Can we talk health care for a bit?  I know I'm a little late to the discussion, but it's taken me a while to process my thoughts.  

To all you "Nationalized Health Care" naysayers, I have a little secret to let you in on.  Health care is already subsidized.  It's called "before tax deduction" and it means that the government doesn't collect income tax on that portion of your paycheck that pays for medical insurance...to the tune of a $126 billion per year tax break (a.k.a "subsidized").  So, let's just throw the whole notion that we have a completely independent, non-government-intervening system today right out the window.  Because it just ain't true.  *Side note: The $126 billion tax break just so happens to roughly equal the cost of public health care systems in other countries. Interesting, right?*  

The problem isn't if/how the Government should/shouldn't be involved.  The problem is that our health care costs are skyrocketing and IT WILL BANKRUPT OUR NATION WITHIN OUR LIFETIME (insert any of the hundreds of economic models showing a variety of doomsday scenarios here) if we don't find a way to contain costs.  Whether you pay for your own insurance or your employer pays for the bulk of your insurance or you're eligible for government tax-payer-paid programs, we all have a vested interest in reducing our medical costs.  Yet the recently passed health care bill doesn't address that single, most critical problem.  It extends coverage to a broader set of people more likely to be jobless and have health problems (ignoring the root cause of poverty-correlated conditions like obesity-induced diabetes, alcoholism, smoking, and substance abuse -- which also happen to be the top medical costs in the U.S.) and puts some controls over the immoral, egregious act of dropping coverage for people who actually discover they need covered.  But costs will continue to rise...even more swiftly post-passage of the Bill.  The problem hasn't gone away.  

In the interest of full-disclosure, I happen to be a supporter of Nationalized Health Care (done right).  But I see few winners in the passage of this Bill.  Matter of fact, I know of few people who are satisfied with the Bill.  But Congress passed something, so they and the Media have checked the box and moved onto some other issue du jour and we've all just swept the whole shenanigan into the bin labeled "Last Week's News".  Unless/until the majority of Americans really experience the costs of health care, they will continue to remain passive in the face of toothless legislation that does more harm than good. So I'm about to propose a three-pronged radical reform solution (well, it's not that radical. See my comments.).

First, I'd start the whole health care reform movement by eliminating employer-paid health care programs.  Yep, just rip it out.  It's an archaic, outdated practice that no longer makes sense.  When it was first instituted post-WWII, health care costs incurred by American companies on behalf of their employees could be passed on to a growing middle class in the form of higher prices.  In today's globalized business environment, consumers bargain-hunt for the cheapest prices while at the same time demanding high returns (high profits) on their investments in American companies, forcing American companies to reduce operating/labor costs to remain competitive with countries that already subsidize labor costs.  As labor costs rise, companies are forced to outsource to compete and Americans lose jobs...making them no longer eligible for employer-provided health care programs at a time when they are most vulnerable (no income).  Makes no sense!  And because employers via tax breaks subsidize our health costs and we have only limited plan options from which to choose, we aren't really making informed, consumer-based choices that influence health care prices.  We don't know what we're paying for health care and therefore we can't say that prices are being competitively established.

Second, I'd convert the $126 billion tax break into an income-tax-based formalized public health care system that benefits everyone, regardless of how much they earn or where/if they work...just like we do for public education or parks and recreation.  Of course, my system would be tiered such that the filthy rich would contribute the most BECAUSE THEY CAN!  But I'd also structure the
system to reward preventative behavior that lowers public health care costs and I'd penalize risky behavior.  So, let's say 10% of my income was taxed to support a public health care program.  If I had doctor-endorsed evidence that my weight was within acceptable guidelines and I didn't smoke, then I'd gain a tax credit of 1%.  This gives me the freedom to decide whether or not bad behavior is worth $X,000/year.  I'd further supplement healthy choices by mandating bike lanes on all major roadways and I'd make fruits and vegetables more affordable than potato chips and fast food by instituting tax penalties on unhealthy food choices, cigarettes, liquor, gambling, and gas at the pump.  *Notice that I didn't say I'd outlaw cigarettes et. al. I'm offsetting the costs of preventative health programs by taxing risky behavior.  Consumers would still have a freakin' choice!

Third, I'd set some standard pricing guidelines that enable health care providers to conduct business without the incentive to exploit...maybe even reward doctors who help their patients remain healthy.  Today's profit-driven system is a ludicrous concept.  PROFIT-driven health care.  Of course you're sick!  You need pills, tests, surgeries, and rehab (because I need a new Porsche, house in the Hamptons, and an ivy-league education for my kids).  Puh-leaze!  I believe that medical costs, like education, cannot be held to the same laws of supply and demand that define our capitalist beliefs.  Who can put a price tag on products that save lives? 

Alas, I am not in charge of the change for which many of us voted.  My only sphere of influence is the control I have over my own state of health and well-being.  Therefore, in the interest of America and our future prosperity, I henceforth vow to reign in my own future costs of medical care.  I shall exercise often, super-size never, and just say no to even second-hand smoke.  Leafy greens and colorful fruits shall be my diet staple.  And I shalt not fall prey to advertisements claiming the cure for a bad mood, bad breath, or a bad day can be found in a little white pill.  Who's with me?

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Some statistics:
75% of health care costs are related to five chronic conditions:
-- Diabetes
-- Asthma
-- Depression
-- Coronary Artery Disease
-- Congestive Heart Failure  
* Source: US Centers for Disease Control and Prevention. “Chronic Disease Overview”, Nov 2005
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15% of population uninsured (46 million people). Of these:
-- 22% (~10 million) undocumented people
-- 41% under the age of 25
-- 25% have family incomes under $25k (while 8.5% have family incomes over 75k)
* Source: Kaiser Family Foundation / HRET Survey of Employer Sponsored Health Benefits, 1999 - 2008