If the health care debate seems like a hopeless morass, it's largely because moneyed interests want it to look that way. Matt Taibbi reminds us that the most fundamental issue is simple: Who pays, and how?
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In a political battle marked by ignorance, spin and venality, it's my pleasure to present two paragraphs of common sense:

Heading into the health care debate, there was only ever one genuinely dangerous idea out there, and that was a single-payer system. Used by every single developed country outside the United States (with the partial exceptions of Holland and Switzerland, which offer limited and highly regulated private-insurance options), single-payer allows doctors and hospitals to bill and be reimbursed by a single government entity. In America, the system would eliminate private insurance, while allowing doctors to continue operating privately.

In the real world, nothing except a single-payer system makes any sense. There are currently more than 1,300 private insurers in this country, forcing doctors to fill out different forms and follow different reimbursement procedures for each and every one. This drowns medical facilities in idiotic paperwork and jacks up prices: Nearly a third of all health care costs in America are associated with wasteful administration. Fully $350 billion a year could be saved on paperwork alone if the U.S. went to a single-payer system - more than enough to pay for the whole goddamned thing, if anyone had the balls to stand up and say so.

This is from the must-read article "Sick and Wrong" by Matt Taibbi in the Sept. 3 issue of Rolling Stone. Taibbi's language is raw, but his logic is undeniable.

If the health care debate seems like a hopeless morass, it's largely because moneyed interests want it to look that way - the better to convert principled people into weary, disengaged cynics. And the media have not helped - during President Obama's health care speech, why did an idiotic outburst by an obscure Republican functionary get more coverage than what the president actually said? At baseball games, when an unruly fan runs on the field, the cameras look away.

So here is Taibbi, to remind us that the most fundamental issue is simple: Who pays, and how?

His conclusion? Absent single-payer, a robust public option is absolutely essential because it would be a "miniversion of single-payer, a modest, government-run insurance plan that would serve as a test model for the real thing."

I could not agree more. I've said in this blog and my book that the content of medicine must be reformed or the costs will sink us. Part of that flawed content is insane administrative inefficiency. An incremental step toward halting the ruinously expensive avalanche of paperwork is far better than no step at all.

But now, Senate Finance Committee chairman Max Baucus, a Montana Democrat who has reportedly raked in more than $2.8 million from the health care sector during his career, has released his health care plan. It is still being tweaked by six committee senators, but you already know the centerpiece: so-called "exchanges" of nonprofit, member-owned co-ops that would compete with private insurance companies.

In other words, no government-run, low-cost public option. No "single payer lite" to test the system that the rest of the world knows already works. Senator Olympia Snowe, a Maine Republican working with Baucus, has said there is "no way" to pass a plan that includes a public option. And House Speaker Nancy Pelosi has said she has no "non-negotiable" demands.

The public option is in grave danger.

Matt Taibbi says, "We might look back on the summer someday and think of it as the moment when our government lost us for good. It was that bad."

I've been accused of being too demanding. I've been reminded that "the perfect is the enemy of the good." Perhaps that is true. But every other modern democracy on earth has managed to get to the proper endpoint of health care reform. Is it really too much to demand that we at least get to the proper beginning?

Andrew Weil, M.D., is the founder and director of the Arizona Center for Integrative Medicine and the editorial director of www.DrWeil.com. Become a fan on Facebook.

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