alex cockburn writing in counterpunch, here:

Typically, Democratic presidents like Clinton and now Obama commit during their campaigns for some kind of “reform,” usually meaning some pledge that the “disgrace” of 45 million or so uninsured Americans will end. In 1993 the Clintons tried “health reform”– a monstrosity that I described at the time as looking like a collaboration between Mondrian and Jackson Pollock - and the insurance industry and lobbyists ate it for breakfast. The radical reformers argue for a national insurance scheme, like Canada’s or the NHS, where the state can use its purchasing weight to drive down drug prices, set rates, clean up the system. This plan go back to the Health Service Act introduced by Ron Dellums in Congress on May 4, 1977, providing for comprehensive , community-based health services with progressive national financing. The Dellums bill had been under discussion since the early 1970s when the Medical Committee for Human Rights proposed a set of principles for a national health plan.

It’s not going to happen, any more than Obama will nationalize the banks and tell householders to repudiate their mortgages. The insurance industry, the drug industry, the real estate and finance sector are the most powerful forces in the country. They’ve just got Obama to commit $23 trillion to their enduring welfare. They’re not going to surrender the treasure trove known as healthcare without serious blood-letting on the barricades. They own the Congress. Men like former Democratic senate leader Tom Daschle spring to do their bidding. So, Obama finally produced a timid compromise, whereby uninsured people would be herded under various health insurance umbrellas with “a public component.” Even if the health industry’s hired man, Senator Max Baucus, had not deep-sixed the public component, the insurance industry could swallow it like a python swallowing a field mouse. Though Obama sometimes confides that the public component of his plan is the springboard to full-bore single payer national health, this is transparent fantasy. In present political conditions, the publicly insured component would soon become a ghetto, offering minimal care to the indigent, and gradually shriveled into some sort of punitive maintenance scheme.