Klari is a fabulous woman with fascinating interests, and an excellent conversationalist and debater to boot. And I have slacked off on writing a proper response to her question: what I think health reform should do.
I should explain my stance on the current version of reform pending in Congress: I don't think it's terribly good, but I also don't think it's the OMGENDOFTHEWORLD that the right claims. I also think that if it doesn't pass, we're not going to see health care touched for at least another decade-- by which time, health care spending will inflate to maybe a quarter of our entire economy. Which would be extraordinarily NOT GOOD. Especially when we're staring down the barrel of baby boomer retirement and aging. However, I'm not optimistic about the chances of reform passing, and I'm actually quite frightened by the incredible amount of vitriol poisoning the debate. Like the older guy on the news talking about if it passes, there'll be a "revolution, in the election or armed". Seriously? Pardon my french, but you'd shed blood over a fucking health plan? I think that's a little melodramatic there, and that's certainly NOT the kind of person I like to think about owning firearms.
I think that any reform needs to return to first principles. Is health care a basic necessity like food or water, to which everyone must have access, or it is a commodity-- an important commodity, but still a commodity-- to be purchased in a manner like electricity? Nobody has a "right" to electricity, and there are a number of people that live without it (the Amish are the first to come to mind, of course). Establishing a non-ambiguous philosophical attitude about health care is essential; think of it as leveling the ground and determining the proper foundation upon which all other policy and legislation will be built. This is the first place where I think that all attempts at health "reform" go wrong. I define "health care" in this case as not just free cancer screenings or emergency department services, but actual, substantial care. Regular primary care. Non-essential surgery that improves the quality of life (think knee replacements). The whole shebang, not just seeing an overworked nurse practitioner in a free clinic for school vaccinations or an emergency department that complies with EMTALA. Getting a free screening that tells me that my funky mole might be melanoma, but not being able to access any other care until I'm practically dying of skin cancer doesn't do any good.
Honestly, once the decision is made whether health care is a right or a privilege, everything else is almost academic.
If it's a right, we can either further modify our current delivery or financing systems-- slap another patch program on there-- or start from scratch. If it's a privilege, then there's really not much reason to change how you treat it as we do now-- like heating oil or gas in the north, where the destitute can apply for limited assistance funds in the winter? Let the market sort itself out.
I happen to think that health care, like clean water and air, is a right that needs to be formally recognized. For some, the idea of clean air and water as a right is an abstract notion. Growing up with the stench of the Clairton Coke Works hanging over the valley every morning, surrounded by creeks and rivers that you couldn't touch because of mine runoff or other industrial chemical contamination, I have a pretty good idea what it means to live with lipservice to that right. Sure, they were "cleaning up their act," but it didn't change the fact that we were still breathing in hydrogen sulfide (among other things) and people seemed to die awfully young. Your family could sue them, assuming they could definitively prove that without the emissions you wouldn't have died-- but you're still dead. Likewise, the notion of health care as a right is an abstract concept-- doesn't the ER* have to treat you? Yes-- but it doesn't change the fact that you probably wouldn't wind up there in the first place if you had regular primary care!
I freely admit that my personal beliefs influence my position, both my ethics and religious leanings. I just think that it's the right thing to do. You don't let people starve to death when there's plenty of food to go around, you don't let people freeze to death when there's plenty of clothing to go around, and you just don't let people suffer and die because they can't afford health care. Especially when someone is trying to do it for themselves and needs help.
Now that I've explained the philosophical underpinning, I'll describe what I think that reform from that point "should" look like in another part.
*(I know ED is the preferred nomenclature, but I associate ED with erectile dysfunction)