The problem with the single payer system is that it places no controls on the health care system itself. Currently the model we function under is that the vast majority of hospitals, clinics, surgery centers, and the list goes on, operate as for-profit entities. This is not going to change any time soon.

Part II

Part of the problem for health insurance companies, and yes there are problems, is that they pay taxes at their year end for any retained earnings. Which means they are punished for holding onto funds for the next year to pay claims. Somehow this distinction needs to be addressed in the tax code, but this is not insurmountable. But if we want to control the rising costs of health care, I do agree, we need to take some of the extreme profit motive out of both ends of the equation.

While I understand your argument regarding the shift from for-profit to non-profit status for both the provider side and the insurance side, that move will take years and will continue to provide too many loop holes to control the problem of rising costs.

I think that establishing a universal insurance plus the move to convert health insurance companies a model similar to our utility companies would accomplish the same thing..

Universal insurance ("everyone" is covered) will limit the number of people paying out of pocket which should help to control some of the wild rising in prices of provider care. Shifting health insurance companies into a utility model means these companies would limit the dividend payments paid in stock, limit some of the executive compensation problems that you mention, and force the companies to justify the rates they pay.

There is a resource a little like this already out there --- idealist.org. I ran across it quite recently while helping my son find a college internship. They have a broad range of jobs and volunteer opportunities listed there, and its set up to provide information on a national and international scope.

I found this doing a very simple search on the Web. At some level, I'm not certain I want the Federal Government as the central hub of these sorts of connections. This seems like something organizations, maintaining their own controls over the content, would do a better job of maintaining this.

It seems to me that the move commercial insurance companies have been making away from the HMO model ultimately give more control back to providers and their patients. When I look at my plan there are very few rules related to how to use my insurance. There is no preauthorization required for almost anything, and I have some choice to whether I go to an in network or out of network provider. I also have an HSA now, which allows me to save in advance for procedures, medications, or new glasses in the future. I put this against the straight Medicaid system that the AMA and LA Times report has a denial rate twice the amount of the typical commercial company, and often pays less.

But I agree with you on this -- the commercial insurance industry needs to be further regulated, much like we currently regulate utilities. We should be restricting their net profits, restrict the top incomes corporate executives can make, eliminate the ability of insurance companies from paying dividends on stocks, establish caps on the administrative costs, and create a more standardized process for paying claims. If we are truly nationalizing health care, those that provide it need to be placed under some controls.

While I understand that we climb a slippery slope when we start capping executive salaries in any industry, I think that in the case of health insurance, it is necessary. I know most people here do not believe that health insurance is a good thing, and they have done much to encourage this feeling, they still serve as a buffer in the for-profit health care environment where we find ourselves today. Since I do not believe we can fold up the health insurance tent so easily, my alternative is to treat it more as a public trust and establish some strict guidelines for functioning as a corporation. I also believe we should pull out the capacity for health insurance companies to be able to pay high dividends to investors. Profits should not be shed by health insurance companies at the end of the year. They should be held in the insurance pool. Lastly, just as insurance companies have restrictions on administrative costs when they manage medicare or medicaid insurance, there should be tighter controls on administrative costs placed on the industry. By making these changes you will push out those insurance models that have been built around profit-taking, and force a model which is closer to a public utility.

While executive compensation is a huge issue in the health insurance arena, I have to say that this is a problem in every arena. The executives for the utility companies make the same sort of compensation, so when we pay our gas bill or electric bill we are paying that. As we have heard recently the same goes on in the automotive industry. I don't know if there is a way to fix that problem in this country without some significant laws being written, such as establishing ceilings for executive compensation based on average employee salaries, but I'm not sure this fixes the current health care problem.

The argument about the effectiveness of an HSA can be made one way or another can be made all day, but I think the point is that Cindy was saying she wish she could simply save money into an account over time and that be the pool of her insurance, and Doc correctly pointed out that this is the actual intent of the HSA. HSA's are typically a component of a larger insurance plan, so they also come with whatever network the company is that manages it. Regarding the cost of diabetes to the health care industry, while I don't have the figures in front of me, the cost of lifelong treatment of diabetes is definitely toward the top of our health care costs, with heart disease somewhere close behind. As several have pointed out here already, many incidents of these two disorders could be eliminated with people living healthier lifestyles. Over the past generation we have been living in a pattern of excess which has affected us in so many ways, this is just one.

While I've been participating in this general conversation about the direction of the future of health care, my particular concern is the lack of resources for the chronically mentally ill. As someone who works in this field supporting, reviewing and consulting with a broad range of programs across the country I have seen and heard the concerns of clinicians who are seeing funding diminish over the past few years. Add to this the increasing numbers of people coming into the mental health system, and the downward pressure of rising unemployment and uninsured adults, and we are looking at a rising behavioral health crisis. This is further exacerbated by the reduction in overall resources for care. Fewer psychiatrists in the field, few inpatient beds for patients at risk, and the rising costs of medications. Add to this the disparity of income for those clinicians who work in the behavioral health field. There is a clear need to overhaul the behavioral health system. The good news is that there are some promising programs that need to be funded and expanded. Programs like Assertive Community Treatment, Intensive Residential Treatment, and Community Training Programs that encourage severely mentally ill adults to be less isolated and more compliant with treatment. The problem, of course, is that these sorts of programs are understaffed and underfunded, forcing these people to be pushed back into being constantly hospitalized. By implementing these sorts of programs in a broader scale also addresses a large segment of our homeless and deeply poverty stricken citizens.

In 1945 Harry Truman spoke about the desire to create a National Health Insurance program. It was brought to a vote in Congress by Democrats, but it was ultimately killed with a lot of help from the American Medical Association, calling it "socialized medicine". There's a great article about this on the Truman Library web site.