If you are as confused as I am about what’s going on in the Senate about health care — Slate has an interactive guide to the latest proposals that is up to date as of yesterday afternoon.

For reasons explained by Atrios, lowering the age for Medicare would be a terrible idea. Digby thinks so too.

Tomorrow night the Senate is supposed to vote on whether it will take up the health care bill released this week. They need 60 votes, and it’s a big question mark whether they will get 60 votes.

The Senate bill is somewhere between “not what we wanted” and “better than nothing.” It pulls back a bit on the House bill’s draconian abortion restrictions, but it adds a “national plans” provision that would allow insurance companies to sell policies without regard for state consumer protections.

Conservatives and the insurance companies love the national insurance idea. The insurance companies could all set up shop in Texas and sell cheap junk policies to healthy young people in any state. Most of the young folks likely would pay premiums for quite some time before they make a claim and realize their policies are a ripoff and their insurance doesn’t cover whatever it is they have. Big profits to be made. But if enough healthy young people drop out of the state insurance pools, the not-so-young and not-so-healthy will be paying higher premiums.

The public option will be available only to people who can’t get insurance any other way, and because it will attract a less-than-young and healthy (hereafter abbreviated Y & H) risk pool it is expected to actually be more expensive than private insurance. Robert Reich explains.

The Senate bill has a state “opt out” provision that many leftie bloggers don’t like. I think that if there have to be compromises (and why is that true?) this is one of the less onerous ones. If the public option were to be more robust, and go into effect sooner, I think it would actually hurt conservative state-level politicians in the long run to opt out. As it is, I’m not sure it will make a whole lot of difference to many people.

Many of the provisions of the bill won’t go into effect until 2014. I think this is a colossally stupid move on the part of the Democrats. I know Reid put that in to make the bill cheaper. But it will give the Right plenty of time to spread more “death panel” stories to scare the public with. If they manage to take back the House or Senate in 2010 or 2012, expect them to try to kill the legislation before it goes into effect.

Jon Walker at FireDogLake explains these and other issues with the bill. At the Washington Post, Ezra Klein explains the actuarial values thing. He also explains what parts of the bill go into effect before 2014. The New York Times presents the major provisions of the Senate and House bills side by side.

Between now and then, expect to hear all kinds of rumors and speculation about how senators Baucus, Landrieu and Lincoln will vote. Michael Tomasky argues that obstructing the health care bill would be bad for their political careers in the long run, even if they might take a hit from their conservative constituents in the short run.

As I’ve written many times over the recent months, the political paradox is this, at least for Nelson, Landrieu and Lincoln. As individual senators from red states where Obama has lower approval ratings, they would be rewarded in the short-term by blocking reform. But as members of the larger group of Democrats who represent states where Republicans tend to win statewide elections, a collective party failure is far more likely to hurt them in the long run than it is to hurt safe, blue-state Democrats.

If they’re really thinking long term, they should want reform to succeed. And oh yes, there’s this, too: the fact that they represent poor-ish states (especially Lincoln and Landrieu), where many families are uninsured and would benefit from being able to purchase insurance with a decent federal subsidy. This should make them want a bill.

Emphasis on should. We’ll know more soon.

Yes, I guess we will.

Why should my tax dollars pay for some geezer’s Viagra prescription? Digby writes,

I realize that many people disagree with my moral objections to men getting erections which God clearly doesn’t want them to get, but my principles on this are more important to me than theirs are to them. So too bad. If you want a boner, pay for it yourself.

One could argue that paying for contraceptives and abortions is cost effective, since pregnancy and childbirth are much more expensive. But you can’t say the same thing about erectile dysfunction medicine or devices.

So, no abortion funding, no ED remedy funding. Strip EDs out of Medicare, too.

I’m not sure what all they’ve done to it at the last minute, but the House just passed a health care bill.

Judy Dugan writes in the Los Angeles Times that foreign hospitals and medical centers are wooing U.S. insurance companies and major employers. The goal? To make “medical tourism” a regular part of America’s market-driven health care system.

Right now, medical tourism is an individual choice. People who have been dumped out of the U.S. health care system but who have the money to travel can get their hip replacements and cancer treatments in another country at the fraction of the cost.

But unless Congress gets its act together and takes the insurance industry into hand, soon “American workers may find themselves facing ‘incentives’ for overseas surgery that border on coercion,” says Dugan.

For insurers and employers looking at a $45,000 hip replacement in the U.S., the lure of a $5,400 hip replacement in India — even with $10,000 or $12,000 in travel and lodging costs added on — is hard to resist. So what if there’s a lack of public, comparative data on outcomes, complications and long-term recovery?

Doctors in other countries make a fraction of what U.S. doctors do. U.S. physicians may find themselves in the same fix as U.S. garment workers, competing with workers in the Third World. Patients also may have to sign waivers that free their foreign health care providers from any liability for error or malpractice.

Here are a few early indicators of insurer interest: The Blue Cross Blue Shield website touts “Blue Cross’ Companion Global Healthcare,” a wraparound travel planner and network of overseas providers, selling to individuals and to employers in South Carolina. In California, Blue Shield and HealthNet offer plans for employers of Mexican immigrants that cover treatment in Mexico. And United Health Group, the parent of PacifiCare, sent a speaker to the medical tourism conference to advise on how to get employers to include overseas surgery in health plan networks.

Conservatives want to de-subsidize health care and allow the magical free market to determine cost and delivery. Outsourcing overseas is a logical consequence.

Update: However, as Nicholas Kristof points out — we may get better care by going overseas. Our health care system, in spite of being the best health care system in the world, isn’t that great.

Last August the Organization for Economic Cooperation and Development (OECD) came out with a survey showing that Americans pay way more for cell phone service than just about anyone else. To which Cactus at Angry Bear responded, sarcastically, that this means the U.S. must have the best cell phone service in the world.

I’m just now catching up to this, but I think Cactus could have taken the analogy further.

In the early 1980s, most European countries decided to adopt a uniform GSM system for cell phone service, so that any cell phone would work anywhere in those countries on the same network. Today this GSM system is the most popular standard for cell phones in the world, used by 80 percent of the world’s cell phone users in at least 100 countries.

And then there is the U.S. Our Congress didn’t want to adopt standards — that would be government regulation, you know, which is bad — so it let the free market come up with our standards. So we have a tangled mess of private and incompatible digital networks, and cell phones that don’t work anywhere but here, if then.

Providers like T-Mobile and AT&T do offer GSM service, but my understanding is that they use different frequency bands. So those phone still can’t tap into the standard GSM network that most of the world is using.

I found an article from 2005 on “Europe’s homogenous cell phone culture” that said,

Strangely, in the country that widely supported “universal” service in the early days of telephony, the United States’s Federal Communications Commission (FCC) decided not to regulate cell standards, thus the inconsistent mix of separate systems.

Reuters cited an FCC report saying that its decision was correct since it found Americans talk more on their phones and pay less than Europeans do.

Reuters pointed out, though, that 8 of 10 people in Europe have cell phones while only 6 of 10 people in the United States do.

The difference in service is dramatic. Cell phone coverage in the United States is thin and reception chancy in apartments and, says Reuters, land lines are necessary in ranch houses in Los Angeles.

GSM works everywhere in Europe, including at the bottom of a salt mine in Poland.

It may be that those ranch houses in Los Angeles have cell phone service now, assuming they weren’t destroyed in forest fires or mud slides. California seems like a chancy place to live. But now we don’t even get the cheaper prices. This guy says, “on average, the OECD found that Americans pay $635.85 on cell phone service, compared to $131.44 per year in the Netherlands or $137.94 per year in Sweden.”

Thus it is with health care. We’ve got a Rube Goldberg health care system held together with twine and duct tape, and it hemorrhages cost, and we pay more and get less than anywhere else. And why? Because Congress wouldn’t step in and regulate it.

Yes, Congress will intervene — reluctantly — to patch up parts of the system that are utterly failing. This is how we got Medicare; millions of seniors had no health insurance and the private market wouldn’t sell it to them.

But these measures amount to band-aids that keep the ugly beast alive, so to speak. Taxpayers step in where the private system fails, and then the private system blames government interference for its failures.

Face it — we’re a nation of rubes.

Update: And other people get more paid sick days, too.