I would love it if we could guarantee state-of-the-art, world-class healthcare to everyone in this country. Hell, to everyone in the world. It'd be super. But, we can't do it. Creating an entitlement to top-of-the-line care would bankrupt the country and preclude government spending in important other areas like roads and schools and/or would force the imposition of Palinesque "death panels" to choose who receives medical care and who does not.
But, you object: There aren't going to be death panels! (And you probably call me all sorts of nasty names as well.) You're right, in a sense. Sarah Palin is an idiot and her idea of "death panels" is different from mine. Let's get into the meat of the issue.
First, let's consider scarcity. One essential truth of economics, whacked into the heads of undergraduates on the first day of class, is TINSTAAFL. That is, There Is No Such Thing As A Free Lunch. For most goods (rival goods, to the econoliterate), my use of the good precludes your use of the good. That is, if I eat a hamburger, you can't eat that same burger. This isn't true for a few non-rival goods, like air, a television broadcast, or a pretty view. It likewise isn't true for most rights guaranteed by the government: My right to own a gun doesn't preclude you from owning a gun; my right to practice my religion doesn't preclude you from practicing yours; my right to speak my mind doesn't preclude you from speaking freely too. (This is why proclamations that "health care is a human right" do not ring true to me. A right to a good simply doesn't compute. Does such a right mean that I can compel a doctor to treat me if he is unwilling to do so for the price I offer?)
But, unfortunately, health care (writ large) is a rival good. If I get a kidney transplant, you can't get that same kidney. If I'm getting an MRI, you can't get an MRI from the same machine at the same time. This means that, at some point, there's going to be more demand for a certain unit of healthcare than there is supplied at the price the government is paying. And then who gets to decide? If you and I each need a kidney transplant and there's only one available kidney, one of us is going to die (or stay on dialysis a bit longer). I don't want the government making that decision. Maybe I'm too much of an ACLU devotee (that's right, I'm not a Republican and I don't watch FOX), but I'd be very afraid of a government making that decision for people. What if essential medical care is misdirected to places with a lesser need due to pork? I can imagine West Virginia getting extra equipment because Sen. Byrd decided to filibuster to demand it. What if people voicing unpopular political opinions are placed lower on the list? I can imagine such politicization of medicine: just like Karl Rove fired US Attorney David Iglesias for making politically unhelpful prosecutions, a future President could direct healthcare funds away from states or localities that opposed him in elections.
True, these life-or-death decisions are still made today. The tragedy of Nataline Sarkisyan looms large. As I've mentioned, though, I would much rather a corporation with whom I have voluntarily contracted make the decision, rather than the government.
The government could implement this plan in one of two ways. First, the plan could cover every individual (every individual who has chosen the public option, of course) completely. Or, the plan could cover only a certain dollar amount of procedures each year. In this latter case, woe betide he who gets sick at the end of the fiscal year. That would be a terrible plan. But the first case, too, would end horribly. Covering everyone is sure to be costly. Even if some cost savings are achieved in the first few years of the program, eventually, the program would get huge. Either our taxes would have to be raised to pay for all these services, or funding for important programs like schools, roads and the military would be cut. This is not an acceptable option either.
In the end, a public option is sure to doom this country's finances and/or population. We simply don't have the money to cover everyone completely. Is it depressing that we can't guarantee each others' care? Yes, indeed it is. But it is a fact of life. Congress cannot magick extra doctors and equipment into existence, as much as they wish they could.
A true solution would stay true to America's individualist ethic. End tax subsidies for employer-based insurance, in order to move to a freer market. If individuals were responsible for their own insurance, bad insurance providers would go out of business or change their ways. No one would stay on a plan that denied funding for a transplant to a 19-year-old girl, if they had the choice. Plus, individual-based insurance would encourage experimentation and innovation in the field, trying out HSAs, co-ops and just about everything else that's been suggested. Patent reform and limited tort reform (juries of doctors, perhaps? Guides for juries to determine damages based on the malpractice in question?) would help as well.
At the end of the day, much of this debate centers on Americans' feeling that they're paying "too much" for health insurance. While it's true that health insurance is expensive, government is not the solution. At the root of the issue, healthcare itself is very expensive, and rightfully so. Doctors, nurses and medical researchers are highly skilled, very trained practitioners who deserve high salaries. We should simply seek greater value for our many, many healthcare dollars through reform (as I mentioned above). We should not seek to have Big Nanny Gubmint magically legislate us a free lunch. After all, TINSTAAFL...