The last shot at this, Oregon's Measure 23, went down to defeat at the polls with 79 percent against. In frigging Oregon, of all places. This is like a majority of people in Santa Cruz voting for the war in Iraq.

I don't support nationalized health care. It's too bad the system got screwed up decades ago by connecting health insurance and employers. I think there may be alternatives to make insurance more "portable," and more like other kinds of insurance that are not typically supplied by employers, but that's another subject.

But, if we grant the premise that nationalized health care is inevitable (and given the ever-growing "free lunch" culture in America, it probably is), at least it should be done as intelligently as possible.

Any such plan needs to work out the minimum financial disruption from current systems. Right now, companies pay for a lot of the private health care, through employee insurance. Ideally, any single-payer system would be supported by fees from the same company sources, as the companies ease away from private insurance payments.

Ideally, the two amounts would mostly balance, although I'd love to see someone actually work out the numbers on this. Advocates believe companies would actually come out better after switching from insurance payments to single-payer taxes.

Best of all, the costs would come from already designated cash flows in the business world, and the economic disruption would be minimized. Kind of like if everyone was paying an electricity bill, and the power company was nationalized, but the costs came from an electricity tax that went to all the same people who were paying the bill before, and was about the same amount of money.

Trying to do this off general income-tax funds is a non-starter. It would hit a lot of people who aren't paying anything now (at least as far as they perceive it.) Employee taxes, as with Medicare, are also a non-starter. The employee will get the tax hit, the employer gets the insurance payment savings. In theory, the employer would pass these savings down in wage increases. In theory, that is.

So, if you do it right, employers who are paying through the nose already for insurance will pay through the nose for health care (less, according to socialized medicine fans.) If you can figure out a way to ease the present insurance companies in as contractors for the paperwork and other crap, you might make an enemy into an ally.