Those who are prone to inside-the-Beltway thinking have already drawn hard and fast battle lines over the emerging healthcare legislation in Congress. Mind-numbingly predictable congressional Republicans are barking about the cost of the program, the inevitability of tax increases, and how it is an unforgiveable overreach of federal government. Mind-numbingly predictable congressional Democrats are incapable of articulating any coherent defense for the fiscal responsibility of their ideas, or why a public solution is preferable to market or other private reforms. And this new president of ours, whom I supported and whom I trust, continues his pattern of cool detachment from the workings of legislation in Congress.

Here is a rough outline of how the Democrats should be countering the Republican attacks. Say this, over and over and over again: “You, the American people, already are footing this bill.” Firstly, the 47 million uninsured Americans are not denied healthcare, they (merely) lack insurance. We pay for their healthcare now. We pay for it every time a hospital treats an uninsured patient and cannot collect the bill; those costs are spread to those who can pay. We pay for it every time an uninsured American ignores the nagging pain until he lands as an advanced case in the cancer ward. The cost of healthcare to the uninsured was calculated at $125 billion per year way back in 2004, and surely is much higher now [http://www.commondreams.org/headlines04/0511-07.htm].

The CBO calculates a net federal budget burden of $60 billion per year for the legislation being considered, and estimates that about 20 million Americans would gain health insurance coverage [http://www.cbo.gov/ftpdocs/104xx/doc10431/07-02-HELPltr.pdf]. That seems right about in line with what we have now, roughly the same cost per person as we currently lose providing uninsured care.

The point is, we already pay for this healthcare. The debate is, or should be, about how we do so. Do we want to keep paying as we do now, with clumsy and inequitable mechanisms of hospitals and doctors being forced to provide charity care, and passing along the costs to your insurance plan and mine? Or do we want to shift to a coherent, orderly, public insurance-based system?

We, the American people, already are footing this bill.

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