When the term "Health Care Reform" is mentioned, the first issue that comes to most minds is cost. The most common reasons people say "Our health care system is broken" are economic. Insurance companies, socialized medicine, tort reform, formularies...the arguments really are all too often about the exchange of money.
There is an assumption that health care is expensive, so expensive that no one is expected to be able to pay out of pocket at the time of specific need. Truly, very few have $100,000 laying around in the event of a serious automobile accident requiring surgery, hospitalization, and weeks of rehab. Most don't have $15,000 laying around if they need their gallbladder out. The assumption continues that we MUST pool resources so that the money is there when the need arises.
Wait a second, isn't that socialism? Of course it is, depending on your definition. The only question that's really being debated is who gets to collect and distribute the money (which for fun I'm going to refer to as the "pot of gold"). Private organizations (still commonly grouped under the label "insurance companies") perform that function for many of us, and their dynamics are different than when the government adminsters the pool. But regardless of who takes care of the books, the reason any of us are willing to put our gold into the pot is that we expect to be able to get medical care when we need it, especially if something really big and scary happens.
But there's a problem. Pots of gold are tricky things. It is virtually impossible to look at a pot of gold and avoid thinking "Wow what I could do with that!" Pots of gold tend to make people do things they wouldn't otherwise do, ranging from bending the truth a little about why some of that gold belongs in my pocket to outright thievery (or worse). The bigger the pot of gold, the further people are willing to go.
The economy of modern medicine in America is one of the biggest pots of gold in history. It has attracted thieves and scavengers. Good people tell lies large and small to make sure their part of the gold is secure. In a classic example, the hospital charges us $5 for a Tylenol, and tells us it's to pay for the uninsured patient in the ICU. We grumble but accept this, another de facto socialization of medical economics. Different patients are charged radically different amounts for the same service based on who is managing the pool of money to which they contribute. Many medical providers won't release their prices, because the amount of money changing hands is so fluid that the word "price" is meaningless. Insurers try to trick patients into paying bills they don't owe, and try to avoid paying what they've contractually agreed to pay. Medical providers in turn further distort "prices" to try to compensate.
This is not a free market. This is not an open economy finding the most efficient way to distribute resources. This is people telling each other lie after lie after lie as they shuffle around shares of the pot of gold. And the greatest lie is the one that we all tell ourselves so often. That the pot of gold is infinite, that in MY case (whether it's a lawsuit, an expensive medication, my company's business practice, my personal salary, or one more test on a dying loved one), I can ignore the system as a whole.
This may seem to be belaboring the obvious, but I think getting to the basics is essential if we're going to modify the leviathan social organism that is American medicine.
More thinking to do...
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