As a Brit, with 60 years of a free universal health service, I could sing the merits of a 'single payer' system - but I find the name an odd characterisation: there are actually multiple payers  (through taxations) and multiple arrangements for employment of medical staff,

However, the key thing about Krugman and Brook's exchange is that this is now happening, and should constitute the next phase of debate and reform. Quite frankly, having followed the primaries and the GE avidly, the main thing that the incoming president promised was reform to cover the 40 million uninsured, and close some of the loopholes in the insurance. Debate about single payers and public options developed on liberal blogs, but I never had any sense that this would be the immediate focus of any reform, though maybe a more long term objective.

So that would be  my advice to progressives who want socialised medicine like most of Europe. Instead of calling the current administration sell-outs and traitors, celebrate the more universal coverage that you have gain, and then start persuading the rest of the country that single payer healthcare isn't communism.

And now we are hearing that the House Dems are ready to give up the public option in order to merge with the Senate bill. It seems to be case of universal health care at all costs, even if in the end the country goes bankrupt just to prop up the health insurance industry. It seems to have already happened with the pharmaceutical industry, about which the barring of imported drugs is forbidden. It irks me everytime a see a TV ad for some magic drug and they seem to come one after the other at the cost of billions each year.

Charles... unless you would REALLY like the women of MyDD to learn to tighten their vaginas and increase their breast size, I think some deletions are in order....

http://www.mydd.com/story/2009/12/28/916 28/279#1

http://www.mydd.com/story/2009/12/28/953 3/7462#1

So the Senate passes their HCR reform on Christmas eve with Ben Nelson's "Federalizing Medicaid for Nebraska" amendment. This could be really good or really bad, as the other states wake up to the implications (NYT). Charles Lemos wrote about this the other day in "States React to the Nebraska Compromise".

The States are waking up to two things, (1) The HCR bill sticks them with a huge, unfunded mandate at a moment in time when they're facing a budget crisis due to the impact of the recession on tax receipts. (2) Why can't we all get the same deal as Nebraska?

I would like to see #2 for a number of good reasons:

(1) The Federal Tax code is more progressive than most states. Federalizing Medicaid shifts more of the tax burden to the wealthy taxpayers.

(2) Having the Feds regulate medicaid insurance helps define a guaranteed minimum to health care benefits, which will secure the floor of for all other plans. Presently, Medicaid benefits can be variable depending on each state's budget or opposition to providing welfare to its citizens.

(3) Yeah, there is the little thing of Taxes vs Debt, but the economy could certainly use additional stimulus money. Providing medical care to people has a very high stimulative effect. The recession is killing state budgets everywhere as they are prohibited from running debt. Federalizing Medicaid would provide a huge kick in the stimulus package.

(4) Medicaid doesn't have the famous 20-30% cost hit from private insurance. To the extent that more people are served by an insurance program with 5-10% overhead, national health expenditures will go down.

(5) Cost Control. Medicaid health delivery is frequently offered through FQHCs (Federally Qualified Health Centers) which are much more efficient at delivering cost effective health care than big, for-profit hospitals.

However, you can bet that the States are freaking out over #1.

I have no doubt that every governor in every State is on 24 hour lobbying to their Senators and Representatives. The unfunded Medicaid Mandate has a much higher impact on Blue States, which means that Democratic Caucus will be getting the highest pressure. As pointed out in the NYT article:

Existing Medicaid coverage varies widely. Arkansas, for example, extends Medicaid to working parents who earn up to 17 percent of the federal poverty level, and Alabama offers coverage for those making up to 24 percent of that level. Minnesota covers working parents making up to 215 percent of the federal poverty level, and New York, up to 150 percent. New York also covers childless adults up to 65 making up to 100 percent of the federal poverty level.

This seems like absurdities on top of absurdities on top of absurdity

a) Absurdity : discussing single payer at this juncture

b) On top of absurdity: Asking why didn't a conservative columnist do the job that our team refused to do, and, in fact, despite all polling to the contrary, our team preordained as impossible.

c) On top of absurdity: Saying all of this while there is a great push to pass a bill that makes future government action less likely because of the personalities and partisanship involved in the first two absurdities.  Including by one of the panelists who says pass the bill.