This is great stuff:

We lost.   They won.

We are:

Progressives who favor a single-payer system

Libertarians who favor HSAs

Moderate economists who favor cost control to free up money for other societal goals

They are:

Doctors

Pharmaceutical companies

Hospitals

Private prepaid health plans (for some odd reason referred to as “insurance companies”)

Medical device makers

And many other special interest groups

Minor quibble with “doctors,” as certain specialties will benefit and certain ones will not, but still, that basically covers it.  What’s most interesting (at least for me, because confirmation bias is lots of fun) is his comments on the (completely insane) idea that regular health maintenance (doctor’s visits, normal drugs) and catastrophic care (car accidents, cancer) are still being treated as the same thing:

Private prepaid health plans (for some odd reason referred to as “insurance companies”)

[...]

The way to achieve this is with a combination of HSAs and catastrophic insurance.

His “odd reason” above highlights the insanity: insurance is for low risk, high cost events.  It should not cover doctor’s visits or birth control.  This is not to say that you can’t (or shouldn’t) have a plan that pays for those things, but it is emphatically not insurance, and should be treated and regulated differently.

I also like his proposed alternative (take that, reformers who say no one else has any better ideas!):

Sometimes I think the two political extremes blew an opportunity.  Let Medicare take over catastrophic insurance for everyone, and let HSAs cover 95% of health care bills.  Then provide a subsidy to low income workers’ HSAs.  Voila, no private insurance companies.

That would work, (the vital component is the different treatment of maintenance and catastrophic healthcare) but again, at the risk of being nitpicky, I’d split the “catastrophic” care segment, by establishing some dollar amount “medicare opt-out” that you could elect to take.  That way, if you felt like you could do better on your own, you could go that route, but you’d be ineligible for medicare forever.  Oh, and no healthcare reform (well, you know, other than the one we just passed) is complete without repealing the current bias in the tax code for employer provided insurance over individual provided. Still, these are minor nitpicks.

What it comes down to is this: libertarians warned that this hallmark of progressive policy making would end up getting completely corrupted by precisely those groups progressives hate most, to great financial and political gain.  And they were right. But then, maybe I just want thousands of poor people to die, so who are you to believe?