As always, the devil is in the details. But it sounds like Congress is punting to the states on more than the public option - and since our states are smaller and our local officials more amenable to bribery contributors, this could be a real disaster. Let's wait and see what's in the final bill, but in the meantime, we'll have to keep a close eye on things:

The debate over whether to let states opt out of any government-run health insurance plan overlooks a key facet of the health-care measures being assembled in Congress: When Washington is done, the shape of any new health-care system is likely to be finalized in Lansing and Boise and Baton Rouge.

Besides the opt-out choice, proposed last week by Senate leaders, health-care legislation being drafted on Capitol Hill would delegate to state officials a multitude of momentous decisions, from what benefits are offered to low-income families to what hurdles to put in front of private insurance companies before they can raise premiums.

"The fact is that state programs are going to look different," said Judith Solomon, a senior fellow at the Center on Budget and Policy Priorities in Washington. "Where some people might be expecting national health reform, we're facing the real possibility that what you get is going to depend heavily on where you live."

The prospect of state control over the new system holds both promise and peril, said Jonathan Gruber, an economist at the Massachusetts Institute of Technology who has advised Democrats on health reform. "The plus side is that states are uniquely positioned to reflect the tastes of their residents and market conditions. Plus, we can really learn from the different approaches states take," he said. The downside "is that states can screw up and not meet . . . minimum standards."

Oy. I'm betting on the downside.

The health-care package unveiled by House leaders Thursday comes closer to national reform, health policy experts said. It would create a national marketplace where those who lack insurance could shop for policies, including a plan designed and administered by federal health officials. States would play a supporting role, helping to design the largest expansion of Medicaid in 40 years and to develop high-risk insurance pools for people in immediate need of coverage.

The package under development in the Senate is a different story. A bill approved by the Finance Committee would leave virtually every major decision to state officials.

Rather than create a central marketplace for insurance, that measure would permit each state to establish its own "exchange" and decide which insurers have access to that market. States could let low-income families shop the exchanges or offer them some other kind of coverage, such as policies already offered to state employees. Under a provision authored by Sen. Ron Wyden (D-Ore.), states could even bypass the exchange mechanism and try to expand coverage in other ways.

The Finance Committee bill did not include a government insurance option; Senate Majority Leader Harry M. Reid (D-Nev.) said last week that he would add one before bringing a package to the Senate floor. But to appease Democratic moderates wary of a big new program, the availability of the public option, too, would be subject to state discretion.

Reid's opt-out plan is opposed by Sen. Olympia J. Snowe (Maine), the only Republican to support the Democratic-led reform effort. Snowe is pushing for a "trigger," which would create a public plan only in states where private insurers failed to offer policies that were broadly affordable.

Given that the Senate presents the larger political hurdle to passing legislation, political analysts expect its state-choice approach to prevail. That means that a White House signing ceremony for a health-reform bill could become a prelude to 50 state legislative battles over how to expand Medicaid, how to set up the exchanges and how to enforce new insurance regulations, as well as whether to give state residents access to a public plan.

We have a national health emergency, and Senate Republicans are stalling the surgeon general's confirmation. But then, they don't live in the same country as the rest of us:

A GOP stall on all Health and Human Services nominees has left the department without a surgeon general during a period of a global flu pandemic, prompting the HHS secretary to call for Senate action.

Regina Benjamin, the surgeon general nominee, “is ready to be voted on in the Senate, and we would just strongly urge the United States Senate” to act, HHS Secretary Kathleen Sebelius said during an MSNBC interview Friday in which she discused the department's response to the spread of the H1N1 virus.

President Barack Obama on Saturday declared the H1N1 outbreak a national emergency.

“We are facing a major pandemic, we have a well-qualified candidate for surgeon general, she’s been through the committee process. We just need a vote in the Senate,” Sebeilus said. “Please give us a surgeon general.”

Benjamin was unanimously approved by the Health, Education, Labor and Pensions Committee on Oct. 7, but Senate Republicans are holding up all HHS nominees over a so-called gag order on insurance companies that have been critical of Democratic efforts to reform health care.

“We’ve not received any recent calls from the administration about their nominee,” a senior Republican aide said. “There won’t be any time agreements for confirmation of HHS nominees until their actions have been fully reviewed.”

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(As always, China looks at things a teensy bit differently than we do)

I've been working on getting a world overview of the Healthcare situation. Earlier this week I ran a debate over Health Care in Australia, hearing about issues we only hear rumors about. I kept wondering if in fact, the U.S. was the only country in the civilized (or even semi-civilized) world that didn't have some form of National Health, even as an option to private insurance. Hard to believe, but it's true - we are completely backwards in our relationships to health and healthcare.

Thanks to the BBC, I was able to locate a documentary done in 2008 which asked that very question - and did some exploring in Britain, the U.S. and China and came back with some interesting and very informative answers.

John McDonough (Director: Health Care For All): “All of the incentives, right now in our system reward Health Care providers for the volume of services they provide. So you get more money by doing more and more and more at a higher technological level. And we know the real secret comes from doing the lower complexity level of care much better than what’s being now. So all the rewards come from more procedures. And the more talking you do, the more time you waste and the less money you make. The incentives are completely upside down”.

The one thing I have noticed that's most disturbing about the current Health Care debate is the total lack of knowledge of what the issues and what the alternatives are. Clearly, ignorance is far from bliss and finding out how the vast majority of people on this planet handle things like doctor visits and emergencies is absolutely imperative if we're going to make crucial choices. Having ignorant people dangle the fear card in front of you doesn't do you or anyone else any good. Useful, factual information and knowledge of something your life and peace of mind depends on may save your ass in the long run.

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Rachel points out that the states that have the most elected representatives opposed to health care/insurance reform are also the same ones that rank the worst in a number of national health metrics, such as HPV vaccination rates, teenage pregnancy, premature births, lowest birth weight and infant mortality.

As Rachel notes, you'd think they'd be the states most concerned with rather than opposed to some real reform of our health care system.

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("Those pills are 25 bucks a-PIECE?")

(I originally posted this in February and am reposting it now in its complete form, as opposed to the excerpt which I ran in February. It's a nice companion piece to the post I did earlier this week, and further evidence our friends at the AMA have been doing this a long-long time.)

In case anyone thought the whole concept of Universal Health Care was something cooked up in the 1990's, I'm here to tell you it just ain't so.

Nope, it's been with us forever and attempts to introduce a Universal Health Care program go back to the days just post World War 2. Over sixty years of wrangling, cajoling, hand-wringing and warnings of dire consequences. And strangely, nothing has changed.

In 1945 a proposal known as the Wagner/Murray/Dingell Bill was introduced, establishing a system of Universal Health care for all Americans, regardless of financial status. And almost immediately the forces of paranoia, propaganda and dire consequences roared into place.

A lot of this came via the AMA, whose President was the dubious Dr. Morris Fishbein, the most vocal opponent of Universal Health Care and had the membership of the AMA to tap into.

This clip, from a 1948 CBS Radio program called "In My Opinion", features Senator James E. Murray (D-Montana) who co-authored the bill in question. His vocal opponent was Representative A.L. Miller (R-Nebraska) whose paranoiac doomsday rant belied the fact that he was, prior to his stint in Congress, a practicing surgeon and a member of the AMA.

Do I hear conflict of interest? Do I hear a certain breach of ethics?

Who ever said Politics was ethical? It's politics, fer chrissake!

Miller - "I saw physicians on clean surgical cases without surgical masks or rubber gloves. They were chattering like magpies over the open abdomen"

Murray - "But I do want to talk to Americas doctors. To the doctors through the country who are busy treating the sick, to the practicing doctor who usually hears of health insurance over from the Political Doctors, who are obstructing an intelligent, practical program."