If all of this works, and a five years or a decade down the road things are not verging on catastrophe, there are multiple ways that responsible people (I'd count myself in that crowd, and yes it makes me sick to have to help support assholes who lived it up when they should have been saving just a smidge for the future) might be rewarded for their sacrifice. I am certainly not saying it will happen, but there are ways it could happen.

The IRS does have records and presumably the tax code in 5-10 years could look back at the amount of taxes and deductions and any special credits that have been received by filers during these years. If you don't get anything out of the stimulus or recovery plans of 08,09,10, then maybe you ought to be eligible for some special credits or deductions in the future as payback for seeing the spendthrifts through some tough times.

Fair is fair. I don't mind helping, but I don't like the idea of getting screwed.

I'm with you on that. One of the things that makes a marketplace work is consumers having valid information to compare the providers.

If they were selling sandwiches it works...today I try deli #1, tomorrow I try deli #2. The info I need to compare the providers (taste and price) is fully available to me instantly, and I can even try them repeatedly and average things out.

That kind of model will simply never fully translate to health care.

• How many times will you have most medical procedures done? Once, and they are sometimes done in a near emergency situation. So if I am not happy with the outcome what am I going to do? Have chemotherapy again just to see how it is the with a different provider?

• Even if the info needed to compare providers was properly tracked, health care outcomes are slightly more complex than sandwiches and would certainly be presented as statistics. People can rail all they want that consumers need to inform themselves, but that is just a farce. With few exceptions, patients never can learn enough to fully understand what doctors know. Someone with a high school education might not have a clue about statistics.

• If good info is always cited as what consumers need to make comparisons in health care, why aren't the insurance companies providing this info to us NOW? Because they really don't care about you getting info, they care about running a business. If you happen to get better along the way that is nice too, but they will not sacrifice having a profitable business to make sure that happens. They can't, so the priority is always on making money. BTW-Good info is NOT some bullshit brochure that has a long list of possible risks with no frequency of occurrence at national/hospital/doctor level. No comparison of anything can be made with info like that.

My point is the only way meaningful measures of medical outcomes can be gathered and applied to make health care better is by doing it in a comprehensive system that does NOT require quarterly profits. (I'll spare you all my rant on the economics side and save that for another post.)

I think even without any improvement in information provided to consumers, a single payer system would still be much better than now, simply because everyone would be covered at less cost per person. If total costs actually went up, I am SO ok with spending money on something like that vs spending on a bloated military.

To make that system even better, transparency and rigorous tracking of outcomes are essential.

BTW I agree fully with Sirota's point in the article that if we did a side by side in a fair competition - the existing system would get it's ass kicked and the Republicans know that. Oh wait, that comparison has already been done for us. Just compare our system to those of the other G7 countries - better outcomes for less money, AND there still capitalist nations to boot.