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While Congress marches toward health care reform, I'm surprised that I haven't heard two obvious arguments for why passage is so critical.

First, the 40 million uninsured Americans are not the same ones year after year. The average employee changes jobs every seven years, so this means that at any one time, there are 40 million uninsured. However, the number of people who can expect to be part of that 40 million at some point during their lifetime is easily more than 100 million or more.

I hope constituents remember, "There but for the grace of God go I" before they start railing at their representatives during the holiday recess.

With regard to costs, I wrote a column on July 15 quoting my nephew, a young doctor in North Carolina, who said that a third of his patients are insured, a third are on Medicare, and a third are uninsured. That final third tries to pay, but usually goes through personal bankruptcy if stricken with anything serious. Basically, the insured portion has to pay enough to support the losses from the uninsured.

So, this begs the question, "Why hasn't a single media article pointed out that health insurance premiums that the rest of us pay should drop substantially if our increased tax dollars will be supporting these uninsured people." Moreover, won't it be less expensive to treat people proactively rather than having them show up in an ambulance at the emergency room?

Malcom Gladwell wrote a 2006 New Yorker piece about Murray Barr, a Reno homeless person who had cost the city and its hospitals more than $1 million in repeated admittances. The hospitals just spent the time and money ($100,000 in one bout with Murray) and raised the rates for the rest of Reno's hospital patients. Insurance companies cheerfully picked up the tab and passed the costs on in higher premiums, keeping roughly 30 percent for administration, advertising, marketing and executive bonuses.

Passing this legislation in whatever form it finally takes will be just the beginning. The rest of the work will be accomplished over the coming years as we eat the elephant one bite at a time. No public option? No problem. There's already Kaiser, a nonprofit with a results-based business model far ahead of the rest of the health care industry doing what the public option was intended to accomplish. Other private foundation money will enter the fray to provide nonprofit competition in the marketplace just like Blue Cross once did before the opportunists in its management found a way to take it public 10 years ago and pocket $250 million for themselves.

It may cost more money as we go through the transition, but so what? We spend $15 billion maintaining 10,000 atomic bombs. We subsidize sugar production. How can we save enough elsewhere to compensate? Let me count the ways.

The most productive aspect of this great debate is the extent to which cost control has become part of national policy. Until now, it was just business owners gnashing their teeth at the announcement of ever-rising premiums. These hapless guys footing the bill were three steps removed from the delivery and pricing of the services they felt forced to buy.

For the 90 percent of Americans who work for companies of less than 100 employees, and the army of the periodically unemployed, the coming sea change in health care represents a major leap forward.

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