i can't remember if it was here or someplace else; but it was pointed out that it's not the healthcare system, but the health insurance system that needs reform. we have a lot of really good doctors (we could always use more good ones), the facilities are generally pretty good and most of the drugs seem to actually do something.
That has been argued here (Thomas made that case and I argued against it).
I disagree and think that the problem in the US is in the health care, not the insurance, and that the insurance problems are a symptom of that fundamental problem.
There is a trend toward specialization that is leaving basic medical care as the job no doctors want, and that is driving up health care costs. And quite frankly the costs are ridiculous, I live in a country that has comparable life expectancy to America and I don't even bother with insurance (though I will, just to be safe) and pay out of pocket. My girlfriend just got back from the doctor, the visit cost less than $50 and the blood work in the lab will cost about $50. This is with no insurance at all, just paying out of pocket. In the US, I'd be broke right now.
Here is an article about the specialization problem in America:
Family doctors: An endangered breed
As more medical students shun primary care for higher-paid specialties, experts warn of a severe imbalance that could cripple the nation's health care system.
"As a primary care doctor, you are a gatekeeper of the medical system," said Manriquez, 26, who with Glass is a first-year student at the University of Washington School of Medicine. "Primary care is where you can have the most immediate impact in affecting patients' lives by managing their health."
Still, Manriquez realizes that he's setting himself for considerable challenges.
For one thing, as a family doctor, Manriquez will probably make one-fourth the salary of a specialist while trying to pay down $140,000 on average in medical school debt.
And there is a rising commercialization of medical services, with industry pushing new expensive solutions and hospitals racing to start charging their patients for them. See this article
Of course, there has always been a profit motive in medicine. Doctors who own their own imaging machines order more imaging tests; to take an example from my moonlighting work, a doctor who owns a scanner is seven times as likely as other doctors to refer a patient for a scan. In regions where there are more doctors, there is more per capita use of doctors’ services and testing. Supply often dictates demand.
I, for one, do not want universal insurance paying for this ridiculous medical service that inflates costs so dramatically. I want public health care, not public insurance. That way doctors don't have personal motivation to inflate the costs to make more money in the public system.
The way I'd structure it is similar to how it is in many countries I've lived. The public health care is simple and not "nice". If you have any money at all you want to avoid it. It just does it's job and is for people who can't afford anything else. It keeps people alive, and the keeps the costs of the private sector in check. I think we can do this for far less than we can insure everyone while letting the medical industry keep trying to squeeze blood out of a rock.