I think James Kwak gives a great summary of the problems with our current system - and I think what's revealing is that... it's still needed; it shows how desperately we need to educate people about what our system actually is, before we can explain changing it.

That said, I think, as you might guess, that Kwak is basically off: the problem isn't that democrats are presenting reform as a fix for the poor...to my mind, it's that they're not. A campaign which said "we are focusing on reform efforts that will help people in poverty get better care, better access to care, in an affordable way" would not, I thin, create the kind of opposition we're seeing. What's driving that opposition is, I think, what Kwak describes: the fact that people's current employer-based option is so precarious, and that the alternative seems worse. The "insured" aren't afraid of the poor; they're afraid of their insurers. And they probably should be.

Finally I think Kwak's even more wrong at his conclusion:

Now, I admit that if you are over 65, health care reform is not for you, because you are in the one group in our society that enjoys true health insurance – insurance that you cannot lose, that is paid for by taxes, and that is effectively guaranteed by the government. So maybe there’s nothing in it for you, except perhaps an improvement to the prescription drug component of Medicare. But I cannot believe that, as the only people who have reliable health insurance, you would oppose health care reform that would provide reliable insurance for the rest of us.

Sadly, I think the opposite is clear: older Americans are as self interested as any other group, and their goals are to preserve Medicare as strongly as possible. Thre rest of us... well, that's our problem, isn't it? I don't think we should assume saintly motives in the elderly (it's part, I think of the divide between young and old in this country that we see older people as having an altruism we don't), and I don't think we can assume elderly Americans will favor healthcare reform that improves coverage for others, but looks like a reduction in Medicare. Which is how the current plan seems to play.