Obama sees himself as the mediator, the community organizer who will hear what all sides have to say and facilitate resolution. The problem with that is that needs dynamic opposite sides putting forth their positions. He states that it can't all be done in Washington, meaning that he might appreciate people organizing some marches for this or that, or 2,000,000 converging on Washington to meet in the shadow of the Washington Monument and demand better health care. Then, possibly, he could facilitate.

His approach, to date, is not working and will not work. Research is clear that such leadership is seen as abrogating responsibility. Trying to keep everyone happy is a loser. People lose confidence in such leadership and begin taking matters into their own hands. Things eventually fall apart.

The leadership that does work is when the President assertively gathers data from a wide range of sources, has it presented in a comprehensive manner -- such as through the appropriate cabinet secretary who would present a report to the President and Congress -- and then Congress holds hearings. The data collected must be wide ranging so that there is serious controversy and some people in the present health care system would become outraged since actual, serious change would be implied, undermining what they would see as their vested interests. The insurance companies and the medical institutions would be the ones most concerned with losing status and money. That's when the press and the pundits would begin to take notice and cover the controversy instead of being in the present situation of trying to create a sense of controversy where there is little.

The national dialogue must become heated, various points of view regarding how money is spent, who is getting more than they deserve -- and many, many are benefiting from our failing system -- and what are the competing models of reform must all be thoroughly considered. Presently, it's like a discussion in a vacuum as Obama tries to stay on good terms with everyone. Someone recently noted that the concept of health "insurance" no longer works. We simply need health care funding. My own view is that health care must be viewed as a utility, an essential service, with salaried workers similar to the model of Seattle's Group Health Cooperative. "Single payer" is not the same as "single provider," as the present scare-tactic commercials are suggesting.

If Obama is not going to become the real leader in bringing it all out, then he must have excellent people who will do that. He has let Geitner and Sommers lead in finance that has also been way, way too much happy talk. So he needs to be pushed until he begins to push back. I believe that he is hoping for that, as noted above, but he can't wait too long. He must provide the leadership. We need it now.

Channing
Ventura CA USA

Near term the absence of the public option does not have significance, but it is the long term where it will matter.

The reallocation piece of the healthcare pie has immediate per participant savings however it is paid for. Here is why.

there are 40 million without health insurance, the number that is bantered about anyway. That means 260 million have insurance. Insurance per person averages about $3,500. But in that number is the coverage for those uninsured folk because no one is actually turned away, in fact coverage of the uninsured is MORE costly per person. Something like $4,500 per person. They go through the system in the emergency care door.

Ok, so take $4,500 time 40 million and you have that is about $180 billion. Now take that sum and divide it by the 260 million who have to pay for it. To be safe use 75% of the total because some is paid by the folks who are uninsured, but not very much. So $135 billion divided by 260 million is about $500 per person.

The sum that gets stated as the 'savings' is $700 per person. See how that 'savings is generated. If the uninsured get coverage by whatever means. Those of us who go through already being covered will see our premiums drop. Hence, savings.

But there is where the benefit ends. This is because healthcare is going up 12% per year. At $3000 with the savings we are two years away from being in exactly the same boat and all savings is gone.

The public piece creates a monopsyny, the opposite of a monopoly. When there is one seller they can name their price, we have to pay. A monopsyny is when there is one buyer. When there is one buyer they can name their price as well. The Federal Government public plan will do precisely that. Name their price, and it will be something on the order of 5% annual gain, or less. Under that scenario the Private insurance companies will HAVE to match that gain or gradually lose market share to the public plan.

Hospitals will have to take the 5% gain and figure out how to allocate the dollars, and the system is held to a cost control regime.

So without a public plan there is NO SOLUTION.

Now Obama is clever and he may take this down in two bites of the apple. Getting universal care using the private plans with all their 'promises' of reform and maybe build in cost saving targets, etc., and then creating the public option separately in a another piece of legislation.

Remember, Obama plays Chess at this stuff, always five six and seven moves ahead of everyone else. But progressives have to be adament about the public option.