And why doesn't pragmatism suit? If neither Kerry or Bush is going to make the necessary health care reforms to bring the US medical system out of the Middle Ages, why vote for either of them if that is your threshold issue in this election?

Why give the vote to someone you know won't do for you what you want them to do for you as your elected official? That is an argument against voting at all, actually, as the most pragmatic course. We should be withholding our votes from the candidates who we know won't follow a course of governance we want followed. That is doing our citizen's duty.