So, what took place? Abuse. Everybody started making claims, trying to get more out than they put in. Insurance companies were happy to comply, allowing more and more procedures be covered. They were not only increasing their role in more and more health transactions, they were raking in more profit, adjusting premiums upwards the following year. Some doctors got sucked into the game too. They'd do more "precautionary" procedures and tests because what the hell, insurance was paying for it all and the patient didn't mind much.

This is a very coarse explanation of what happened, but the end result speaks for itself. Today, 45 million Americans are uninsured with many more working stiffs killing themselves to pay unbelievably high premiums, afraid of getting just one large medical bill. Many people seek any job that will provide health care while companies look to lower their contributions more every year. The office I work in had premiums increase more then 18% two years in a row. 

Is it hopeless? I don't believe so at all. We just need to regain control of our democracy. 

What would correct the problem for millions overnight is a basic "catastrophic only" policy. Insurance is what the majority of Americans would prefer, but it's not offered by a single company anywhere in the country because were it offered, no one would pay for marked-up health care any longer. A similar model works nicely for auto insurance in my state - drivers keep their cars running tip-top, paying for maintenance and repairs out of pocket, even paying cash in the event of accidents to avoid making claims above a set deductible amount. It's just what was in place 30 years ago when my father paid his doctor directly, and paid a relative pittance for real insurance and peace of mind.

If we could pay our doctors and hospitals directly, it would keep both the doctor's costs low and the premiums low. The health care corporations would lose - in fact it would eviscerate the industry which has grown immensely by adding paperwork to our medical transactions. But with the middleman gone, the costs would be that much more within reach of actually paying out of pocket. There are other ways to bring costs down as well.

Today we have a nationwide recruitment program seeking classroom teachers to address shortages in 16 major metropolitan areas, with hundreds more local programs educating and certifying college grads and career changers for careers in education. If health care is as fundamental an entitlement, there is no reason we can't train preventive care workers to man screening and treatment facilities, pre-buying many common services in bulk to contain costs, as would restoration of Medicare's bargaining power. We already know investment in prevention pre-empts emergency room costs, but it simultaneously drives medical costs lower. This is one facet of Barack Obama's campaign already, though he, Hillary Clinton and John Edwards all support continuation of middleman corporate health profiteering.

In conclusion, I think this large and important issue could be best addressed by adding Kucinich's plan to eliminate healthcare middlemen with Obama's plan to ramp up preventative programs and awareness. But the catastrophic-only policy is the missing ingredient that would preclude the need for single payer medicare-for-all where the government would have such a  large role. 

I invite other perspectives on this issue because millions will likely cast their '08 vote for the candidate that promises them the best options for coverage. But are the candidates appealing to the same individual greed that got us into this fix? We really need to work on normalizing costs, not looking for systems that subsidize costs.