We've all heard the right-wing canards about health care reform. Any deviation from the current private insurance system is immediately derided as "socialism," or "a massive increase in government spending,"or perhaps even "destined to become a huge bureaucratic nightmare." Of course, I've never heard it explained how our privatized health insurance system is not expensive or overly bureaucratic, but never mind that. I want to talk about our "big three" Democratic presidential contenders, and how none of them has really had the guts to go all the way on health care reform.

What I keep hoping for is a presidential candidate who openly and whole-heartedly supports a single-payer national health care system. Effectively, this would be an expansion of the existing Medicare system to cover everyone living in the U.S. Medicare, despite its flaws, is still a great system. It's free, universally accepted, quite comprehensive (with the exception of Bush's meddling with its prescription drug coverage) and operated with drastically lower administrative overhead than private insurance. The only problem is that it's only available to people 65 and older.

We need to expand this system to cover people of all ages. If you'd like the gritty, operational details of how such a system would work (and I know I do!), then check out Physicians for a National Health Program (PHNP), an excellent organization for health care professionals working to promote such a system. Think about it: you could walk into any doctor's office or hospital, flash your national insurance card, and pay nothing for your care - ever. What's more, this is all possible with only a pretty modest increase in existing payroll taxes. The massive overhead of executives, marketing and arbitration maintained by private insurers would vanish. Federal government payouts to private companies for government employees' health insurance would stop. Doctors could lower fees due to vastly simplified administrative procedures. Best of all, your employer (or yourself) doesn't have to cover part of all of the cost of your health insurance, so they can pay you more to boot.

So, where do our erstwhile Democrats stand on this issue? They all talk about "universal healthcare", but that has become as nebulous a term as "family values." Hillary Clinton wants to pass a series of legislation to reduce costs and emphasize preventing care. Hmm...I don't see anything in there about restructuring the health insurance program. Next? Barack Obama and John Edwards both favor the creation of a national health insurance program. Good. But wait...it's targeted at those who can't afford private insurance. The problem is, we already have that. It's called Medicaid and unfortunately, it's not very good. Expanding it to cover more people really isn't going to help.

I appreciate how powerful the healthcare lobby is, and I know Edwards and Obama are trying to toe the line while still moving forward. Here's the thing though: we can't have an effective national health program while private insurance exists, or at least not private insurance that duplicates the coverage of the national system. If any private insurance companies exist, they will lobby with all they've got for cuts to the national program to ensure the service is poor. In turn, the wealthier (i.e., more politically powerful) Americans will continue to use private insurance, causing the national program to continue to languish. Any program created to compete with private insurers rather than totally replace them is doomed to failure from the get-go as long as the private insurers continue to wield such power in how the government would run the national program.

Don't get me wrong. Completely dismantling Anthem Blue Cross/Blue Shield, United Healthcare and Aetna is not going to be easy, nor could it necessarily happen overnight. I can see why candidates would be too afraid to take on that issue. Even Howard Dean, the most visionary candidate we've had in recent years, flat-out said that if your top issue was single-payer health care, he wasn't your guy. But it can be done. Teddy Roosevelt busted the trusts. F.D.R. reigned in the finance industry. So, who's the next great innovator? Ever more Americans continue to join the ranks of the uninsured. Every day people are driven to financial ruin because they had the misfortune of getting sick. It is literally adding insult to injury. Can we afford to wait any longer?