You seem to have read what you wanted to read, not what I wrote. I realize that I got off the subject of health care reform, by pondering the general question of whether the United States is simply too large to function well. That was Tech's conclusion, starting from the problem of health care and generalizing. If he's right, and other people have wondered the same thing, what's the optimum size for a society based on democracy and free markets? (We already know that larger nations have existed, but maintained their cohesiveness through rigid social organization and oppression.) Is there a natural limit on the size of a free society? If so, and we've gone beyond it, is that the root cause of so many of the problems we see today?

Breaking up the United States would be a radical solution to solve just one problem, but is it a general solution? I'm looking for ways to solve problems, and I have absolutely no interest in contrived "proof" that a problem is intractable. That's just defeatism, and I won't cut and run.

Sigh...nevertheless, you did go to the trouble of writing a pretty good post, with minimal jingoism, even if it wasn't on topic (locally). Your control's not perfect--"assumption of socialist inevitability" leaked out--but overall pretty resonable.

This may sound odd coming from me, but I'm not sure plucking the business pigeon is the best answer. It's a natural thought, since we've spent the years since WWII developing a business-centric approach to providing health care, to the point where people think that employers are obligated to do it. The problem with making it business's responsibility is that health care gets transformed from a basic necessity of life into a negotiable benefit, subject to extraneous factors like a business's internal health and the specific market it's in. That's why we have such inconsistent coverage today: Some businesses use health care benefits competitively to attract employees in a tight labor market; others see not providing it as a competitive advantage due to lowered costs. The reason for health insurance in the first place has gotten lost in the logic of business.

Business seems generally favorable toward the idea of universal healthcare, and I think it's because they see it levelling the playing field for business. With the cost of health care off the table for everybody, everybody can focus more on competing directly through products and services, instead of indirectly through dealing with the labor market.

The alternative of a tax on individuals seems fairer to me, since it's individuals who receive the benefit. I'm not so sure that people generally think of health care as free, because employers make sure that their employees (who get health care) know how generous they're being. Benefits are itemized on the pay stub (necessarily, since they're treated as income for tax purposes) and in an annual accounting. Plus, not very many people any more have their health care fully paid by their employer. In most cases people share in the cost, making a payroll deduction that's matched by the employer, which tells me that most people are likely to be painfully aware of what it already costs.

Your worry that business wouldn't pass on cost savings is a reasonable one (congratulations on discovering an appropriate cynicism toward business!). Of course, wouldn't you expect market forces to correct that eventually? It might even be that to the same extent as providing benefits is used to attract employees, passing on the cost savings would be used constructively in the same way. Or, and I know that this isn't the optimum choice of most of us, a law that "grandfathers" the cost of benefits could be part of the mix, requiring employers to continue to pay existing employees the same amount that they used to pay in health care benefits (new employees would be exempt). That would last only a few years, given today's fluid labor market, but might ease the transition.