Point on Peter.  Our society was built upon rights with responsibilities.  Unabaited rights to health care without commensurate responsibilities is not in keeping with our country's founding principles.

Clearly, the most opportunity for cost mitigation lies in attacking the root causes of medical expenses -- personal health behaviors.  Perhaps if people understood and agreed with the rights vs. responsibility concept, they would migrate toward healtier behaviors.

Well stated. Yes, we are already paying for healthcare for the uninsured, however, access is difficult and functionally impossible for many.  

The economic hand-wringing is over the cost of health insurance, with no consideration to the cost of healthcare services.  We could save 20 to 40% of our costs by adding price competition into the mix.

You get votes by telling people what they want to hear.  They want to hear that *access to* healthcare is a right, so it's a right.  

It may not be as fundamental as freedom of speech or property protection, but all of us grow up with enough 'public' structures around us that we mix up the distinction (eg. public highways). In many ways though, viewing healthcare as an economic good is a uniquely American phenomenon when it comes to 'industrial' countries.  However, Americans haven't done a better job managing it (for whatever reason).  

Growing up in Canada, the issue of healthcare as an economic good isn't a question at all.  For Canadians, on average, it's a right, period.  However, what Canadians lose from having that egalitarian view of healthcare is unclear to Canadians and Americans alike.  To some people though, the cost of having access to something at the price of losing efficiency and productivity is a worthwhile cost.  If the end result is mediocrity for all instead of a much better solution for most, then so be it.  You mentioned the current financial crises.  For many people I spoke with, the lesson is that sometimes the shot at being best through market-regulated competition isn’t worth the risk (of choking productivity / innovation / competition due to regulation).  If you apply the same reasoning to healthcare then you get support for a public system giving universal access to mediocre healthcare rather than the risk of some people not having access to a much better system.

It is evident from your commentary how the parts making up the whole for health care and the health of American Society requires stakeholder participation.  There is much confusion here in Canada as well as in the USA on the issue of  privilege, a right or a responsibility.

The debate of who will pay for medical services is driven through the economics of health care.  It is interesting to me how health care is one the the last areas of business services with improvements in technology where the costs of delivery continue to rise.

Peter your comments are enlightening to fuel further discussion on creative solutions.  In the mid 90's we have an All American Ross Perot who discussed the issues with the Medicare & Medicaid Trust in his book "Intensive Care: We Must Save Medicare and Medicaid Now".  This is a quick read as the issues facing these universal plans for qualified Americans is now in the forefront once again.

Thanks you for your insights!

James R. Taylor

jtaylor@lifescale.com