i agree with jcopel...the public option is a great idea...to everyone out there who thinks it is not should examine themselves. If you think the way things are now is great then you are probably a very lucky person who has not really ever been sick and has a really big paycheck. things now are crazy because private insurance is ridiculous! you! if you qualify then great but a lot of people can't even get approved because of a pre existing condition. Ehat are they supposed to do? When you become "too expensive" you get denied and have to pay all of your medical bills alone. Many americans live paycheck by paycheck and if they get sick they have to do something. What about those peoples' children? Is their fault that they were born and need food? socialized things like medicare, social security, and public education are only around because people are stupid and can't take care of themselves or have made some bad decisions or were in a situation in which they couldn't get out of as a "winner". If you don't think the public option is a good idea then you haven't had a life that most americans have had or have turned into a person who only believes in helping themselves and how much money they get. If you don't think the public option is a good idea then you really have had it "good" in your life.

Tsk, Tsk, Tsk Dr. Copel.  For being a physician and from Yale, you seem to have no industry intelligence re: the health care delivery system we are in.  It is obvious that you are far to Left, no reason to state it.  Liberals believe in the government making all good and well, while those to the right believe in the spirit, hard work, and ethics of the individual.

First, name just ONE governmental program that is fiscally solvent?  How possibly with this track record could they compete on a level playing field.  Medicare is not efficient for a "plan" that no infrastructure to speak of around Quality, disease management, consumer empowerment, network management, etc.  Their declared low administrative rate is merely a percent of their giagantic premium or cost.  Their infrastructure for adjudicating claims with a commodity benefit structure is fixed and is more per capita (what counts) than very complex health plans in the commercial market.  Per capita, they are more expensive than the private market and they do less.  You know ratio's have both numerators and denominators.  5% of $16,000 is more than 12% of $6700 (ave. cost per capita).

Sure spoiled Medicare recepients love Medicare--no restrictions, no oversight, freedom to abuse and massive overutilization.  When it becomes fiscally bankrupt, see how they like it then when benefits are drastically cut or premiums jump 300% (currently have 37T dollars in future unpaid liabilities right now).  It is just a matter of time till their likes become dislikes.

We have a "system" that is neither fish nor foul--is not single payer/government run nor a true competitive model.  The government has not protected the people (the constitution was to protect the people from the government and from state to state abuse) from massive consolidation of stakeholders, i.e. hospitals (now systems up to 40 hospitals in one state), payers (remember 60% of the insured are insured by NON Profit payers), and to a lesser extent health care professional providers-especially physicians.  Market leverage is the game now--not competition.  Adam Smith would die (if he were alive) a sudden death to call our current system free enterprise.

I assume it is your child who cannot afford or access INSURANCE by their career choice.  Is that not their choice and do we need to protect us from ourselves?  Insurance reform can and will occur if universality and portability is achieved, till then it is a non started since it cannot fiscally be solvent with healthcare on demand.  Is it OK to get car insurance after you caused the accident.  Not only is it "unfair" (a liberal term that they interpret as social justice and equality) but it is economically unsustainable for the insurer.

Yes, there has been some abuse of bonuses in all business segments--let transparency (someone used that term a lot) to cure this evil--not the government who sends checks to prisoners and missed projections of deficit over 6 months by 2 TRILLION DOLLARS, or mismanaged a simple program as cash for clunkers.  Open your eyes and stop the wishful thinking. 

I too feel we should stop comparing other country's models with our own.  Fundamentally the people of America would not tolerate the rigid systems to which we are being compared.  Yet Americans have not dealt with the fiscal crisis of our current model that is heading for a cliff.  No elected official will deal with it, since any money saved by hard decisions is someone's income (especially the lobbies, large partially owned government corporations, Pharma, etc) and most Americans like the care their health plan creates for them but want it for not only less, but for nothing.  Remember all entitlement demands are provided by the compassion of the productive few and fewer.  I have not heard any thanks lately, just more demads of entitlement, wishful thinking, and "talking heads" of the clueless.

Why don't you pick on academicians (MDs) who cannot sustain their value to their income.  Why not Pharma who made more income in Year 2002 than all health plans since 1944 combined including capitalization.  They are the major profiteers in our system.  All docs practicing in the open market are FOR PROFIT--are they all corrupt by your insinuations?

So lets have no insurance except catestrophic for everyone and full market transparency and let the buyer choose, or have the government run everything inefficiently till it crashes down around us as it is right now.

Rob MD