is that the insurance industry (link ) and big pharma (link ) are stealing us blind. And this is weighing down those businesses who are providing health benefits. This is particularly true in the American automotive industry. I think the Republican approach is wrong-headed, in that market forces alone will not fix the problem, and I think the Democratic approach mostly ignores the real problems.

I've always wondered why more people didn't push for this, on both sides of the aisle. It seems to hold appeal for people on the left, since providing healthcare to everyone is an eventual goal. But it's also immune to arguments from the right, since children can hardly be expected to pay for, evaluate, and participate in the healthcare market on their own. Given the social conservatives' push for protecting the fetus, you'd think they'd want healthcare protections for newly-popped-out babies, as well?

If the kinds of medical expenses we are really talking about were reasonably affordable, then a market-based solution (like the current one) could be manageable and even superior to a government run system. But the expenses that need coverage are astronomical in relation to the normal earnings and assets of "the average citizen."

We handle other astronomical expenses by sharing the costs and amortizing the capital investments over decades. For example, they just replaced one 36" water main in my subdivision. It probably serves about 1000 homes, if that. The one it replaced was sixty years old. It cost over $5 million. That's a lot of money. Yet some cancer patients are charged that much if they choose to live. How can we expect the average citizen to handle that kind of expense, or die?

Health is different from property. People choose to buy property or to risk property, and capitalism provides the insurance. Back when the amazing infrastructure of our medical system didn't exist and its benefits were less concrete (and less hyped), maybe it made sense to let the market provide the solution. But times have changed. Patients know that procedure X might save them from a debilitating disease or from death. The people seem to agree that using these procedures is wise; society thinks they are a good thing, even a necessary thing, like freeways and sewers.

The market approach is not working; we all know the numbers. The process is so obsure that the consumer effectively cannot know what a procedure will actually cost in advance. The consumer cannot choose to deny incurring much of the cost ("Nurse, take out that spit tray, I don't need it and I refuse to pay for it. Ditto on the kleenex; I brought my own. Doctor, only one Xray today, I've got to buy the son some shoes."). When payouts reach such proportions, the insurance market is effectively closed to new competition; the ante is too high for new businesses to moderate the effects of increased monopolization.

We should begin treating healthcare like we treat our sewage systems, water mains, freeways, and other necessary pieces of infrastruture. I don't see how we can do otherwise. How we get there, what we cover, how the process works, is all up for negotiation.

The added bonus is that we would remove a big imbalance in labor market and allow it to operate more freely. American employees are more expensive than elsewhere because our employers bear the additional cost of health insurance.

Anyone who argues that "every American should be required to carry health insurance" and that we should "provide assistance for low-income individuals to obtain coverage" isn't much of a conservative. And to describe that solution as one that harnesses "market forces" (when in fact it sounds like a Big Government solution) is, frankly, absurd.

My basic approach would be as follows:

1. Tax employer-provided health benefits as regular income. Eliminate all the other provisions in the tax code that subsidize health care. No more HSAs/MSAs/FSAs, no more itemized deduction for medical expenses, etc. Everyone pays for health care using after-tax dollars. Use the extra money to cut income tax rates across the board.

2. Phase out the federal Medicare, Medicaid, and S-CHIP programs. States would be allowed to run their own health programs if they want, but not with a single cent of federal tax dollars. Again, use the extra money to cut income tax rates across the board, and of course eliminate the Medicare payroll tax.

3. Repeal the laws saying that hospitals are required to provide uncompensated care. If someone shows up at a hospital and doesn't have insurance and can't pay for a procedure, too frickin' bad. You do not have a right to free health care.

4. Allow people to buy health insurance from providers in any of the 50 states, even if the out-of-state provider does not follow the regulations of your own state. This lets you get out of all the mandated coverage provisions, which makes it possible to buy a much cheaper bare-bones policy if you want.

5. Let the states fight it out. Some states can pass universal health care programs; some can leave it to the market to sort it out; and some can do something in between.

My ideal health insurance plan would be a high-deductible plan with big incentives for healthy behavior. For example, I would make anyone who smokes or with a body mass index above 25 pay extra on a sliding scale (your premiums might be tripled if you're 60 years old, you smoke, and your BMI is 40), and I would allow you to claim a rebate for getting vaccinations (get a flu shot, get a $100 check in the mail).

Universal health care, in some form, is coming I'm afraid. If the GOP decides to let the status quo ride and act as if the market will magically fix things then they'll be taken kicking and screaming to a socialized system.

While it sounds efficient, I don't know if single-payer health care is really gonna work. If they plan to collect the monies to fund single-payer insurance in the same way they run our "single-payer" tax system, I'm not looking forward to it.

I think requiring employers to provide basic care is a good start, but there will also be a number of people who don't work (or retire) and will continue to need adequate care. Lastly, prevention can only get you so far. Some medical conditions are inherited. We shouldn't be able to just say "too bad, you shouldn't have inherited such an expensive disease."

BUT, despite all that, the biggest concern with universal coverage is the rationing of health care. At this point, I can make an appointment to see my neurosurgeon, dentist, and PCP all within 2 weeks or so. I just fear that once we move to Universal Coverage, people will take the queue times to months, clogging the system with minor health problems (colds, headaches, etc.) that can be easily remedied at home. There's also the component of people who chose unhealthy and risky habits. As long as they are willing to pay higher rates (like most other insurance pools) or that healthier individuals can get rebates, I think we'll be OK.