Much of the discussion here reminds me of the endless quest to perfect a perpetual motion machine: everyone has a great idea how, in a frictionless world with no entropy, to invent a machine that, once started, would continue to run forever on its own momentum.
That's a weak analogy I suppose, but still, people keep trying to devise a clever way to circumvent a basic fact of life that will never go away no matter how much you wish it would:
There is always rationing of one kind or another.
That's a way to paraphrase economics 101, the most basic rule of economics that always holds true in all circumstances: what people want always exceeds what people can afford (i.e., unlimited wants must deal with limited resources).
If you don't ration by price, you ration by time (waiting in line, waiting to be seen), or you ration by quality (St. Clown has some excellent posts on this point).
There is no possible way to give everyone everything they want, no matter what "system" you devise.
It is the refusal of progressive leaders to accept this reality that continues to make a mess of the system: every intervention, no doubt with the "best of intentions," necessarily and inevitably will have a side effect that was unexpected that will subvert the desired outcome.
Only after you accept that choices must be made somehow, and then focus the conversation on who will make those choices, and how those choices will be made, can you begin to make progress.
I like Scooby's idea the best: open it up to true competition. We need continued innovation to keep costs down; a one-payor system removes that incentive.
(a medical devices tax? seriously? what were they thinking??)
