Washington Post business columnist Steven Pearlstein was online Wednesday, Jan. 17 at 11 a.m. ET to discuss recent movements in health care reform in the states and in Washington, D.C.

The transcript follows.

Read the column: A New Consensus on Universal Health Care (Post, Jan. 17).

About Pearlstein: Steven Pearlstein writes about business and the economy for The Washington Post. His journalism career includes editing roles at The Post and Inc. magazine. He was founding publisher and editor of The Boston Observer, a monthly journal of liberal opinion. He got his start in journalism reporting for two New Hampshire newspapers -- the Concord Monitor and the Foster's Daily Democrat. Pearlstein has also worked as a television news reporter and a congressional staffer.

His column archive is online here.

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Fredericksburg, Va.:"Consumer-driven healthcare" - an Orwellian phrase if ever there was. I'm trying the insurance industry's high-deductible HSA approach and you know what - my insurer is finding new ways to cut coverage for supplies I need to cover a chronic condition by applying those costs towards my high deductible - which now serves as an umbrella of sorts to shelter their money. Is anyone noticing this?

Steven Pearlstein: I'm sorry its not working out for you, because I actually like the idea of high deductible policies, and have one myself. But these plans do need tweaking, particularly as they relate to chronic conditions, as you are learning. I'd have a talk with your employer and see what you can work out. The one thing I can say about the insurers is that they know they need to refine these things.

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Sterling, Va.: Regarding trends in cost, quality and access - Is the United States in a health care crisis?

Steven Pearlstein: For many of the 47 million Americans with no insurance, its a crisis. For employers who now consider rising health care costs their biggest problem, its not a crisis, but is headed that way. For consumers who find that more and more of their income is going toward health care because of higher deductibles, co-payments and the like, it is becoming a financial hardship. And for a country that spends $2 trillion a year on health care, including some big public programs, with very little to show for the last $500 million in terms of better health outcomes, it is a huge waste. A crisis? Well, I guess it depends on your perspective. Meanwhile, many of us are healthy and like our doctors and have had good experience with hospitals. We don't have to wait in long queues for major surgery or MRIs. We use lots of drugs, and there is now a prescription drug benefit for seniors. The poorest, most disabled and elderly all have pretty good health insurance. So it is a mixed picture.

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Princeton, N.J.: Hi, Steve. It's me again. I'm writing the night before because I have to get a fasting blood test tomorrow and that usually requires a 2 or 3 hour wait. At this point I hardly know what more to say to you about single payer health care system. I've given you tons of facts which you really haven't denied except when you called them all myths. You seem to believe that an efficient single payer system like Medicare for all is somehow un-American. Again let me say, forget about the basic immorality of our system. Forget about the competitive disadvantage it puts our businesses in. Just look at health care as a business decision. Look at efficiency. Compare our system with those of other wealthy countries. The results are overwhelming. If I get back in time, I'll drop in on the Q and A.

Steven Pearlstein: Ah, my single payer friend. We can argue the policy details until we're both blue in the face. But, my friend, it just ain't gonna happen. So its time for you to think about Plan B. That's a political judgment, not a policy one. And by the way, the politics would be the same whether I wrote columns favoring single payer, government run system or not.

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New Brunswick, N.J.: The United States already has a universal single payer system, which, aside from a botched RX program and inadequate funding, works quite well. The only real problem is you have to be 65 to get universal health care in the United States. It is ludicrous that we don't expand access to Medicare to everyone regardless of their age and create a mechanism that allows Medicare to negotiate for a Medicare Rx program.

Our current healthcare system is ostensibly a statement from our elected officials that lobbyist and campaign cash provided by the bloated insurance industry and greedy drug companies are more important than the health of millions of Americans who are loosing their health insurance, are underinsured or have no healthcare to speak of.

Steven Pearlstein: Somehow I think its a bit more complicated than that.

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Arlington, Va.: Steven:

I just read your interesting and informative article, "A New Consensus on Universal Health Care." I'm glad to hear that there's consensus building on some kind of universal health care or insurance. The details of the draft plan were interesting. At other times I have heard that corporations are troubled by the rising health care costs and feel that they make them less competitive versus foreign rivals that don't pay for insurance for their employees. Why is the draft plan preferable to a plan where the government pays for the basic insurance? Is there something in the convoluted plan that is superior? I know there are limits to government run plans, such as those in England and Canada, including limited care options and longer waits for some procedures. At the same time, our "system" is much more expensive, covers a smaller proportion of the population, and seems to drive consumers to new tests and medications even if older cheaper alternatives work well. How do the conservatives that oppose a government run system and favor a competitive market approach get around the excessive cost and incomplete population coverage of our current system?

Steven Pearlstein: Well, they can't get around those issues. So they often have the usual ideological objections -- that only a pure free market system would work. That would mean no regulation of insurance. It would mean no regulation of doctors and hospitals. It would mean no tax breaks for health benefits. It would even mean no Medicare and Medicaid. They blame these things for the inefficiency, and think it would all be better if we just pay for health care ourselves, maybe through a tax-free account. In some instances, they are right about what contributes to the cost escalation. But they kid themselves that the free market is the answer. Health care is different than other goods. We don't let people die on the street. We don't believe the sick should have to pay their entire income for health care while the healthy should have to pay close to nothing. We don't believe the poor should have worse health care than the rich, the way the poor have worse housing or cable television service. And it is these exceptions that drives our system and makes it less than efficient. That doesn't mean we have to accept all the inefficiencies,. That's why we are talking about health reform. But it doesn't necessarily mean that the answer is always more markets. Sometimes, it needs to be more government management of markets.

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Alexandria, Va.: I know this is off-topic (I hope your resident single-payer expert won't mind), but I'm curious to get your thoughts on the tax changes proposed by your buddy Max Baucus -- specifically on the issue of deferred executive compensation.

We heard your screed last week on why tax incentives for small businesses aren't necessary as part of a minimum wage increase, but are the pay-fors much better? Not really, methinks. I'm as outraged by exorbitant CEO pay as the next guy (and I'm a Republican, by the way), but the heavy hand of the tax man isn't going to change corporate behavior. Subjecting executive compensation packages to shareholder approval, on the other hand...

washingtonpost.com: Last week's column: Minimum Wage, Maximum Myth and the Jan. 10 Discussion Transcript

Steven Pearlstein: Right on all counts. There is a rationale for limiting tax deferrals for anyone, but you can be sure some smart lawyer has already figured out a way around this ban. The time Congress tried to cap corporate pay by fiat, I'll remind you, we wound up with the stock option problem. So be careful what you wish for.

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Crookston, Minn.: Health care is big money, really, really big money. That's why the previous Minnesota legislature turned over the delivery of public health programs to the insurance industry. Now we have layers of profit driven insurance administrators making medical decisions for our most vulnerable people.

Steven Pearlstein: I think it rather remarkable that the insurance industry now is forced to consider some cap on how much of the premium dollar goes to profit and administrative expenses, and how much to provide direct health care. That's in the California proposal, and I think you will find it coming front and center in the national debate. They understand that, if they want to avoid going to a big expansion of the government runs systems, they need to put a lid on their costs and their profits.

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Silver Spring, Md.: Great column on healthcare, Steve. I was thrilled to hear that California was joining Mass. on providing universal coverage, without forcing any sort of competition-void single provider system. Obviously the details are still fuzzy, but I have a question on one part of your column - "Conservatives and their small-business allies would have to swallow some form of "pay or play" -- either providing employer-paid health insurance or paying a tax to the state subsidy pool." - Something initially strikes me as off here... employers either provide their employees with a chunk of the cost of healthcare or pay into the subsidy pool - but earlier in the column, you talk about subsidies for incomes up to 300% the poverty level... which is what - $40,000? So if I make 45k from a small employer who doesn't provide me coverage, I still can't get a subsidy because my income is too high? Or would the subsidy pool provide for up to 300% poverty level AS WELL as people uncovered by their employers? Obviously there is no definite plan yet - but as for Massachusetts, California and the proposed national implementation - what is the answer to that?

Steven Pearlstein: Well, its complicated and not exactly clear. The tax on employers who offer no insurance would go to low income people who can't afford premiums. But it might also go to provide you some sort of tax break to make your coverage more affordable. That said, the idea of pay or play is to get employers to "play."

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Silver Spring, Md.: You quoted Andy Stern saying, "Democratic leaders in Congress say this is not the time."

Do you have any more specific information about which Democratic leaders have said something similar.

(In other words, who do we have to convince? >Pelosi? Reid? others?)

Steven Pearlstein: Pelosi, Reid would be good places to start. They think they are with this proposal to have Medicare negotiate prices with the drug companies. But even if you think that a good idea, which I don't (and won't survive a veto), it is hardly comprehensive health reform. I think at this point they fear health reform will be too internally divisive and deprive the party of a clear, crisp issue for the 2008 presidential race that can be used against Republicans: to wit, you had eight years to reform health care and you did almost nothing. In fact, Republicans did pass a Medicare drug benefit, flawed but nonetheless popular. And Democrats are as much to blame for inaction on health care as anyone. But it does make a good issue.

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Falls Church, Va.: Very thought-provoking article today; you've obviously thought about these issues quite a bit. I'd like to offer a few reactions, and I hope you won't think I'm attacking.

Requiring everyone to buy insurance: Are there really that many healthy young males out there with disposable income who have currently opted out of health insurance? If the answer is no (and I think it is), then requiring universal coverage is not going to bring much new premium money into the system. This then suggests that the primary effect of a universal-coverage requirement would be simply to bring the currently uninsured indigent population into the system, with all of their costs to be borne either by state subsidies or higher premiums on the paying population.

My question: Can't this same result be achieved simply by expanding Medicaid and county-level indigent services? Why go through the rigmarole of creating a complex new system?

Or to put it another way: With so many people subsidized, and if premiums are not allowed to vary actuarially, this proposed system seems to shift away from being health insurance to being essentially a tax. That's not necessarily a bad thing, particularly for a worthy goal. But in a democratic society, isn't it more legitimate to enact such a tax openly, rather than disguising it through layers of complexity?

Steven Pearlstein: All good points. Let me answer briefly.

I think you underestimate the benefit of getting healthy young people without insurance into the insurance pool. Its not insignificant, and it has been getting bigger as the price of health insurance has gone up.

Second, expanding the current public programs ought to be part of the arsenal of reform, as it is in Mass. and may be in California. But that doesn't solve a big part of the problems with the individual and small group insurance market, which are big and getting bigger. This is clearly one area where free markets don't generate the socially and economically optimal outcome, and some regulation and management by government is necessary. And this problem, too, is growing as more employers drop coverage and more of the work of the economy is shifted to small businesses that have no insurance -- in part because they appear to be "cheaper" because they offer no insurance.

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Falls Church, Va.: How would non-compliance be addressed under the proposed system? Would everyone have to file proof of health insurance with some agency? What happens if they don't? The state could fine them, but then they still don't have health insurance (and suppose they don't pay the fine)?

The state could enroll them in a default insurer of last resort, but how would it force the person to pay premiums? Also, would the state itself serve as insurer of last resort, or put the person in a private plan? How would it decide which one?

Steven Pearlstein: All good questions, that Massachusetts is about to answer. Tax returns are one place you can do enforcement. Or when somebody shows up at the hospital with no insurance card.

Here is an important thing to remember in this as in almost every aspect of health care: you won't get a perfect system, and its important not to let the perfect be the enemy of the good. There may be some people who simply refuse to pay premiums -- and no, we won't let them die when they get into car crashes. But we can greatly reduce the amount of free care (which all the rest of us are now paying for through higher taxes and higher insurance premiums), and hopefully redirect that money to subsidizing health insurance for those who can't afford it.

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Okemos, Mich.: I was a lobbyist in 1994 for a health insurer who was a member of the "Alliance for Managed Competition". Do you see any elements of these HIPC (Health Insurance Purchasing Cooperatives) plans entering the debate again. They seemed to be a sensible way to marry the societal needs of universal coverage to the practical requirements of enrollment/risk sharing and fairness to the industry. The bills in congress then were Cooper/Grandy in the House and Chaffee/Breaux in the Senate.

My impression of the Massachusetts coverage and the proposed California plan is that they follow the car insurance enrollments and fail to take the more delicate risk analysis and risk sharing the HIPC models anticipated. Am I wrong? How does the landscape look for reducing our healthcare spending and getting our per capita expenditures more in line with the other industrialized nations?

For the record, I wholeheartedly support bringing universal coverage to this country...it is long overdue and we need to shift the dollars spent on executive salaries to the delivery system.

Steven Pearlstein: The dirty little secret is that this consensus I have outlined has many of the features of the Clinton managed competition plan. It is the answer to the failure of the individual and small group insurance market. It is designed to create large pools where risk is spread, reducing the average price and definitely reducing premiums for people and groups that are older and sicker. We might, additionally, think of improving that further with a national reinsurance program, perhaps federally subsidized, that gives insurers enough comfort that they are not going to get stuck with disproportionate share of the most expensive cases in a year that they will feel comfortable lowering their premiums. That was John Kerry's contribution to the health care debate in 2004, and my sense is most health reform gurus are intrigued with that idea.

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Arlington, Va.: Are you familiar with New Jersey's car-insurance experience with the Joint Underwriting Association ("JUA")? Essentially, uninsured motorists were assessed fees and covered by the JUA, a state entity. To be affordable to those motorists, the assessments had to be held artificially low, because these were the worst drivers, who were otherwise priced out of the private market. The costs of that coverage began to pile up, and private car insurance companies pulled out of the New Jersey market, for fear of being assessed fees to cover the JUA's expenses. Eventually, nearly half of NJ residents got pushed into the JUA, because private rates continued to climb as companies left. As the JUA's deficit got bigger, the state finally closed it and paid off most of the deficit with surcharges on private policies. To this day, NJ car-insurance rates remain among the highest in the nation, and its car insurance market among the most restricted.

What's to stop a similar spiral from happening with universal health coverage? With rates subsidized or prevented from rising, deficits are going to build up that will either have to be paid by other policyholders or by the state. Private insurers will simply leave the market if they're forced to absorb losses.

Steven Pearlstein: These bad spirals are why you have to be very careful about managing these insurance markets -- no question. One lesson from New Jersey, obviously, is that you can't set premiums artificially low, particularly for people who have much more control over their likelihood to make claims (good driving) than people have over their health. So in the health reform model, you do allow premium prices to fluctuate according to age and health status, but within reasonable bands. And then you mandate that everyone has to have coverage. That should mean that insurers can set premium prices that cover their costs and allow for a reasonable profit, without having to engage in cherry-picking. And to discourage cherry-picking, you may need state insurance commissioners to punish those who do it flagrantly and require them to take on any customer who wants to sign up.

Put another way, you have to design the system, and administer it flexibly enough, to avoid the situation that companies will opt out. What will keep them in? The prospect of making a reasonable return. Nothing less, nothing more.

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Arlington, Va.: Doesn't the TennCare experience bode badly for the plan proposed in your column? In Tennessee, broadly expanded indigent coverage brought increasingly higher costs, which eventually drove away private insurers, and left the state bearing the rising cost of coverage until the expense became politically untenable and the program was cut way back. Wouldn't the same sequence of events occur under your plan?

Steven Pearlstein: I think, in a way, I've just answered that. The way to avoid these bad dynamics is to keep the pool large, insist that everyone be in it, and maybe have federal reinsurance of the worst cases. That should allow the insurance market to work.

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Carlisle, Pa.: What is your opinion of Canada's health care program? Is it broken and what can the U.S. learn from them in healthcare reform?

Steven Pearlstein: It works up to a point. But there are long waits for some procedures and tests, some expensive drugs are not generally available. They also have docs who are used to much lower standards of living than our docs. Now you can say, well, we'll just make our docs earn less. But that is a very, very, very big political hurdle to get over, which is why people like me think its not particularly useful to be fixated on a government-run, single payer system.

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Annandale, Va.: I am concerned that "Doctors would have to agree to have their compensation from insurers tied, in part, to how well they conform to treatment protocols established by the various medical specialties." As a seven year, now savvy survivor of a challenging case of prostate cancer, I have learned that even medical specialty groups are sometimes well behind in adopting better practices. An excellent example is laggard recognition of the threat of decreased bone mineral density as a result of hormonal blockade therapy for prostate cancer. Leaders knew of this threat and were telling how to counter it prior to 1999, but the oncology community was advising its members several years later, and the urologic community was at least a year or two bind their oncology colleagues. Do those advocating reform understand this issue?

Steven Pearlstein: I think they understand that there is a tradeoff: less freedom of docs and patients to decide to use whatever treatment they want, in exchange for a system that is affordable for everyone (and, by the way, has better overall health outcomes). The problem with better overall health outcomes is that there will be a small number of people for whom the health outcome is worse because docs and patients were limited to following protocol. But society-wide, things will be better. By the way, the protocols won't prevent patients from getting care outside protocol (which, by the way, is what happens in Canada). It will mean they have to pay the incremental cost themselves, rather than expecting all the rest of us to pay for it.

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Great Falls, Va.: When I was 23, I chose not to have health insurance. I was healthy, taking a year off between college and graduate school, and seldom had any reason to get in a car (which I judged to be the biggest health risk facing me at that age). I could have afforded health insurance, but money was tight and it was worth the small risk not to have it.

Sure, it's not a huge number of people that are similarly choosing not to be insured. But it's a nontrivial number. How can we justify having a government mandate that people carry insurance? That sounds awfully overbearing to me.

Steven Pearlstein: Well, it may sound overbearing to you, but we need for people like that to contribute to the pool when they are young and health so they can afford insurance when they are old or when they are sick. As they say in the Midas TV ad, pay me now or pay me later.

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Washington, D.C.: I don't mean to make light of your Princeton correspondent's medical condition, but wouldn't he be waiting a lot longer than a few hours for that blood test under a single-payer system?

Seriously, cost control has to come from somewhere, and many countries with universal coverage address the issue by rationing health care in the form of delays in treatment. Is that more moral?

Steven Pearlstein: We all need to be very clear about something: This whole exercise is about rationing. I prefer the word rationalize, as in rationalize the expenditure of $2 trillion a year to get the maximum bang for the medical buck. But whether it is a single payer system or the consensus health reform I outlined today, we are talking about bringing some rationalization to the system.

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Clifton, Va.: I am a Federal employee and have decent health care that I pay for. The last thing I want is Congress and liberals to screw it up. I can afford to choose my own doctor no crappy HMO's for me. I don't need a referral if I twist my knee I just go to my orthopedic guy. Its too bad the some don't have decent health care. If you can work get off your lazy butts and get a better job with health care. It isn't the govt's job to make decisions for you. I do not want to see my health care go down the tubes in quality so that more folks get free health care at my expense. Sorry they can suffer or die. Not my problem!

Steven Pearlstein: Well, it is your problem, Mr or Ms. federal employee, because the rest of us are not going to continue to subsidize the cost of your gold plated system. A second point is that there are people whose employers don't provide such wonderful health insurance, and they are forced to pay huge premiums for much less generous coverage because of the failure of the individual and small group markets. It has nothing to do with not getting off their butts.

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Drugs: One thing that could be done is to reinstate the original ban on drug ads. We keep hearing, ad nauseam, that any attempt at negotiating lower prices, bypassing the US ban on Canadian drugs, or adjusting the patent regime will "stop innovation".

But the single largest line item in Merck, Pfizer, etc... budgets is marketing, dwarfing the expense of R&D. Seems to me that this is something which can and should be knocked out of health care costs, especially in the age of the internet, where consumers can go and research out info.

Steven Pearlstein: You know, lots of people want to ban drug companies from advertising. I suppose I could go along with that, or at least on some more stringent limits. But I think the onus also be put on the AMA to adopt some ethical standards that prevents their members from taking anything of value, including free drugs, from drug reps. The cost of the detail men and their supplies is an equally large part of the marketing program, and it is fundamentally corrupting. It is one thing to send written materials about new products to practitioners, and quite another to bribe them with meals, trinkets and free drugs.

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Vienna, Va.: Medicare's track record on efficiency is hardly a great model, despite the pleas of the "please-make-the-government-pay-for-my-health-care-because-then-it's-free" crowd. It overpays for many many services (part B drugs being just one example) and consumers are still very disconnected from the care they get.

Steven Pearlstein: A point worth making and remaking.

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Princeton, N.J.: Answer to DC - Absolutely not. Go live in Denmark or England for a few years. And remember they spend less than half as much per patient. Think of what they could do with our level of expenditure.

Steven Pearlstein: Nobody that I know of defends the "efficiency" of our health expenditures. And our country is not Denmark -- if it were, we'd all be happy to join and work for closed-panel HMOs. Unfortunately, we're not. As for England, I'm not sure I'd use that as your model. There is widespread dissatisfaction in England right now with the health plan.

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RE: Consumer Healthcare: Gotta say, I actually love my plan. My employer pays for $1K/year in what amounts to an HSA. If I burn through that the next $800 comes out of pocket. After that, I'm on what amounts to a standard BCBS plan. My employee contribution is down $40/month from what the BCBS plan was. Also, since my $1k/year HSA pays the full cost of everything, there are no copays until I get to the BCBS plan (if I ever do). 40/month + ~8 $25 copays = $680... just shy of the $800 I pay if I go over $1000. I'm 25 yrs old and healthy - I love it.. if some catastrophic happens, I've still got the coverage I used to pretty much, but in the meantime, before I get hit by that bus, I'm saving $40/month. People seem to forget, insurance is just that.. insurance - just in case. It's not SUPPOSED to cover going the doctor every time you get a cold - it's supposed to cover going to the hospital when that cold turns into pneumonia. My plan does just that... I'm also lucky enough to have an employer who effectively pays for those trips to the doctor when I get a cold. 9 times out of 10 you should pay more for insurance than you get out of it - that's the POINT of insurance! Anywho... just thought I'd speak up in favor of the general concept.

Steven Pearlstein: You are absolutely on target. We have got too used to thinking that "somebody else" pays for basic, ordinary health services, and that is a weakness of our market-based system. Putting a bit of that back is a good thing, as long as consumers have choice and the information to make intelligent decisions about what services they need and what they cost.

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Myrtle Beach, S.C.: As a practicing RN for the past 32 years, I want to know why we can't go back to non-profit hospitals, and clinics adjoined to ER's to give "routine" emergency care?

Steven Pearlstein: Neither do I. And, while we are at it, why RNs and physician assistants can't handle more of the routine treatment of the most common ailments for which there are very well defined protocols. I read the other day how the AMA and specialty societies are all upset about the walk-in clinics that are open 24/7 and charge less. Maybe they ought to respond by providing cost-effective, convenient service rather than trying to use government regulation to snuff out competition.

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Princeton, N.J.: Where is the waste in the present system and will it persist in the new consensus? Doctors have to fill out 1,500 different complicated forms for private insurers. This wastes over 200 Billion a year. Private companies have overheads between 15 and 20%. (The Canadian system has an overhead of 1.3%.) This wastes over 100 Billion a year.

The problem is that the rules are set by the private insurers who are not interested in efficiency or good healthcare, but simply making money. If it saves them money to have a doctor fill out a 40 page form to prescribe a certain drug, they require the form. (This is an actual example.)

Steven Pearlstein: Why do you think we're all talking about investing billions in electronic records and digital prescriptions and health care IT? Just because administrative costs are high, it doesn't mean they have to be.

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New York, N.Y.: High deductible policies are great if you are wealthy and can self-insure up to the deductible. They are not a viable option for access to comprehensive and preventive care for middle and lower income Americans, who are most of the uninsured. What people pay in premiums for low deductible policies, they pay in out of pocket costs to meet their deductible, before their coverage kicks in. So, high deductible policies simply move the money around...they aren't cheaper coverage.

Adam

Steven Pearlstein: Wrong. They are not just for the wealthy. They are preferable for the healthy, however.

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Washington, D.C.: Let me add the following into the mix. Thirty years ago or so I lived and worked in Stockholm, Sweden for about three years. Yes, the taxes were high, but I had health care whenever I needed it. At that time (but no longer), everyone was assigned to a particular hospital (not necessarily convenient, TRW). The health care was generally fine, mostly -- just like here. But I found out that there was (and probably still is) a two-tiered system. That is, the "national health" program was essentially "free" (i.e., tax-paid). If one wished to go to a private doctor, one had to pay for it. I did both, as needed. It was fine.

Here, I have such a high deductible (to be able to otherwise live my life) that I essentially self-insure my yearly physicals, etc. But that also means that I had to eat an MRI several years ago because my deductible wouldn't be reached, and my current physical therapy sessions are also self-insured. Outside of arthritis in my "boomer knee" I'm in good health. And I'm lucky. I really don't like the insurance companies taking my hard-earned money and my not being able to get anything in return -- or having to fight tooth and nail for the benefits.

Sorry for the length of this, but I would like to see the implementation of a two-tiered system along the lines (not literally, please!) of that which I experienced in Sweden. And I don't at all mind being expected to pay higher taxes because of it. A healthy workforce is a productive workforce, after all.

Steven Pearlstein: High-deductible policies are a version of what you experienced in Sweden, only instead of the public system being financed through mandatory taxes, the "public" part of the system here would be financed through mandatory premiums. The difference is largely semantic.

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Silver Spring, Md.: As a small business person, I would much rather pay than play. I would rather not be in the business of having to arrange health insurance for my employees; but I would like them to be able to get affordable, adequate health insurance from some state organized pool. This would be much more efficient than every employer, or pools of mall employers negotiating their own plans. I don't understand why more business people are not with me on this.

Steven Pearlstein: That's fine. It may, in the end, be more efficient and result in lower premiums if you and your employees access a pooled system. BTW, we also ought to make it just as easy for you to join an organization of small businesses that does that for you, giving you all the same rights and benefits as a large employer (like ignoring state laws on what services must be covered).

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Steven Pearlstein: That's all the time we have for today, folks. See you next week.

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