There is and always has been a cottage industry of alternative proposals. But it all has to be packaged together. The public has just been exposed to the current package(s) selected from the body of literatue and the body politic, which proposals are not themselves fully formed. So that's what we're working with.

(My simple preference for geting something done quickly would be to elimnate the employer's tax deduction for providing polcies, and a mandatory national program to guarantee no-deductible preventive care and very high deductible or catastrophic coverage for all.)

Thanks for the Obama Senior Moment link. I think it comports with my understanding (on its restricted scope of issues), except that the poor are denied preventive and wellness care. The nature of rationing is almost unknown, though, to be born in the as-yet undescribed scope of authority of the yet to be created agencies.

This isn't cause to reject the proposals (or what the proposals end up becoming.)

What I haven't seen, although they may exist in the muliple, thousands of pages proposals, is the great body of consumer protection provisions that make up so much of insurance law. Hoefully they're in there. The immunity from review provisions I did see smack of the government grabbing similar protections for itself that employer provided insurance holds under ERISA (and the governemnt employee programs also have under FEHBA).

It's also true that the US rations by "ability to pay" but in practice the more accurate description is by the availability of insurance, public or private. A point the article doesn't get to, and which the proponents haven't been pushing to my knowledge, is that actuarial fairness is built into larger pools of participants. The larger the better. So while the WSJ makes they point that thousands of carriers in the open market have a different method of rationing than centralized government entities, it doesn't mention the unfairness of smaller pools where the healthy and wealthy get better rates.

I also liked the comment at the end about how AARP can be brought back with prescription benefit sweeteners. Where we're positioned now is that the government has promised to make one really big sausage, and has told us most of the ingredients.