparently does since it believes what ails health care is the government does not control enough of it. To me this is like giving a teenage boy a Ferrari after he crashes the Corvette under the pretense that what he needs is a more, not less, powerful engine.

Dan, er no.

There are two separate issues here:
1) the TOTAL growth of health care as a sector of the economy, The nature of the entity paying those bills being largely independent of that.

2) the efficiency of how well that ever growing dollar amount is being spent. Whether or not John or Jane needs X or Y or nothing at all.. are they getting that determination in a cost effective manner.

Number two is somewhat of a trick question though as the real cost of that X, Y or nothing question in far too many instances won't be (truly) known for decades to come. But we sure do have plenty of evidence of what happened with the Johns and Janes from decades past.

Whether Jay's preference for a solution is best or mine is or yours... there is absolutely no question whatsoever that it is a total mess. And it can't continue. And Congress needs to do something.

Another year or two of this stagnant economy and the employer based insurance model will die all on it's own. Do we wait until then to have another (dare we hope better?) model in place and just ignore all the symptoms of the current "system"?

I'm on record here as being no fan of (only) expanding federal payment plans but the cold hard truth is that any payment system change (even my own) is going to upset the current profit making and deduction taking stakeholders.That is unavoidable.

There are other alternatives but each will still come with it's own set of problems.

With the government paying so much money out to health care providers, it is important to consider whether cost savings could be attained by having government or the health care industry running both the hospitals and insuring the care. This way, the health care provider would operate only on the revenues from premiums instead of charging per service. Achieving profit would involve prevention of high cost procedures and limiting the cost increases of procedures.

Essentially, as it stands, health care providers charge what they can justify with health insurers and any increases in their overall cost are passed along to consumers who have little ability to bring down costs aside from not using health services. Given that the highest costs of health care are usually for the most serious care when patients have the least time to shop around, patients are really unable to benefit from a true market driven solution.

MrRational,

(1) It is impossible to say whether increased private health care spending is good or bad for the overall economy. If I recall correctly from my Econ101 class there is the concept of the indifference curve. Perhaps if Americans spent less on health care they would spend more on Spam but their utility would be the same. What I do know is the massive amounts of money Americans spend on health care creates an incredible incentive for companies to develop better health care technologies. My father is alive today because of these technologies. One cannot wish for less health care spending without taking into account how this may impact health care innovation.

(2) Public health care management is a disaster. Medicaire is insolvent and the problem is growing rapidly worse. The basic problem is there are too people demanding coverage and insufficient people paying for it. Lowing health care costs 10 percent would only defer the trainwreck. So either the government raises taxes or decreases the health care benefit it provides. Neither option plays well in Peoria which is why every effort to socialize health care fails - the majority simply does not want to accept the options the politicians are selling.

(3) The only option the majority will accept is a forced deregulation of the health care insurance market. As long as Barack Obama is president I do not see this happening unless Republicans do take over Congress in 2010 and, like Clinton in '95 with Welfare Reform, Obama realizes he would rather serve a second term than be a "wonderful" one-term president in the eyes of the far-left.

Dan, I largely agree with you on the political realities of getting change through Congress and have posted about that any number of times. It doesn't seem to matter though as both sides have constituencies with (in my view) unrealistic expectations of the goals and even in many cases the process.

What I don't agree with though is more knee jerk bashing on operating efficiencies of the Federal programs which just plain isn't true. You can whine all you like about the inefficiencies of the mandate but the operating efficiency within that mandate is very nearly spectacular.

If you're inclined to do some quixotic reading take a look at my middle path thoughts:
http://talk.baltimoresun.com/showthread.php?t=224510

Rational,

I have read your proposals and believe they are constructive. My retort was specifically about the phrase "Congress must do something" that both you and Jay used. Many of the problems with prohibitively expensive health care insurance are a result of state regulations, such as requiring mental health coverage and imposing community rating. Plus any state could allow out of state insurers to compete.

I'm not aware of Congressional mandates on private health insurance and adding them would worsen the situation. Thus my fear that Congress will do something that will only only compound the inefficiency of the system.

Thanks Jay for allowing my edit to be posted. I could have just submitted a revision but thought that would clutter things but I won't ask that of you again.

Dan, gotcha.
As to Congress doing *something*...
how about "lead, follow or just get out of the way" as an instruction to them? ;)

But as that is also a Quixotic notion we are left with them as the overarching authority to regulate this interstate industry with so very many facets in every corner of the land and every corner of our lives.

Like it or not they are the ones driving the bus. And to extend that analogy... the problem isn't so much Congress as it is all these backseat drivers.