And while we’re making such a fuss about Jonathan Cohn this week, he has a book review out of One Nation Uninsured, by Jill Quadagno. Not having read (or even heard of) this book which is a history of why universal insurance reform has failed in the US, I can’t comment much on it, but the story as relayed by Cohn is more or less true. Every time reform gets close one special interest or another kills it, and nothing ever gets done because the voting public perceive the reform to be a income transfer from them to poorer people.

Some people are working on the first issue (Brian Klepper’s group, the Center for Practical Health Reform is one), trying to get the industry as a whole to realize that the Titanic is headed for an iceberg, and that some level of reform is needed that will stop the attempts by providers and suppliers to find the ever expanding frontier and make us all live happily together within our borders. But I don’t hold much faith in that.

I do, though, think that the next time around, the pressures on the voting public are sufficient that enough of them might identify with the UN- and under-insured that a universal plan might sneak through.  But that does mean that things have to get pretty bad over the next 2-8 years for that to have a chance.  But then again, as was reported by the team at UCLA, California is on its way to having less than half the population with employer-based insurance. If that trend keeps playing out, and everyone else is getting only a high-deductible plan, middle class discontent may just be bubbling up enough for real change to happen.