Where have all the supporters gone?

"Campaigning is fun; watching the person you've elected engage in the long slog of governing, less so." (Washington Post)

Anyone astute in politics knew that Obama's pie-in-the-sky promises were mostly unreachable but many got sucked into the "change" idea and the rah-rah of the campaign swept people up in the rhetoric of the moment. Problem is that's just what it was - a moment. Reality is another whole story. But, when problems are afoot (like they usually are but this has been a particularly stressful time) we grasp at straws and a nice-looking, smooth-talker can convince us of just about anything while in this vulnerable state.

Part of the problem was the rush job. In his efforts to keep the crazy promises of moving quickly, he failed to remember how long it takes to get anything through congress. But, in matters such as health care, the issues should take study and discussion (bipartisan) to achieve a quality product in the end.

Nobody wants another federal disaster to deal with, change, appeal, and learn from. We should study Japan, Germany and Thailand; not just Canada or England for universal health care that works. We should also remember that we are the United States of America; not just America. In that, we can study Massachussetts - what works about their plan; what doesn't. Then we could let states adopt programs with some government grants to launch it and to give it a fair chance to start. Once the pilot proves successful, other states can follow without putting it in the hands of the federal bureaucracy. State government has its problems too, but why not start out on a smaller scale that can be adapted once most of the bugs are worked out. Maybe we really don't want Uncle Sam running it all.

We could also learn that we can't half do this thing. If we're to ever get universally available and affordable health care we need to fix the other problems with the system - tort reform, exclusions, mistrust of the system which backfires (refusal of coverage for certain medical condition such as mental health or harm to other insurance policies due to previous treatment for certain conditions like cancer and depression). We also need to eliminate the gatekeepers in Medicaid/Medicare, private insurance, etc. and, we need to be able to shunt the money saved into the new system so it will actually be affordable. Adding another level or another program to the already existing one, with its own set of differing "regulations" will only cost way more and will dilute the primary advantages to a universal system.

Part of what makes government-provided insurance a mess is the requirements such as low income, asset testing, requirements and rules for coverage of procedures - all of which must be screened, evaluated, reassessed periodically, and patients end up in and out of coverage. Then billing is complicated, each doctor or facility must have specialists to sort out the mess. The only way a system can work to cover all is if it is without any billing needs - everything is covered. The way it is done in many other countries could work, but not if they have to sort out the "public option" from the privates, etc. Let's face it: lobbyists will never allow abandonment of the systems they profit from. We need to either provide vouchers for all people to pay for their health care as they choose through private companies in competition, or we have to give everyone the same, eliminate the sorting, billing, etc and go paperless and bill-less.

Again, this is so complex, it makes sense to start on a state level anyway. We're a very large country so adopting some half-baked plan to cover everyone will never work.

I believe there are enough smart Americans to make this work, but they are being paid by those who will make sure it doesn't. That's my opinion