The irony is that Republicans at the state level have been far more innovative in pushing reforms like medical savings accounts, medical quality initiatives, and cost controls born by healthcare users. If things do not change quickly (and I'm afraid I don't know what would spur Democrats to be concerned about real issues instead of pleasing their health provider donors), Republicans could start winning with their MSA's and other measures that shift the costs to the least healthy and most vulnerable populations because the Democrats have only "reactionary" proposals (and nothing that changes real issues).
The most pressing issue for people is the cost of healthcare. Few politicians have articulated how much the rise in out-of-pocket costs has hurt working and poor families. This is independent of whether one is insured or not (what difference does it make to be "insured" when premiums, deductibles and copays are a serious burden to getting decent care?). When polling is done about healthcare, this is where the concerns of "average" Americans are and yet NEITHER party seems to care. This is a distributional issue nearly ignored by major politicians. It is sadly ignored by every "progressive"/Green/Red candidate as well.
Besides the burden of costs that disproportionately attack the poor, there is also the continuing shift of costs from social insurance to "individual responsibility". While those most in need of services have always paid more, the momentum is to continue to ramp up how much each healthcare user pays. Insurance companies use public insurance as insurers of last resort (who do you think pays for those needing really expensive drugs and therapies--it is not private insurers if they can help it).
"Single payer" is a start although I do not think simply mouthing "single payer" is very good politics (there are real cost/distributional issues within "single payer" framework that need to worked out). The principles of equity within social insurance (as long as it also is coupled with reasonable attempts to finance and control costs equitably it is great). However, the "single payer" movement cannot continue to be controlled by health care professionals (or those whose politics lay simply in appeasing providers) who believe that they are exempted from the cost controls.
I personally believe that polls show that "universal access" and "single payer" are somewhat desired but are seen as "radical" as well. I believe the only way to make these radical changes palatable are too really show that an (re)organized delivery system is central and that insuring everyone is the happy artifact of that reorganization. And that means drastically changing how health care is delivered and how providers get paid.
Peace,
Jim
"You’ve done your best at the gym you've got your lip-gloss on
You’re going to the doctors to see if it's a medical problem
'Cause no one takes you home
No one takes you home"
Kathryn Williams
Quoting Doug Henwood <dhenwood at panix.com>:
> Nathan Newman wrote:
>
> >-Expanded health care? What the fuck happened to universal health care?
> >
> >It got defeated.
>
> C'mon, Nathan. Defend Kerry all you like, but show some fidelity to
> the facts. Clinton's health care proposal was a doomed disaster.
> Remember the exchange between David Himmelstein and Hillary Clinton?
>
> D: "With 75% in the polls and strong presidential leadership,
> single-payer could win."
>
> H: "C'mon David, tell me something interesting."
>
> So instead, Clinton proposes some impossibly complicated scheme with
> heavy private sector involvement and almost no political support.
> That got defeated, not a real universal health insurance program.
>
> Doug