My favorite insight in this debate is the gender-based distinction: how men and women are fundamentally different consumers of health care. That fact throws a monkey wrench in the economist-preferred solution of health savings plans, whereby one hedges the risk of medical expenses later in life through mandatory savings beginning in youth, when he is in theory much healthier (the government would still insure against "catastrophic" medical expenses, under which I assume the preemie example oft used by Adam would fall). This proposal works well for men, for whom on balance major medical complications do not arise until middle-age or later, but doesn't account for the elevated and routine health needs of young women.

On the other hand, I take issue with the idea that the American system is a "market"-based approach. If it's a market, it's experienced a text-book failure. Insurance is all about pooling and minimizing risk. But to do that adequately, and thus arrive at an actuarially-fair rate, insurance companies need solid information on what the consumer's risk truly is; and, in the realm of health care, the company's information will never be as thorough or reliable as the consumer's. They can ask you if you smoke or not, but they'll never know that your Great Aunt Pattie died of heart disease, or that your family has a history of diabetes, etc. In short, any attempt at a market for health insurance leads to grave information asymmetry, and that tacks on a "risk premium" -- the added cost associated with the risk that there's something wrong with you the standard medical history form won't discover -- to your rates. This expense is one of the biggest drivers of soaring health care costs in America right now. Really, the only way to overcome this failure is to allow insurance companies to gather more information. Read: genetic profiling. Since we've already closed that door as a society (for now), the only other solutions are medical savings accounts, which again obviate the need for non-catostrophic insurance, or a single-payer system, which pools enough people together to somewhat offset the risk premium. With America as massive as it is, we could in theory see dramatic reductions in premiums if everyone were in a national pool.

Realistically, though, single-payer would be enough of a political stretch as it is in liberal California. At the national level, it would be impossible to pass through Congress. Can you really imagine the GOP supporting a system that would require the federal government to choose which procedures to cover and which not to? Instead, they're going to enfranchise the millions of uninsured either through piecemeal programs that mirror the principles of private savings accounts -- i.e. subsidies for insurance -- or by taking the car insurance approach: making it mandatory.

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