I do support his larger aims like: covering all Americans with adequate insurance and reducing cost. But there are a lot of ways to get from here to there. So, there are a lot of options I would support.

What I would not support is the status quo. Nor would I support an expansion to cover the uninsured without identifiable cost reduction mechanisms. One last issue that I think is very important is closing insurance loopholes like: denying or capping coverage. If you have insurance, you have insurance – full stop. If provisions are not there to stop insurance companies from denying and capping coverage, you should consider this effort a failure.

The govt will always 'out compete' the private sector, because its pockets are deeper, and it can rely on compulsion to get its tax income, compared to the voluntary purchasing of goods and services from private companies.

Socialised medical care suffers from producer capture. That is the system ceases to focus on the needs of the patient, and instead focuses on making life easier for the people running it. Thus when I go to see my GP (General Practitioner – the gateway to NHS care) he has little incentive to listen to me, and investigate my problems. His salary is the same whether I get better or die. His sole interest is how to get through his appointments in as fast a time as possible so he can go home. The same goes throughout the whole NHS. You are entirely at the mercy of the conscience of individuals throughout. And while the majority do a reasonable job, a significant minority are there to collect their salary for doing as little as possible. And being employed by the State they are almost impossible to sack.

As a patient I have no power over the providers of my medical care. I have no defined rights to care. I cannot take my custom elsewhere as I can when I spend my own money on something and get bad service. And because the NHS is so monolithic the private sector is entirely crowded out, and is thus even less competitive. Though how you can compete with 'free' is open to question.

My Grandfather was a GP before WW2, and left the UK to practice privately in Ireland because he disagreed with the introduction of the NHS. He said the NHS would destroy the independence of doctors, and reduce their focus on helping patients. Anyone looking at the NHS now couldn't help but agree with him.

It is not for me to say whether the US should reform its medical system. The fact that a proportion of the population of the US has no cover at all is hard to swallow. But be under no illusion – providing cover for free for the people at the bottom has to be paid for somehow by the rest. That will either be in cash terms (extra taxation) or by the rationing of the care available for all. There is no free lunch. For Obama to claim otherwise is nonsense. But then he's politician. They tell us what we want to hear, not the unpalatable truth.

For more critical pieces regarding policy or the effects on Obama's future political fortunes, take a look at a few other commentaries. Here are three:

http://blogs.reuters.com/james-pethokoukis/2009...
http://www.pollster.com/blogs/instant_poll_roun...
http://www.newdeal20.org/?p=4590

His numbers among independents are up enormously in the polls I am reading. Remember, this is politics and that's what counts.

1. The fact that a government-sponsored and operated plan (the “public option”) would have a very good chance, if not a certainty, of killing off all competition when the purported purpose is to provide some competition where there is little now. Ineed, he trumpted why this would happen: no need to make a profit and no need to pay high executive salaries. Did he even nod in the direction of acknowledging that this is what each and every competing company must do in a captialist soceity? No. Did he offer to open up the field for insurance companies, permitting them to offer healthcare insurance across state lines, with the thought that this might provide competition where there is none (his example was Alabama, where, apparently, a single provider has some huge percentage of all of the business) without the need to put a U.S. government plan into the mix? No.

2. Did he really say — yes, he did — that fining people for not having health insurnace was analogous to forcing those who drive automobiles (which for some reason I have trouble understanding is viewed as a privilege awardded by the state rather than a right) to buy accident insurance? Let's see if I get this. Now we are to be fined for not getting health insurance because we are alive and walking around as if being alive and walking around in America is a government awarded privilege? What? Can it be that this will pass Constioutitional muster?

3. Refusing insurance on the basis of prior condition was addressed as was capping benefits and watering down benefits for those who trigger them becuase of an illness or medcial need. But nothing was said about premium levels based on age or prior condition. One supposes that these factors can still be taken into account by insurance companies and charged out at a different level than those with no medical history and who are young instead of old.

4. Nothing was said about increasing Medicare reimbursement rates to something like a local average payout by insurance companies, requring health care providers to report their prices to some central authority (like, say, the Comptroller General) and published on the internet for all to see and analyze and to incent doctors from dropping out of having Medicare patients at all.

6. Nothing true was said about carving into benefits now provided by Medicare to the tune of a half a trillion or the curtailmnets of benefits under Medicare to conform to some nuttty committee's idea of
“best practices” — read by rationing care and cutrailing thois or tha treatment for this or that beneficiary.

7. The truth was not told about the number of Americans needing all this and the grant of benefits to illegals unless the President actually meant to confess that this number is not even close to 47 million people, as advertised.

8. Nothing was said about capping medical lawsuit damage awards against doctors and hospitals (e.g., limiting recovery to, say, $1 million per plaintiff, including as a single plaintiff any group of similarly situated plaintinff involved in a single law suit) and lawyers' split of any damage award (to, say, 20% or something like that).

9. The promise not to increase the deficit when all this goes into effect
was flat-out preposterous.

10. Nothing was said about reducing the text of the plan to, say, a single page or two when this ought to be easy to do unless the whole thing is larded with new government agencies opf one sort ofr another and special carve outs for those whose support is being bought.

So, a “great speech”? Maybe for a college debate, but, as for great policy, too much was twisted or left unsaid and undone in the plan being proposed.

You’re talking about a speech on subject matter that has some pretty serious implications to our economy and isn’t particularly “sexy”. Obama could read the phone book and make it sound good- what about the specifics?

Oh yeah. None.