That the "opposition party" is just that. Not only do Democrats need to understand that this is the Republican role right now (it is not to give Democrats cover through "bipartisanship"), they should have understood that this was their role during the 8 years of President Shrub.

I'd wager that most of us who voted for Democrats voted for change, and change means, well, changing (duh). And since Republicans were in charge for so long, this means not doing things the Uniquely Republican Way. Seems obvious, but Obama and the Democrats just don't seem to get it. Nor do they get that if reform works, voters simply won't care that Republicans didn't sign off on it. So their first focus should be to get it right and forget the Republicans, who are a national embarrassment anyway.

... or conveniently omits, is that his demographic (Christian, Caucasian males) has dominated this country from Day 1, and still does. Everyone else is playing catchup, and has had to deal with crushing discrimination along the way (and many still do). This alone means his hypothetical is not at all equivalent with her "wise Latina" comment. I took her comments as those from someone in the trenches recounting and passing on her experience to others fighting their own uphill battles for equality. They were not comments denigrating other groups or casting her group as superior--like, say, Allen's macaca moment.

Democrats had to give up on an expansive welfare state to elect Bill Clinton. The British Labor Party struck out the core clause of its charter, which endorsed nationalized industry, in order to get Tony Blair into office.

Republicans need to reinvent their party, there is no doubting that. The GOP needs to mean something real and concrete to the average person. Hate will only go so far.

But change at the expense of your core principles doesn't always work out for the best. The two examples cited by Winant that I quote above are a case in point. The Labor Party is rudderless, out of ideas, and has alienated its core. The changes it made got it into power, but they have nothing to show for being in power except scandals and war and an expansion of the surveillance state. The English people have not accrued any real benefit to show for 12 years of unprincipled Labor rule. The joke is that they will now turn to the Tories. Out of the frying pan into the fire.

Much the same can be said about the capitulation of the Democrats. What core principles (other than staying in power) do Democrats hold dear? Civil liberties? FOIA? The rule of law? Decent jobs that pay living wages for working-class Americans? EFCA? Decent and affordable health-care for all Americans? To Democrats all these are subject to compromise. Rahm Emmanuel explained this unprincipled attitude best when he said that the only non-negotiable item on the table was success. But to what end success?

You neatly covered 2 of the 3 reasons our costs are so high: administrative costs and profit. The third is related to profit and is the overuse of expensive medicine. This is encouraged by the fee-for-service method we use here: more services, more fees! Thus expensive tests are ordered because they generate big profits. Pharmaceutical companies constantly come up with newer, more expensive (and thus more profitable) replacements for cheaper but often just as effective predecessors. To ensure that doctors don't stick to the tried and true older drugs the manufacturers advertise the new drugs directly to the public, who, though they know little or nothing of medical best practices, then go and demand from their doctors "the best." (Vioxx & Celebrex are two of the most prominent examples of this.) In addition to being very expensive this is not good medicine.

The French system is a good system. No system is perfect, and the nay-sayers will of course latch onto every little imperfection of this system to explain why we must not change our far worse system. But here is the key: The French have this system because French citizens actively participate in politics (in the street, when necessary), hold their government accountable, and demand these solutions. We must do the same, or we'll get "reform" that isn't reform.

As long as we're into basic education, the AARP has a good article along this vein at http://www.aarpmagazine.org/health/8_myths_about_health_care_reform.html. (or click my sig).

It's a pity that we must restate the most basic facts over and over again in the face of massive disinformation from parties vested in the current hugely profitable system. The simple, incontestable fact remains that we spend double per-person than any other industrialized nation, but with outcomes that rival those who spend the least. The bottom line of any opposition to meaningful reform is this: To cut costs we must reform the business in ways that will cut into these obscene profits. Those who profit naturally don't want this to happen. Those who feed these profits without getting much in return (that would be most of us) should not be unwittingly spreading the health care industry's misinformation on reform.