This was in a different thread, but I thought I would detach it and get some feedback from others. In my opinion, we never discuss healthcare reform, but instead argue about health care financing reform. As a result, the debate always comes down to who is paying for whom instead of having any real debate about what can be done to improve the system for all.

I think its time we thought about the fundamental principles of what a government should do about health care, and frankly I come to this conclusion- we should develop universal healthcare- probably by state instead of federal, but a basic amount of coverage for all in a similar way that we provide a basic protection for all through the army, police and fire services.

Here goes:

I believe that human existence has a couple of central paradoxes. One important one is the fact that we are both individuals and independent and social and interdependent. We are individual citizens, but always citizens of something bigger.

As individuals we should always standup for each others' individual choices of conscience, up to a point.
As citizens, we should bind together to accomplish our collective hopes, and bind together to protect our selves from common ills, up to a point.

The basic outlines of this:

As for our hopes- I think the government does need to continue to invest in basic infrastructure. That is the basis of individual economic growth- education, transportation, communication, coordinated energy policy and research for research sake- so many breakthroughs in the modern era require more than profit motive to get off the ground. With out govt. initiative in military, space and university research- there is no Steve Jobs or Zuckerburg.

As for our fears- there are certain ills of the world that effect us as a group, regardless of our individual merit or responsibility. There are bad things that happen to us, more or less randomly and those things we should bind together in common cause. In my opinion these ills are:

Invasion, Crime, Fire and other Natural Disasters, Illness and disease.

In other words we should never tell people in these areas to "do for themselves." In all of these areas, it has been tried in the past and frankly has been mostly abandoned to real and sustained human progress through coordinated action.

We are no longer peasants armed with pitch forks hoping that various kings' private armies leave us alone, we train and equip a people's army that serves "we the people." Invasion effects all regardless of merit, all should contribute to defense regardless of where the invasion attacks. We should never privatize this. "Those bombers are headed to homes without Anti-Aircraft riders, let them pass." That is not acceptable.

Crime effects all regardless of merit, and we contribute to basic protection, regardless of who is victimized. Those who desire are free to purchase more security above and beyond the basic protection. "Sir, we can not respond to your burglary because you have been previously burgled. It a pre-existing vulnerability." That is not acceptable.

Fire and natural disaster effects many people, regardless of merit, and we commit to the common alleviation of these ills regardless who is effected. Those who want more protection are free to purchase more on the open market. "I am sorry folks we thought your house was within our network of protected homes. You are going to have to get a fire engine from your own network to put out your fire." That is unacceptable.

Illness effects people regardless of individual merit, and I believe we should bind together on that issue as well. Those who want more than the basic level of community protection are still free to purchase more for themselves. No freedom is lost with universal healthcare, just like no freedom is lost with universal common defense, police, or fire protection.
Until we learn the lessons that these other areas have taught us, we will suffer from all the inefficiency, inequality, insensitivity, poor outcomes, bloated costs and inhumanity that are beloved "private corporations" can force down our throats.

Government initiative and coordination on matters of basic economic infrastructure such as research, education, transportation and energy development and distribution because it benefits all and is what makes private success possible.

Government paid soldiers, policemen, firemen, and doctors because they protect us from what we should never be left to do for ourselves. We can do all of that ourselves- but progress dictates that we shouldn't.

In our collective pasts, we have had private armies, police and fire, and we democratized that for the better of all. Its time we do the same with healthcare.