If your eyes have glazed over as have mine from reading one too many wonkish articles about health care reform then let me direct you to two, short, to the point posts by John Hempton (here and here).
Drawing on his Aussie experience he points out that unless costs are controlled, health care reform in its current American iteration will be a failure:
He implies however – though does not say so directly – that universality (necessarily involving some socialization of costs) – could be a disaster if costs are not controlled. I will go further and say that it will be a disaster if costs are not controlled. Australia has spent the last twenty years on measures that control costs (with considerable success). In the UK – but to a much lesser extent in Australia – those measures include queue rationing of some services. Queue rationing known here as “hospital waiting lists” was for a long time one of the dominant issues in State politics. Queues are less of an issue now than (say) ten years ago – but if you run the expression “hospital waiting lists” through Google News you will still find that it is a political issue. Anyone who tells you that you can have universal coverage without some queue rationing is lying. A decent part of the system however is working out what procedures must take place quickly and what procedures can safely wait a while. In Australia some people are in pain whilst on waiting lists.
Hempton suggests that in order to get to a workable regime the entire medical industry will have to see its profitability “crushed.” Note this doesn’t mean that you bankrupt every participant, merely that the profits they take out of the system are reduced to mere mortal sorts of sums.
As much as it might go against my libertarian inclinations, I would get behind a system that moves in the direction Hempton suggests. We cannot continue on the present course, Obamacare is an empty promise and it’s most likely too late to attempt any market oriented reforms. The best we could probably hope for is to import some experts from Australia and other countries that manage to run successful programs, have them design our system and then find some politician willing to force it through regardless of the political cost.