The delivery and financing of healthcare is complicated business, and we don’t claim to know definitively what system would be best for the greatest number of Americans. What we do know is that the system we have doesn’t work, that costs are rising far faster than incomes, that it makes no sense to burden private business with having to provide care for the workforce and that a for-profit insurance model encourages the denial of treatment.
Without question, we’d like to see a swift shift to a national healthcare system that eliminates the profit motive, cuts out the money-sucking middlemen and allows businesses to focus on what they do and frees them from the crushing burden of financing medical care.

But we’re not the ones who have to sell the idea to an electorate that shudders at the mention of “socialism” and to elected officials who are terrified of those voters, or dodge the stones and arrows of the Rush Limbaughs of the world and stand up to the powerful medical, insurance and pharmaceutical lobbies that help finance campaigns.
That job belongs to President Barack Obama, who is in the process of rolling out a basic framework for national healthcare reform. Sadly, political realities make it imprudent to propose a seismic shift in the way healthcare is delivered and paid for, but from the sound of it, he’s taking baby steps in the right direction.

Obama wants to make medical care accessible to the roughly 46 million Americans who have no insurance. Yes, that’s 46 million people — 15 percent of the U.S. population — who can’t get basic and preventive care and must rely on expensive emergency-room care. He suggests financing the plan through a variety of means: reducing the value of itemized tax deductions for the nation’s top earners and ending George W. Bush’s tax cuts for the rich, and forcing private Medi-Cal providers to compete for the government’s business.

That last idea gives us hope that Obama won’t shrink from the insurance lobby.
If the insurance companies fight back, Obama has got to get tough — really tough — and use his considerable rhetorical skills to give the public some straight talk about the role of private insurance in the healthcare system. In other words, he needs to do what Michael Moore has tried to do but doesn’t have the gravitas or public popularity to effectively pull off. Conservatives love to say the doctors and patients should retain the ability to make decisions about medical care, but they don’t have that ability now; pointy-headed insurance-company paper jockeys do, and their masters are company shareholders.

We’re not so naïve to think that once private insurance is removed from the system, all will be hunky dory in Healthcare Land. Conventional wisdom has it that what’s driven up the overall cost of healthcare so dramatically is progress in medical technologies and treatments—high-tech equipment and designer drugs. Even a single-payer, government-run system free of marketing expenses and outrageous executive salaries would have to contain costs so that taxpayers are reasonably charged, and, frankly, we’re not sure how to do that without some kind of tiered system in which people with money pay more for care that’s considered a luxury rather than essential and basic. And who decides what is essential care and what is not? A writer for the blog Stubborn Facts not long ago used costly ACL surgery and the cholesterol-lowering drug Lipitor as examples of new-ish care that might not be essential. Like everything in this arena, that’s debatable.

In any case, we’re frustrated by claims that the country can’t afford a national healthcare system. It’s not like we’re not paying dearly for the broken private system we have now—the one in which the rich get excellent care, the shrinking middle class gets increasingly inadequate care and too many people get none at all, increasing the long-term cost for the rest of us.

For the long run, why not just convene a team of three healthcare economists to determine how much it would take to provide every American with preventive and essential care and come up with an equitable way to spread the cost among the taxpayers? Would that be so hard?

Meantime, we applaud the president for standing up to the status-quo crowd.