Speak for yourself, son.

"It's also the case that individuals don't care as much about their premiums as they normally would because their employers typically pay more than 70 percent of the cost, and employers don't care about the cost as much as they normally would because they just deduct it from worker wages. So no one, from insurers to employers to individuals, really feels the full cost of the system, and so no one is that interested in cutting costs.* And this is not something we're going to fix in health-care reform."

Who is Mr. Klein forgetting ... who, who? Oh yes. The deliberately uninsured individual who pays out of pocket for necessary, minimal medical treatments.

Sadly, just as those on business expense accounts do not blink at paying $89 for a low-end hotel room, medical consumers who choose to pay-as-you-go actually pay MORE than what is billed to an employer-insured individual, because of the group rates negotiated for standard procedures (like an office visit, needed to procure an antibiotic prescription every 5 years or so.)

Now give the kid credit; he's starting to wise up on how businesses -- even in the big bad insurance industry -- work in real life:

One of the oddities of the health-care reform debate is that we tend to despise insurers for two contradictory things. On the one hand, we hate them for saying no. No to procedures, no to people, no to reimbursements. On the other hand, we hate them for raising premiums and being expensive.

But saying no, of course, is what holds down costs. So when it comes to cost control, insurers are in a bit of a "damned-if-you-do, damned-if-you-don't" situation. And they've chosen "don't." Sharon Begley explains why:

Why do insurers pay for unnecessary care? Partly because they're battle-weary, having been successfully sued for refusing to cover, for instance, high-dose chemo plus bone-marrow transplants for breast cancer -- which turned out to be not just useless but, for thousands of patients, deadly.

Unfortunately, by the time he gets around to understanding what those already conditioned to "Consume and Pay for only what you can Afford Today" do, I fear it will be much to late to take the Entitlement Bones from the mouths of teething children.

You think it will be tough killing this bill now ... in 15 years, you try deciding between a physically healthy child growing in poverty, and an older worker who's put in all his life working for the union insurance and pension -- before that was eliminated to equal things out -- which one is going to see the doctor and be pre-approved for the basic medical treatment that day.

Let's not encourage the entitlement mentality that kills the "Pay as You Go" economy for everyone. Then, there will be incentives to work for the best opportunities you can position yourself and your family.

And most importantly, there will be an underlying social structure solidity in that we're not going to change the rules of the game and artificially entitle some growth populations, seemingly forever. You can't legislate "equality" where none truly exists, as our school districts are starting to see locally for the costs of treating healthy and mentally ill/learning disabled children as equals to be accomodated, despite the much higher pricetag in bringing one up to the norm. It's simply unaffordable to mandate such good intentions, and budget cuts become necessary in the real world to achieve artificial "equality".

Best still to allow states to work with their own poor and uninsured populations to meet their needs. Wisconsin isn't doing so bad with our own BadgerCare and BadgerCare further rollouts. The states whose industries are being subsidized via undocumented labor naturally will have those costs show up on their books somewhere in terms of education or healthcare needs. Maybe they could group together and tackle the problems of their citizen uninsureds, at the same time as addressing the costs of unseen/undocumented peoples.

Florida and North Dakota have different populations, and different health needs. The rural number one health problem is transportation and access; the urban coastal areas might need more vaccinations or ways of convincing people to come into clinics and treat. Same money needed; different ways of delivering.

But when nobody can afford a hotel room in your region on the need-based, market-determined rates without employer subsidies (even with cheaper undocumented labor) -- that's not a good thing because you're relying only on the true elites and those subsidized by others to fund your business.

That's not honest competition. That can lead to poor quality at over-inflated prices. The finanically healthiest will steer clear of paying for such situations and accomodations.

You really do have to control costs, and have some accurate measure of paying in for what you're taking out, before you can mandate anyone's behavior. Otherwise, just as mandatory prohibition drove the best drink underground, surely plenty of doctors (and nurses!) will follow the money and find the most lucrative positions for themselves. Where they still can use market-determined rates to calculate their worth, and surely will find no shortage of customers. (think Private schools, vs. their federally mandated brothers and sisters in past decades. You tell me: quality overall? Up or down? At least the system as it stands now still permits those who work and sacrifice and -- quite frankly -- want it bad enough to prioritize their own values and have a shot at least at getting there.)

You don't like paying for your co-workers' family health bills? Vote with your feet. Find another job. Get thee to a state of your liking; investigate what you need, what you can or can't afford. Timing counts! If you can't pay, just say "nay". And don't forget to set aside something for a rainy day. Because at the end of the day, you simply can't give more than you've got, and expect uncommitted others to pick up the tab for your promises. Let's break that habit today, for the sake of a healthy future, deal?

-------------

* And Fwiw? I generally don't pay for someone to prepare or bring me my daily bread either. Don't even stay at hotels much, choosing camping outdoors when that's an option. Nor do I choose to pay extra for cable tv. I know plenty who do though, and then can't afford to pay for their healthcare premiums. Things that make you go "hmmm..."

Tell me again where it ends that I'm paying for the wealthy elderly to hang on to their inheritance money for their kids, and now I'm paying for the sweet co-worker lady who has 6 kids with 3 fathers, only 1 of whom did she see the need to marry?

Pay as You Go, with an insurance option for those who find it financially beneficial, + Needs Tested Government-Run Social Programs that don't encourage program growth. You want to control costs and balance a budget -- there's an elementary place to start some Change and Hope going around.