Though I shudder to imagine what health care would be like if it adopted the customer-service standards of an outfit like, say, US Airways. Though Kaiser Permanente does come pretty close.

Anyway, the reality is that there will always be some kind of triage in health-care delivery. Proponents of 100% private insurance advocate triage based on ability to pay — or, to put it the crudest terms, survival of the richest. Single-payer systems are forced to practice triage based on availability of resource. Under both systems, people die unnecessarily.

The only difference is that under the pay-to-play scenario outlined above, only the “deserving” will receive medical care. So who gets to play God and decide who “deserves” to live or die?

Break up the monopoly – drive down medical costs. Like the trucking industry and the airlines, that must be the first step. This is the step the whole industry most fears, so it never gets discussed. It’s Orwellian.

Like the the gun nut who will never allow the government to pry his hand from his handgun, I am never going to allow the government to steal from me so they can pay for the huge buildings filled with beaurocrats, the fat lady at Walmart riding her rambler, the precious young thing practicing his risky ‘alternate lifestyle’, the demented 90 year old kept alive at any cost.

I think you have this almost exactly backwards. Insurance reimbursesment levels are generally derived from the payment schedules set up by CMS (medicare). Insurance invariably pays more than government for one primary reason: CMS is supposed to get best pricing (although there are exceptions). The only groups authorized by law to contract at less than Medicare rates are Medicaid, which where I live (Tennessee) pays from 10-20% less than Medicare. Many insurance companies (such as Blue Cross/Blue Shield here in TN) are moving to a 100% Medicare reimbursement policy. Medicare has a highly convoluted, involved, bureaucratic, slow, inefficient method for determining reimbursement that is frequently divorced from reality, but it does not put in the prevailing insurance rates into its calculations. (An example I like of being divorced from reality is one of the things I do will get reimbursed from Medicare 4 times higher just 60 miles away over the Kentucky border, even though my costs are the same or higher to perform.)

And interesting enough (for my field), Medicare reimbursement for a lot of the tests I perform have not risen in 4 years. So even though you hear about these dramatic increases in costs, they are not trickling down to the labs.

As a Navy retiree, I also have Tricare, formerly known as “CHAMPUS”. It’s a farce. Tricare pays about 15 cents on the dollar of claims. (Between Tricare and the company plan, I guess we’re OK.)

I’m convinced that there ARE major savings to be wrung out of the costs of health care – and that the government is PRECISELY the wrong people to do it!

Medicaid recipients fall into two main groups: poor families with children, and chronically sick and poor individuals. Neither of these groups can qualify for low-cost private insurance.

Which brings us to…

“For high-risk patients with chronic medical conditions, a risk pool like California’s “Managed Risk Medical Insurance Board” would be used to obtain more affordable policies than would otherwise be available”

Well, technically, if a poor person with a chronic disease would currently pay $10,000 a year for medical coverage (if it were available), and would only have to pay $8,000 under the plan, that is indeed “more affordable.” But how about a few more specifics here? “More affordable” to whom?

For the past few years, health-insurance companies have been stampeding out of the individual-coverage market; what on earth makes you suppose they’d be eager to rush back into it, given the very real possibility their profits would be even more negligible than before?