The purpose of insurance is to protect against catastrophe. High dollar deductible major med plans are not terribly expensive. For example a major med with a $5000 deductible costs $200-300 a month for a family. Everyone needs a major med plan, not first dollar coverage. We are never going to have a single-payer system in this country, but the government could easily subsidize a major med for the working poor. Of course if people did not have the cash for the emergency room visit the hospital would still go after them, but their liability limit would be $5000, and the bill for the ER visit would have been pre-negotiated by the major med carrier. Our employees costs of routine care were the same as under any Blue Shield low deductible plan. They did not have to negotiate with the health care providers. Since a family major med is $200-300 a month, and we put $5000 into their HSA, the conclusion is that the routine non-catastrophic medical costs are most of cost of medical care. These are the precise costs that people should be controlling on their own. Every year that we had the HSA plan the cost of the major med went down, while the low-deductible plans were going up a lot. Our agent told us that Blue Shield was experiencing very low costs for the major med, so it was quite profitable. It seems that when people are responsible for themselves, they do a pretty good job. After all, if they were neglecting their health to save money, they would inevitably have a major health problem, and the major med plan would have to pick up some big costs. That did not happen. I'm 73 and I have not seen a Doc for six years, so I am hoping the Dems do not screw up the Medicare HSA plans which will soon be available. I'll be on one in a flash.

I was CEO of a small R&D company until I retired a few years ago. Since I really liked the idea of personal choice and responsibility our employees had an HSA plan. We bought them a $5000 deductible major med, and put $5000 a year into their HSA. In effect they had a zero-deductible health insurance plan. Funny thing was that this plan cost less, in total, than the so-called low-deductible plans. In other words giving the employees some control of their medical decisions reduced the cost of medical care. The sales rep from Blue Shield who arranged our policy told me that many employers did not like HSA plans because they did not want an employee to quit and walk away with thousands of dollars of the "employers" money. So they preferred to buy plans that were far more bureaucratic and cost more, or they just reduced the benefit package. Since most medical costs are due to poor life-style decisions, forcing (allowing?) employees to see that they are throwing away their money in their HSA account on avoidable health problems might induce them to live a more healthy life. My personal observation is that the medical system is set up to create chronic patients who will need continuous and costly care forever. So anything that induces us to take a little responsibility could have a snowballing effect on reducing medical costs.

Immigrant workers (legal and illegal) drive cheap cars, usually old American V-8's from the 70's and 80's. So do a lot of poorer Americans. These cars cost not more than a thousand or so dollars, so gas mileage is irrelevant. Not only are they old and unsafe, but they pollute a lot. Many of these cars are not insured for liability, since insurance costs are a huge cost to people making minimum wage. We have friends who have had collisions with these cars. The driver and his passengers generally flee on foot, since they are both illegal, uninsured, and frequently unlicensed. The farm lobby prevents stricter enforcement of the laws, since that would require higher wages.

This is a great or greater problem than Hummer drivers, but there is a simple solution. All cars older than a reasonable age should be bought up by the state and destroyed. Legitimate antiques would be exempt of course. Thousands of these cars could be removed from the roads for a few million dollars. A small increase in the gas tax would easily cover the cost. A lot of owners of these cars would go for the quick buck if the price was a reasonable amount above market value, not realizing that they could not replace the car. They would have to demand higher wages to afford a more modern vehicle. Good news all around.

And the oil. (And the Saudi Royal Family, too, of course.) Lots of campaign money comes from Texas Oilmen and from the Saudis through the Texans. If McCain wants to run for Pres he needs the money. If we lose Iraq the Texans are on their way out as Masters of the Universe, and the Saudi Royals with them. Osama will be the next ruler of Arabia, as well he should be. We don't really need the Mid-East as a country, but the Texans need it to maintain their power and prestige. Nuclear, wind, oil shale and tar sands, and coal will see us through, with lots of good jobs for Americans who don't mind getting their hands dirty. How many Salon readers are willing to do a real days work, as opposed to whatever it is they do now?