On Fire: Update

The size of the Station Fire:

c. Saturday morning: 7,500 acres

c. Saturday evening: 20,000 acres

c. Sunday morning: 35,000 acres

c. Sunday evening: 42,000 acres

c. Monday morning [as per KPCC radio; web site not yet updated]: 85,000 acres

On Fire

I took this photograph from the street just outside my front door. The Station File is burning in the Angeles National Forest, which blankets the mountains overlooking northeastern Los Angeles County. It started on Wednesday and now burns across more than 35,000 acres.

The men and women of the fire service battle it tirelessly but have so far been able to accomplish little. Their air tankers circle like moths above the incandescent hillside. I know that, up close, they are impressive craft. But from my present distance, they appear no more consequential before the enormous ridges of orange-gold flame visible through the smoke than those moths would be, and still less consequential before that smoke, which looms like a second mountain above the mountain, high into the grey-blue sky.

As to how the fire started, the question scarcely needs to be asked. The drought continues, and the heat wave, going on a week, seems to increase day by day. I slept on a towel last night and woke up after a fitful sleep to find myself braised in my own juices, for the towel was soaked through and the room was as stifling, though the windows were open, as it had been the evening before.

Meanwhile, the fans, which run day and night, fill the indoors with the smells of ash, of campfires, and of danger.

The air conditioner does not work. Like many things in our otherwise-beautiful home, the arrangement of its parts leaves something to be desired: the ducts bearing cool air run hard by pipes bearing hot water. The latter cause the former to sweat nearly as profusely as we do, and the moisture runs down the drywall, and through it, causing it to sag and buckle, as we do, in the relentless, unquenchable heat.

Update [1:00 PM]: The air conditioner has been repaired, and for the first time in many days, the air is blessedly cool, at least inside. The problem was not condensation after all, but several blockages in both the primary and secondary drainage systems.

By the way, I took the second photo above, not outside my front door, but at the Glendale Galleria. The mall is air-conditioned, you see, and so the whole of unconditioned East LA descended upon it yesterday seeking refuge -- with a predictable impact on our wallets.

Talk Sense Now, Joe

Joe Lieberman, you've been talking a lot of nonsense about how we ought to reform our health care system, but how we can't afford to do so this year. I shall tell you what I told the good folks at KPCC:

The reformed system you set in place will stand for many decades. During that time, there will be economic upturns and downturns. Rest assured, that whether you pass something this year, when we are poor, or in a year or two, when we are rich again, we will one day be paying for your choice in times such as these. I count seven recessions since the passage of Medicare.

Where we happen to be in the current economic cycle this year or next year is completely irrelevant. And you've been around the block enough times to have figured that out for yourself.

Yours, very sincerely.

Verdict: Follow-Up

This post is a follow-up to my previous post, "Verdict on 'The Public Option': Against." Specifically, it's a follow-up to Adam's excellent and in-depth comment on that post. I started to reply in my own comment, but that became even longer than the original comment, which seemed a bit excessive, so rather than showing some self discipline and cutting the sucker down, I decided to make it into a whole new post. So go read that first post, then read Adam's comment, and only then continue reading below. Otherwise, it may not make a whole lot of sense -- and you'll have no one to blame but yourself.

---

I think that maybe the term "market" is getting in the way. Let me come at it from a little different angle: I think Jane is a grownup who should be able to make her own decisions about how to prioritize her own spending. It's not my business to "let" her spend or save more or less of her own money -- provided she's not asking me to foot the bill (see my earlier post on "Things That Are True About American Health Care"). A dual mandate -- everyone must have insurance, every insurance company must take every comer at a "reasonable" (TBD) rate -- takes care of that.

So if we've established that Jane has insurance to cover at least her catastrophic needs, the next question is: how should she pay for it?

1. She could pay a flat rate for an all-inclusive, comprehensive plan that covers everything with no deductible and no co-pays. There are lots of things in life that people pay for in this way, including some health plans. But I get my home phone service this way too. My parents like to take vacations this way. Generally, when things are "all-inclusive", customers tend to use a lot more of them, and vendors tend to pad the prices in exchange for the convenience and to make sure they don't lose out.

2. She could pay a mostly-all-inclusive rate with some kind of minimal out-of-pocket expense to discourage frivolous use. Lots of insurance plans work this way, with minimal deductibles and/or $5-20 co-pays. I talked to one doctor who told me that this kind of plan makes a big difference over the previous option: with even a $10 co-pay to consider, a mom with 3 kids will make appointments for each them when necessary; with no co-pay, any time one of them goes in, she'll ask for all of them all to be seen, as long as she's there anyway. It might not make her kids any healthier, but the cost is no skin off her nose, so why shouldn't she use the system that way? It's the tragedy of the commons.

3. She could pay almost everything out of pocket and use her insurance only for catastrophic costs. This will encourage even more discretion on her part -- but perhaps equally important, philosophically speaking, it will enable/encourage her to act as an empowered, independent adult.

A health savings account helps Jane increase the threshold of "almost everything." It's like a 401(k) for health care: you choose some amount of your income to defer into it, then when you need care, you pay for it from the account. (401(k) dollars can be borrowed for other purposes; I'm not sure whether health savings accounts typically work the same way, but they should.) It's like the "cafeteria"/flexible spending account many companies offer, but you don't have to guess how much money you'll spend ahead of time and the funds roll over indefinitely. The tax incentive plus automatic deductions from your paycheck make it easy to do the right thing by saving.

Then the account is paired with a high-deductible (a couple grand) standard health insurance plan to cover you if you don't have enough in the savings account or choose not to use it. Just like with a 401(k), many employers will deposit some additional funds in your account up to some level, which ensures that you'll nearly always have a certain minimum balance in the account. I have a family member with a plan like this -- her employer contributes enough to the plan to meet the deduction every year, so in terms of net funds out of pocket, it's no different than an all-inclusive plan -- except that if she saves money, she gets to keep those savings in your own account.

What's not to love? I'd take a plan like that if my employer offered it.

For all of the people telling me that we don't buy health care like we buy widgets (not just you, Adam :-]), a lot of times, we do. With the exception of negligent young men like us, most insured people get annual checkups. Many, if not most, people get semi-annual dental checkups. A large percentage of women use birth control that they have to buy again every month or every few months. Any time a couple has a baby, they have 9 months warning. These expenses are relatively low and very predictable, and insurance companies are clever enough to price them into the plans they offer and to make sure that they get their cut -- even if they're not-for-profit and that cut is just administrative overhead.

As for fire insurance or the fire department: it's an interesting analogy, but I don't think it holds. Neither pays for smoke detectors or their batteries. They don't pay for improved wiring for my home, or better insulation, or any other maintenance measure that might hypothetically reduce the risk of fire in the future. A fire or homeowner's policy (sold to me by a private company, and paid for with my after-tax dollars) only pays out if there's an actual fire; the rest I pay out of pocket at my discretion. I decide how much homeowner's/fire insurance I want, at what rate, what deductible I'm comfortable with, and so on.

You could make the argument that I would be better off if someone forced me to hire an electrician to inspect my wiring once a year or to buy a more comprehensive fire insurance policy with a lower deductible. But those choices have associated costs, and I'm not sure who's better able to decide which costs make sense for me than me. A case in point: just a couple of weeks ago, I went in to see my dentist. He gave me several recommendations; some of those were covered by my insurance and some weren't, and I chose to take his advice in some cases and to wait and see in others. I made a financial trade-off with respect to my health care, just like I do in every other part of my life.

My opinion: it's only just to mandate that I bear a certain cost if by not bearing that cost, I pass it on to other people. To beat the dead fire department horse a bit more, I'm required to have a certain gauge wiring in my home, and I'll probably get a break on my insurance premiums if I have a smoke detector and/or sprinkler system. I'm happy to apply the same standard to health care and mandate that everyone have a certain minimum level of insurance to cover emergency and/or catastrophic care. It might be a reasonable cost-saving measure to enhance that mandate with minimal-but-regular publicly funded checkups. But beyond that, I start to get a bit uncomfortable. Not panicked! Not worked up into a lather about the supposed evils of The "S" Word. But ... uncomfortable.

Promising Political Upheaval in Iraq

There's a new political coalition in Iraq, and it doesn't include the current prime minister. That's an unhoped-for blessing on top of the coalition's two other notable characteristics: it's a secular group including both Sunnis and Shia, and it includes a number of parties that previously joined al-Maliki's Dawa party in the Iranian-backed United Iraqi Alliance.

I say that al-Maliki's absence is an unhoped-for blessing not because I have anything against the man, but because it seems to me to provide evidence for the development of a real political culture in Iraq. After long years of infighting, majority and minority parties are learning to work together to use the political process to their benefit. It's too early by far, of course, but I might even go so far as to hope that the next election transfers power to a new party and a new prime minister. Because there as here, it's the political process that's most important, not the outcome of any one contest.

Some Non with Your Fiction?

I saw the new movie "District 9" recently. It was a good film, and I thought the use of extraterrestrials as a socially disadvantaged class was an interesting way to bring social commentary into an action picture. (Although more accurately, the movie is really a socially conscious drama that happens to feature a lot of action and ultraviolence.)

What I didn't realize until today is that the "alien" ghetto in the film isn't just a metaphor for the South African township of Soweto; it was actually filmed there. The shacks in which the aliens live are not sets; they're the homes of human beings who live in Soweto today. The movie that I thought was a historical commentary on apartheid turns out to be a very modern criticism of its legacy. It's a very sobering thought, but it makes me appreciate "District 9" even more.

Verdict on "The Public Option": Against

With all the conviction on each side of the question "should a universally available government-run health care payer compete with private payers," I had a hard time, for a long time, gleaning any actual evidence for either position. But after some reading, a good deal of listening, and even more thinking, I've concluded that the answer is No. I believe that such a system would be a half measure less desirable than the full-throated alternative on either side of it.

Adding Up the Numbers

Opponents of the public option often make vague conspiratorial statements like "We can't expect the government to play fair in any competition." But you don't have to imagine any such thing to conclude that "competition" will be pretty one-sided. Let's look at the numbers:

A lot of people's health care is paid for by the government today (60%, by one JAMA estimate -- quoted here and here):

• The elderly, who are eligible for Medicare (about 15% of the population)
• The poor, who are eligible for Medicaid (about 20%)
• Government employees, who receive health benefits from their employers (about 8%)
• Veterans, who are eligible for benefits through the VA (about 10%)
• Public school teachers (about 1%)
• ...and so on.

Clearly, these are overlapping groups, but we can nevertheless see that a substantial fraction of the population who have health insurance today will be enrolled in any public plan fairly immediately. Add to this fraction the 15-20% of people who currently have no insurance, but who will be mandated to enroll in some insurance plan and who would receive very substantial subsidies to join the public plan -- most of those people could be expected to join that plan.

By my reckoning, we've got over 50% of the population in the public plan semi-automatically -- we're not even counting any person or company that might "choose" the plan yet.

• Consider the "brand" power of any public plan. Everyone will know that the plan exists and that they are eligible for it. Everyone will know something about what the plan covers, because everyone will know people enrolled in the plan. This ubiquity will encourage further enrollment.
• Under measures in both Houses, families could be eligible for subsidized premium payments even up to income levels four times the poverty level -- almost $90,000. Will these subsidies be available for premiums paid to private plans as well?
• As a federally chartered organization, will the Federal insurer be able to operate nationally under a single set of rules? If so, that would represent a significant cost advantage over private insurers, who are regulated separately in each state.

Without even considering the differences between for-profit vs. not-for-profit business models, or any extraordinary government measures to push its own plan, it's not unreasonable to imagine a scenario in which 75% of the population is enrolled in the hypothetical public plan. The remaining 25% would be divided among all other insurers put together. That means that any public plan comes to market with more than ten times the economy of scale of any competitor.

We're talking about Walmart-level inequities of scale and more -- except that "Walmart" will be run by the government. (Tangent: I wonder what the correlation is between generalized rage against Walmart and generalized enthusiasm for publicly funded health care....) Mom & Pop, Inc. cannot compete on price with Walmart, regardless of how efficiently Mom and Pop run their business and regardless of whether they hope to turn a profit. They are outclassed, and so will be private health insurers.

If You Can't Beat 'Em...

When a business cannot compete on price, it typically moves up the value chain: it charges a premium price, so it must have a premium offering. But premium insurance plans are precisely those that are likely to be taxed in order to pay for the subsidies that will be required for the less-well-off. Closed, too, could be the secondary insurance market: In the UK, where everyone receives their primary insurance from the National Health Service, rather than through their employers, many employers offer secondary insurance as an employment benefit. But with primary insurance in the US still tied to employment, a sizable secondary insurance market is unlikely to develop: how many employers are likely to offer you two health insurance policies simultaneously as a standard benefit?

My conclusion: "competition" between public and private health care insurance plans is a fantasy, whether its backers acknowledge/hope/plot it or not. A public "option" will become a de facto single payer system -- but by maintaining the fiction that it is one of many competitors and is tied to employment, it will be unable to deliver all of the benefits of a true single-player plan. If we're to have a single-payer, a government-only-payer, health care system, we'd better start having that public debate. Let's stop pretending that we're talking about "If you like what you have, you can keep it, but there's this other option...."

Cost vs. Access

There are two goals of any health care payment reform: controlling costs and broadening access. These two goals may or may not have a single solution.

When contemplating single-payer health care, the implicit question is, "Can a government provide quality universal health care?" Clearly, it can. It does throughout the rest of the developed world. For all of the hand wringing in the United States over rationing and long wait times, Europeans are overwhelmingly happy with their health care, and they have health outcomes as good as or better than those of Americans. Even in the US, users of the government-run Medicare report greater satisfaction with their care than do users of private insurance plans.

I happen to have a philosophical problem with government-run health care (whether the government is delivering it or merely paying for it), just as I do with government-run airlines or grocery stores. I think government ought to concentrate more on governing and less on offering an assortment of commercially-available products and services. But government is clearly up to the task, and reasonable people can disagree about how much involvement it should have in the delivery of infrastructure services. Is health care really so different from schools or roads?

The second question, of cost control, is the thornier one, especially if we answer the first question with a single-payer system. We know what leads to lower prices in every other industry: price transparency, vigorous competition, and continuing innovation. With the possible exception of the first, these are not the qualities of commodity infrastructure. These are not qualities we expect from any other government service. We're not eager for the Next Greatest Thing in highways; they work well enough, much the same as they have since the Eisenhower administration. So how do we encourage competition? I've written about that before.

I believe that government can help us achieve both goals, but not by starting insurance companies itself.

• If there's to be competition among providers, I need to be able to move easily from one provider to another at any time. That means that "provider networks" are a bad thing. That means that medical records in closed formats are a bad thing. The government can help establish the right incentives.
• If I'm to exercise good judgement about the medical costs I incur, I need to be exposed to those costs myself -- I need to transition from a comprehensive insurance plan to a combination of a health savings account and a catastrophic insurance plan. Government can help with that too.
• Decreasing costs will naturally lead to increasing access. Government can take us further by imposing coverage mandates on certain individuals (not on employers -- that leads to the aforementioned, afore-dreaded vendor lock-in), just as it does for car insurance.

Now if only any part of my brilliant plan were actually on the table in Washington.

Health Care and the Free Market

Thanks, Adam, for the excellent Krugman link you added to my recent post on health care reform. It's fortuitous, because I was planning on commenting on David Goldhill's interesting new article in The Atlantic today (with the unfortunately overwrought title of "How American Health Care Killed My Father"), and Krugman's points dovetail perfectly.

Krugman first. He argues that a traditional free market won't work well for health care:

[Y]ou don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance.

I generally agree. We mandate car insurance, because if you hit me, and you don't have insurance, you probably don't have the cash to buy me a new car either; I'll have to pick up the tab for your actions. The same applies to health care: if you need to be admitted to the hospital, and you can't pay for it, the hospital is going to treat you anyway, and it will shift those costs onto me.

We should favor systems that move costs closer to those responsible for incurring them. Since almost no one has the means to foot the bill for catastrophic care out-of-pocket, I would argue that mandating that people carry a certain level of health insurance is actually more market-based than the model we have for the uninsured today. At least the person incurring the cost of the care would be responsible for the cost of the insurance, if not the cost of the care itself.

I think Krugman takes his point a bit too far, though, and here's where Goldhill makes an important distinction, between comprehensive care and catastrophic care. (I find Goldhill's perspective very interesting; he's both a Democrat and an entrepreneur, and his proposal at the end of his article does a good job of blending what I think are good ideas from both perspectives. This is the creativity and leadership we've been lacking in Washington.) Goldhill:

[H]ealth insurance is different from every other type of insurance. Health insurance is the primary payment mechanism not just for expenses that are unexpected and large, but for nearly all health-care expenses. ... We can’t imagine paying for gas with our auto-insurance policy, or for our electric bills with our homeowners insurance, but we all assume that our regular checkups and dental cleanings will be covered at least partially by insurance. Most pregnancies are planned, and deliveries are predictable many months in advance, yet they’re financed the same way we finance fixing a car after a wreck—through an insurance claim.

I would take this idea further, and argue that not only should we get used to footing our own bills for routine care, but that even in the case of catastrophic care, we should receive the bills, and work with our insurance companies, ourselves. If my car gets wrecked, the shop sends me the bill, not my insurance company, whether I'm in a position to pay it or not. Yes, this is likely to be a bill for hundreds or thousands of dollars, not hundreds of thousands of dollars, but I suspect that the simple act of forcing me to confront the bill, and accept the transfer of funds through my own metaphorical hands, will encourage me to consider my health care choices more carefully even when those funds are not my own in the final accounting.

Krugman:

The second thing about health care is that it’s complicated, and you can’t rely on experience or comparison shopping.

This statement I completely disagree with. I don't know a thing about cars, but I know when mine is running and when it isn't. I expect someone trying to sell me a car, or offering to service my car, to explain my problem in language I understand and to make their case about why they're the one to fix it. I also don't know a thing about cancers of the eye and face, but I know people who've been affected by them, what their prognosis was, what methods were used to treat them, and what the outcomes were. Why can't I expect the same from a doctor as I would from a mechanic: that she would share her track record with my condition and compare her prices with those of other physicians having a similar track record? Sure, I'd be even more confident in my pick of a mechanic or a doctor if I had the judgement of someone actually in their field, but then I wouldn't need to hire them, would I?

Goldhill:

[C]onsider LASIK surgery. ... The surgery is seldom covered by insurance, and exists in the competitive economy typical of most other industries. So people who get LASIK surgery ... act like consumers. If you do an Internet search today, you can find LASIK procedures quoted as low as $499 per eye—a decline of roughly 80 percent since the procedure was introduced. You’ll also find sites where doctors advertise their own higher-priced surgeries (which more typically cost about $2,000 per eye) and warn against the dangers of discount LASIK. Many ads specify the quality of equipment being used and the performance record of the doctor, in addition to price. In other words, there’s been an active, competitive market for LASIK surgery of the same sort we’re used to seeing for most goods and services.

Precisely.

(Unfortunately, Goldhill then embarks on a faulty analogy, in which he compares MRIs with DVD players and relates how the latter went from being premium items to commodities due to robust competition. What he fails to consider is that the DVD player was at the same time replaced at the high end by the Blu-ray player. There will always be a premium product, and in the world of health care, for better or worse, we all believe that we're entitled to that one. I argued recently that we probably aren't, in fact, so entitled. Nevertheless, the way to make us all start realizing that, and start acting on it, is to confront us with more of the financial ramifications of our choices, not fewer.)

Krugman's final point, and my next-to-final point:

There are, however, no examples of successful health care based on the principles of the free market....

I greatly respect Mr. Krugman, and he is not typically wont to be glib, but I had to raise an eyebrow at that one. He is, in fact, correct, but not because (a) the American system is based on free-market principles and is failing or because (b) other large developed countries have tried free-market health-care financing and failed or even because (c) most other countries with non-free-market health care financing systems are doing a great job at containing costs.

Indeed, a market-based approach to health care financing has not really been tried: most of America's health care bills are already paid for by tax dollars [Journal of the American Medical Association, which unfortunately requires a subscription to access articles -- but quoted here and here]. The rest of the developed world finances health care in a way that is even less market-based than our own*. Their costs are rising too -- in the UK, faster than in the US.

The "free market" is not a black-or-white state that exists or not, and I agree with Mr. Krugman that there is no panacea to be found there. But I think we can do better than we are doing today, and this brings me to my final point. I learned about the Mr. Goldhill's article while I was listening to NPR. I get most of my news from NPR, and I help pay for NPR, because I appreciate being the customer of my news outlet. I think I get a better result than if I'm merely the product, fattened on cheap titillation for sale to advertisers. I suspect the same thing holds true when it comes to health care.

* I can't help but think that this situation is not unrelated to the fact that 12 of the 20 largest biotech companies are based in the US, while no other country has more than two. Is the health care industry one in which we more value the steady application of proven techniques or one in which we hope for rapid innovation? If the latter, what kind of pressures and incentives do we believe will most effectively drive those innovations?

Unger on Health Care Reform

Yesterday, I stayed up late writing a pithy (or so it seemed to me at midnight on a school night) post on health care reform. Today, I listened to humorist Brian Unger give his version of our American predicament, which is both funnier and more succinct than mine. Plus, I suspect that he was paid to write his essay.

My favorite part:

Some of us — a lot of us — already receive health care under some form of government plan, but don't believe in health care under some form of government plan. That makes us hypocritical or selfish. In some camps, I hear that makes us patriotic.

Things That Are True About American Health Care

I've been sitting on partial posts on the subject of health care for some time. Whether because the debate has reached a head [AP] or because I'm too tired, at this late hour, to polish any more but too wired to sleep, I have decided to lay some ideas on you.

Here's my first principle:

1. As long as I pay my own way, it's not your business. But if I ask you to pay, it becomes your business.

This angle lays bare a critical difference between health care and free speech and the problem with the rhetoric of "rights." Sorry, fellow Barack Obama voters: health care is not a right; it's a privilege. What does it mean for me to have a right to something that costs money I don't have? If I have a right to food, and I don't have any, but you do, do I have a right to enter your home and take some of yours? But back to health care specifically:

If I can pay for the care I get, it's not your business, and it's not the government's business, what kind of care that is or how much it costs. Health care is like any other good or service in the marketplace: the buyer and seller agree on a price. I might be a dupe, and I might strike a horrible bargain for myself. That's my problem; it's not your problem.

But the very moment I ask for one thin dime from someone else, I lose any entitlement to my "don't ration my health care" soap box. If I'm bleeding out in front of you, but I'm flat broke, I'll bend my rule just a little bit and declare that it's reasonable for me to expect you to pay to bandage me up. But the cost of those bandages is very much your business.

But let's take things a bit further. If I eat nothing but doughnuts, breakfast lunch and dinner, I'm a lot less sure that you owe me the cost of my diabetes medication. If I'm 104 years old, and I have a heart condition in addition to my lung cancer, and I'd like that experimental cancer drug that might or might not add 6 months to my life, but I can't pay for it, I'm not sure you owe me that drug either. You definitely don't owe me that MRI I asked for because my kid came down with a case of the sniffles. I drive a 12-year-old Chrysler, and sure, I'd really like that new Toyota with the traction control and six airbags -- it would be a heck of a lot safer; it might even save my life one day. But you don't owe me that either.

Of course, you are paying my way. You're paying for my emergency room visits [Washington Post]. You're paying for my Medicare [Entrepreneur.com] coverage. And of course, you're paying your own way too, whether you get health insurance from your employer or not, because sooner or later, all of those costs trickle down to you and me, buddy. And those costs are probably too high.

2. As a country, we don't get enough health for our health care dollars.

Personally, I don't find it particularly interesting that the United States spends more per capita on health care than any other country. Smart people with different goals can disagree about what dollar amount, what percentage of one's personal income, or what percentage of a country's GDP constitutes a reasonable investment in good health. But what I think everyone should agree on is that, whatever we spend, we ought to get a good value. In the United States, that's not currently the case, as least not overall. Whether in terms of life expectancy [UC], preventable deaths [CBS], or any number of other factors [Economist], we lag behind many countries that pay a good deal less for health care than we do.

3. Improved health can spur economic growth.

If you're healthier, you'll miss work less. Our company will do better, and we'll both be more likely to get a raise next year.

If you're healthier, you won't get me -- or my kid -- sick, either of which will make me have to miss work myself.

If you're healthier, you'll have more money to spend on the widgets I've been trying to sell you.

If I don't have to worry about losing my access to health care, I can leave my dead-end job and develop that great idea I have.

As an employer, if I can share the costs of my workers' health care, like my competitors in other countries can do, I can offer my goods more cheaply.

4. There's a lot of political momentum behind health care reform right now. Let's take advantage of it.

If you'd like to see more people able to afford their own health care, then you agree that there's a problem to be solved. If you think you're paying too much for other people's health care, then you agree that there's a problem to be solved. If you believe you're paying too much for your own health care, without getting any healthier, then you agree that there's a problem to be solved. If you think that American competitiveness is at stake, then you agree that there's a problem to be solved.

A lot of people with the ability to reform our health care system are putting a lot of skin in the game to see that reform happens -- not just in government, but in the businesses too [LA Times], large and small [Nancy Pelosi]. Now would be a good time to work with them [AP] to solve these problems.

The liberal guy leading the charge [Barack Obama] has taken the most liberal proposals off the table [SinglePayerAction.org], annoying a lot of people in his own party. Now would be a good time to compromise.