In January, I argued with a friend over coffee, saying that Obama was crazy to launch a full-throttle effort on health care reform. With this being such a hot-button issue for the right and their media surrogates. I argued that Obama needed to build up some cred points first (fix the economy, show progress in Iraquistan). The fact that he launched into this I ascribed to ineptitude, hubris, whatever. Maybe Ted Kennedy's last wish. I predicted that Obama's reform initiative would die the death of 1000 cuts. I told my coffee friend that if Obama mentioned the term "single payer" once in 2009 in any sort of affirmative sense (like "We are looking at that"), I would give my friend $100 cash.

I didn't have to worry about my $100. I think Obama pretty much banned the utterance of that term anywhere within 10 miles of the White House. And he jumped so fast and so high to assuage the anxieties of Pharma and Insurance, that I could no longer conclude that this was simply a new president getting buffeted by the consequences of his premature effort. This is simply a fact that, as Taibbi says, this was in the cards all along. And I should have no more illusions about President Hope. Who won't get get my vote in 2012.

We spend way too much on health care but leave millions without care and exposed to financial ruin. Our health care outcomes and metrics suck compared to countries we often take the chance to deride.

Whether explicit or implicit, all health care systems impose some form of rationing. Ours just happens to do that by leaving people without care. If we expect to provide care for more people without increasing overall costs, we'll need to figure out how to drive costs out of the system. Other than muttering about "competition" none of the half-baked, half-hearted current allusions to "reform" seem to do anything I can understand that really addresses the cost issue. On the contrary, the body politic including President Hope have worked very hard to make sure that the 31% cut of the take that is more of less wasted on insurance-related administrivia is institutionalized for the next 100 years. But the insurance companies are very relieved. Still on their guard, but relieved a great deal.

So I'm with Taibbi. I think the fix of the special interests was in all along.

I have been a provider and a patient im military acute care settings and a patient in the VA system. Now there was certain stilted quality to some of the standardization of procedure in those settings, but they got the job done. I got pretty darned good care, something that was more than once noted by civilian docs and dentists down the road years later.

Now the VA has taken some knocks and had its problems, but you would think that many folks familiarity with thinks like "universal" military coverage and Medicare would make folks more comfortable with the notion of some big evil single payer system like Canada's or the UK's.

Some of this I think is tied to the great American value of individual versus collective good. I worked on a hospital-based research study and travelled to study centers in, among other places, the US and Sweden. This was a totally non-invasive study. A 30-minute standardized interview about medication history and medical conditions. In the US, you'd spend 20-30 minutes explaining the study and about 1 in 5 people would agree to the interview. In Sweden, informed consent took about 10 minutes and more like 4 out of 5 would agree. Doing something for the general good of others. Not high on the list here in the US.

But I think this is really something that politicians and the media leverage. The general distrust of institutions and the "What's in it for me?" factor. The primary problem standing between welfare and the people of the United States is that in this single-party democracy all of the key players have already been bought and paid for by special interests. Your welfare doesn't figure in.