With the Senate Finance Committee set to approve its health care bill this week, Democrats are tantalizingly close to bringing legislation that would make sweeping changes in the nation’s health care system to the floor of both houses of Congress.

Party leaders still face immense political and policy challenges as they combine rival proposals ”” two bills in the Senate and three in the House. But the broad contours of the legislation are in place: millions of uninsured Americans would get subsidized health benefits, and the government would move to slow the growth of health spending.

Senior Democrats said they were increasingly confident that a bill would pass this year. “I am Scandinavian, and we don’t like to overstate anything,” said Senator Kent Conrad, Democrat of North Dakota and an architect of the Finance Committee bill. “But I have a solid feeling about the direction of events.”

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Unlike the United States, where the Medicare program for the elderly costs taxpayers about $500 billion a year, Switzerland has no special break for older Swiss people beyond the general subsidy.

“Switzerland’s health care system is different from virtually every other country in the world,” said Regina Herzlinger, a Harvard Business School professor who has studied the Swiss approach extensively.

“What I like about it is that it’s got universal coverage, it’s customer driven, and there are no intermediaries shopping on people’s behalf,” she added. “And there’s no waiting lists or rationing.”

Since being made mandatory in 1996, the Swiss system has become a popular model for experts seeking alternatives to government-run health care. Indeed, it has attracted some unlikely American admirers, like Bill O’Reilly, the Fox News talk show host. And it has lured some members of Congress on fact-finding trips here to seek ideas for overhauling the United States system.

The Swiss approach is also popular with patients like Frieda Burgstaller, 72, who says she likes the freedom of choice and access that the private system provides. “If the doctor says it has to be done, it’s done,” said Mrs. Burgstaller. “You don’t wait. And it’s covered.”

Read the whole article from the front page of yesterday’s New York Times.

Critics of pending health care reforms claim they want to ensure that the government does not thrust itself between patients and doctors to dictate what medical procedures can be performed. Yet many are trying to do just that when it comes to one legal and medically valid service: abortion.

Republicans and anti-abortion Democrats in both houses of Congress are seeking to prohibit millions of Americans ”” those who might receive tax subsidies to help them buy insurance ”” from purchasing plans that would cover an abortion.

In a rational system of medical care, there would be virtually no restrictions on financing abortions. But abortion is not a rational issue, and opponents have succeeded in broadly denying the use of federal dollars to pay for them, except in the case of pregnancies that result from rape or incest or that endanger a woman’s life.

These restrictions…constitute an improper government intrusion into Americans’ private lives….

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Perhaps no other issue Congress deals with touches every American as intimately as health care. Yet a new poll by NPR, the Kaiser Family Foundation, and the Harvard School of Public Health finds that, so far, the public feels profoundly shut out of the current health overhaul debate.

“Most people don’t feel that they personally have a voice in this debate,” said Mollyann Brodie, director of public opinion and survey research for the Kaiser Family Foundation. “In fact, 71 percent told us that Congress was paying too little attention to what people like them were saying.”

Nancy Turtenwald is one of those people. The tourist from Milwaukee was walking around the sparkling new visitor center at the U.S. Capitol Tuesday. She was quick to agree with poll findings that the lawmakers debating the massive health overhaul bill just a few blocks away weren’t much interested in problems like hers.

“I don’t think they are people like us, you know?” she said. She thinks Congressional lawmakers know very little about the daily lives of the average American ”” and the health care costs they face. “How often do they go and buy gas and bread and stuff to see what it’s really like for the people like us?”

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The Senate Finance Committee voted down a government-run “public option” as part an overhaul of the nation’s health-care system Tuesday, rejecting the first of two amendments offered by Democrats.

The panel’s chairman, Sen. Max Baucus (D-Mont.), and four other Democrats sided with Republicans in opposing a public-option amendment offered by Sen. John D. Rockefeller IV (D-W.Va.). Baucus said he voted against the politically volatile provision because he feared that a bill including it would not get the 60 votes it would need to pass on the Senate floor. The committee voted 15 to 8 to reject the amendment.

After the vote, the panel began debating a second public-option amendment introduced by Sen. Charles E. Schumer (D-N.Y.).

“We are going to get at this, and at this, and at this, until we succeed, because we believe in it so strongly,” Schumer said in offering his amendment. He disputed Baucus’s contention that a health-care reform bill including the public option could never pass the Senate, saying the more Americans hear about its benefits, “the more they like it.”

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As if it were not complicated enough, the debate over health care in Congress is becoming a battlefield in the fight over abortion.

Abortion opponents in both the House and the Senate are seeking to block the millions of middle- and lower-income people who might receive federal insurance subsidies to help them buy health coverage from using the money on plans that cover abortion. And the abortion opponents are getting enough support from moderate Democrats that both sides say the outcome is too close to call. Opponents of abortion cite as precedent a 30-year-old ban on the use of taxpayer money to pay for elective abortions.

Abortion-rights supporters say such a restriction would all but eliminate from the marketplace private plans that cover the procedure, pushing women who have such coverage to give it up. Nearly half of those with employer-sponsored health plans now have policies that cover abortion, according to a study by the Kaiser Family Foundation.

The question looms as a test of President Obama’s campaign pledge to support abortion rights but seek middle ground with those who do not. Mr. Obama has promised for months that the health care overhaul would not provide federal money to pay for elective abortions, but White House officials have declined to spell out what he means.

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Reporting from Vancouver, Canada – When the pain in Christina Woodkey’s legs became so severe that she could no long hike or cross-country ski, she went to her local health clinic. The Calgary, Canada, resident was told she’d need to see a hip specialist. Because the problem was not life-threatening, however, she’d have to wait about a year.

So wait she did.

In January, the hip doctor told her that a narrowing of the spine was compressing her nerves and causing the pain. She needed a back specialist. The appointment was set for Sept. 30. “When I was given that date, I asked when could I expect to have surgery,” said Woodkey, 72. “They said it would be a year and a half after I had seen this doctor.”

So this month, she drove across the border into Montana and got the $50,000 surgery done in two days.

“I don’t have insurance. We’re not allowed to have private health insurance in Canada,” Woodkey said. “It’s not going to be easy to come up with the money. But I’m happy to say the pain is almost all gone.”

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Jarvis,” I asked my husband, “should we have a discussion about end-of-life care?”

“Yes,” he said. “We need that discussion — almost in religious terms.”

I wasn’t sure what he meant. The reason the whole subject comes up so much nowadays is political: Who would pay for end of life care? I reminded Jarvis that, according to a July Wall Street Journal article, most health care spending in general occurs in the last six months of life. And a recent UC Berkeley report noted that health care accounts for 16 percent of our gross domestic product; it will increase if nothing is done, providing a huge drag on our country’s economy.

“All the more reason we need that conversation,” Jarvis said.

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If Grady Memorial Hospital succeeds in closing its outpatient dialysis clinic, Tadesse A. Amdago, a 69-year-old immigrant from Ethiopia, said he would begin “counting the days until I die.” Rosa Lira, 78, a permanent resident from Mexico, said she also assumed she “would just die.” Another woman, a 32-year-old illegal immigrant from Honduras, said she could only hope to make it “back to my country to die.”

The patients, who have relied for years on Grady’s free provision of dialysis to people without means, said they had no other options to obtain the care that is essential to their survival. But the safety-net hospital, after years of failed efforts to drain its red ink, is not backing away from what its chairman, A. D. Correll, calls a “gut-wrenching decision”: closing the clinic this month.

The sides confronted each other in state court on Wednesday morning as lawyers for the patients sought to keep the clinic open until other arrangements for dialysis could be secured. Dialysis patients and their families packed the benches and 60-year-old Nelson Tabares, a seriously ill illegal immigrant from Honduras, was wheeled into court in a portable bed.

Despite a judge’s urging that the two sides negotiate a solution Wednesday, there was no agreement by the end of the day on how to go forward. For the time being, a restraining order keeping the clinic open stands. The judge is considering whether to extend it.

The dialysis unit on Grady’s ninth floor might as well be ground zero for the national health care debate.

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Is health care a right or a privilege? Should government be more or less involved? Perspectives abound among all groups involved: patients, doctors, hospitals, health insurers, the pharmaceutical industry, legislators.

Most would agree that the needs of the uninsured represent a top priority for reform. Perhaps the experience of an entity devoted to addressing those needs for the last six years might be insightful….

Read it all from the letters section of the local paper.

When it comes to health insurance in America’s cities, you don’t have to look far for contrasts.

Mount Pleasant had the lowest percentage of people lacking health insurance in 2008 among relatively large cities in the Southeast. Its 6.2 percent ranked 22nd among all U.S. cities.

Across the Cooper River, that picture is much bleaker. North Charleston ranked 481st in the nation with 25.1 percent of its 84,902 residents without health insurance. Among adults ages 18 to 64 living in the city, 30.5 percent are uninsured.

The figures come from the U.S.Census Bureau, which obtained data from the nation’s 532 cities with populations of at least 65,000.

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Claiming that the opposition is “bearing false witness” by spreading misinformation about his health-care plan, President Barack Obama has asked religious leaders to become the latest conscripts in the battle over health-care reform. And although each version of the proposed health-care bill so far has explicitly authorized the government plan to cover the cost of abortion, many Catholic leaders and organizations have joined up, pledging their support.

For faithful Catholics, it is discouraging to see that Catholic Charities USA and the Catholic Health Association have both embraced the plan. And it is even more discouraging to learn that some parish priests and bishops are leading the fight for it. While Cardinal Justin Rigali, chairman of the U.S. Conference of Catholic Bishops’ Committee for Pro-Life Activities, has urged lawmakers to block the current House legislation unless it can be amended to prohibit public financing for abortion, his is a lonely voice. In a commentary posted on the Web site of the San Bernardino Diocese in California, Bishop Gerald Barnes denigrated those who have participated in what he called the “anger-fueled conduct” at town meetings and directed followers to the Bishops’ Web site to learn about Catholics’ moral obligation to help others gain access to quality health care.

The Web site advises Catholics to “join the efforts of local groups funded by the Catholic Campaign for Human Development.” As it happens, the Catholic Campaign has been involved in funding left-leaning organizations and activities from its earliest years….

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Supposedly the Senate’s version of ObamaCare was written by Finance Chairman Max Baucus, but we’re beginning to wonder if the true authors were Abbott and Costello. The vaudeville logic of the plan is that Congress will tax health care to subsidize people to buy health care that new taxes and regulation make more expensive.

Look no further than the $40 billion “fee” that Mr. Baucus wants to impose on medical devices and diagnostic equipment. Device manufacturers would pay $4 billion a year in excise taxes, divvied up among them based on U.S. sales. This translates to an annual income tax surcharge anywhere from 10% to 30%, depending on the corporation….

This new tax will eventually be passed through to patients, increasing health-care costs. It will also harm innovation, taking a big bite out of the research and development that leads to medical advancements.

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Two of every three practicing physicians oppose the medical overhaul plan under consideration in Washington, and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted, a new IBD/TIPP Poll has found.

The poll contradicts the claims of not only the White House, but also doctors’ own lobby ”” the powerful American Medical Association ”” both of which suggest the medical profession is behind the proposed overhaul.

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Sen. Max Baucus spent the past few months trying to negotiate a compromise health care overhaul package that would have bipartisan support. But when Baucus, the Senate Finance Committee chairman, finally released the details of his massive bill on Wednesday, there was no sign of Republican backing.

Many Democrats are worried that Baucus offered far too many concessions to Republicans ”” most notably dropping the idea of a government-run health care plan to compete with private insurers ”” without securing any firm support from across the aisle.

The top selling point of the Baucus bill was supposed to be its bipartisan appeal. Without some Republican support, Baucus’ version could end up adding to the cacophony of competing proposals passed by several committees in the House and Senate.

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Some of my summer in France was spent listening to indignant outbursts about U.S. health care reform. The tone: “You must be kidding! What’s there to debate if 46.3 million Americans have no health insurance?”

I think the French are right. I don’t think there’s much to debate when France spends 11 percent of its gross domestic product on health care and insures everyone and the United States spends 16.5 percent of G.D.P. and leaves 20 percent of adults under 65 uninsured. The numbers don’t lie: The U.S. system is wasteful and unjust.

It’s not just the numbers. It’s the intangibles. Two of my children were born in Paris ”” a breeze. One of them got very sick on arrival in the United States ”” and my wife fainted in a doctor’s office from the anxiety of finding the appropriate care (when we did, at the eleventh hour, it was excellent). The American health system is an insidious stress-multiplier whose hassles, big and small, permeate already harried lives.

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The president’s contention was questionable.

But Rep. Wilson’s rash rudeness was a disgrace for him, an embarrassment for South Carolina and a particularly appalling breach of protocol by a native of Charleston, a bastion of gentility. Fellow federal lawmakers swiftly responded with bipartisan condemnation….

And we express sincere disappointment at seeing Joe Wilson descending to such deplorably bitter depths in a sorry spectacle that’s a sign of our increasingly acrimonious times.

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The key words are “abortion neutral.”

What those two words mean is that neither abortion opponents nor abortion rights advocates would use the overhaul effort to advance their agendas. Most important, they would not try to change the legal status quo regarding federal financing of abortions.

That truce did not mean that those activists ”” or Americans generally ”” were themselves abortion neutral. Far from it.

When it comes to health care, abortion rights supporters strongly believe that abortion should be treated no differently than any other medical procedure to which Americans have a legal right. Abortion opponents say that a procedure they view as lethal to a distinct member of the human species, no matter how early in its development, hardly qualifies as health care.

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“God of grace and God of glory,” prayed the Rev. Cynthia Hale during a national conference call Aug. 19 on health care reform, “É We believe that it is your will that every man, woman, boy and girl receive quality health care in America.”

On that point, no religious leader would contest Hale, pastor at Ray of Hope Christian Church in Decatur, Ga., who offered the prayer at the kickoff of an effort by the faith community to mobilize religious support for the ideals of health care reform favored by President Obama.

From the pulpits and through public statements, religious leaders have been weighing in on various elements of what they say is a crucial moral issue. Catholic bishops in New Jersey, in letters to the state’s members of Congress, have lobbied against possible inclusion of abortion coverage in any federal health care plan, a possibility Obama dismissed in his prime-time speech Wednesday. The Episcopal Church USA passed a resolution favoring a single-payer system, while some Catholic bishops in the Midwest have publicly opposed any massive government effort.

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But he chose again to duck the biggest dispute of all: whether the new insurance exchange must contain a government-run “public option.” Mr. Obama once again outlined the arguments for a public plan and once again said it was not essential. Perhaps the president’s advisers made the right political calculation in determining that Wednesday night was not the time to embrace a particular alternative, such as nonprofit cooperatives or a trigger under which a plan would be created only if private insurers do not reduce premium costs to a certain level. But this laissez-faire strategy guarantees that the rather peripheral debate over the public option will continue to dominate the health-care discussion.

Mr. Obama sketched out a measure that would cost $900 billion over the next decade — about three-fourths the size that the administration initially envisioned but still containing the basic elements of universal coverage. The money would come from an amalgam of savings in federal health spending programs and a new tax on insurance companies that offer plans costing more than a set amount. This is an ungainly and inefficient, but politically safe, way to approach the goal of limiting the amount of health benefits that can be offered tax-free.

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President Barack Obama’s address to Congress on healthcare reform was short on specifics and long on ideas he and his advisers had already floated this year.

The historic speech left some liberals wanting more details and conservatives emboldened to torpedo the president’s top domestic priority.

The big question of the night was how Obama was going to address the public health insurance option, but he largely repeated what he has said for weeks: He supports it, but will sign a bill that does not have it.

Read it all, and, yes, Joe Wilson should apologize–that was uncalled for.

A group of Episcopal bishops plan to travel to Washington, D.C., the week of September 14 to lobby on Capitol Hill in support of health-care reform.

The group, “Bishops Working for a Just World,” seeks universal heath-care coverage and solutions to domestic and global poverty and the environmental crisis. Bishops make annual trips to the nation’s capital to advocate for specific legislation or changes to legislation.

“The issues that we lobby are the issues voted on by General Convention,” said Diocese of Newark Bishop Mark Beckwith.

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While some were moved to tears by the president’s soaring rhetoric, others were moved not at all. Where some saw a new clarity, others saw more vagueness. And while some praised him for reaching out to Republicans, there were those who felt he was overreaching in some ways and not reaching far enough in others.

Americans listened intently to President Barack Obama’s much-anticipated speech on health care reform Wednesday night, and not surprisingly, their reviews varied. Few said they had changed their minds.

Matt Petrovick set his treadmill at a leisurely 2.8 mph pace so he could pay full attention to the television on the wall in front of him. He’s not sure the president’s words boosted his heart rate, but the speech certainly got him going.

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President Obama’s spirited defense Wednesday night of his broad healthcare goals avoided making concrete commitments on some of the most contentious issues, reflecting a guiding principle of his legislative strategy: to put off the most controversial decisions until the very last moment.

It is a strategy born of political reality. At this stage of the process, when neither the House nor the Senate has even begun a floor debate, lining up firmly on one side or the other of the hot-button issues invites gridlock or even defeat.

And so, though some liberal Democrats have threatened to revolt if Obama does not insist on a new government insurance option — the so-called public plan — the president told the joint session of Congress that he would consider other approaches to making coverage affordable for the uninsured.

“The public plan is only a means to that end,” he said, “and we should be open to other ideas that accomplish our ultimate goal.”

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I am not the first President to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.

Our collective failure to meet this challenge ”“ year after year, decade after decade ”“ has led us to a breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can’t get insurance on the job. Others are self-employed, and can’t afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or expensive to cover.

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