On the demand side you have varied risk (old plus healthy young).....that reminds me of CDOs and tranches of bundled-up blue chip stocks with high risk junk. Okay so let's look at this model to spread risks. So staying on the demand side, if you have a monopolist (say the US government on behalf of this) then there is your power in the market where the supply side has oligopolists - big pharma, fro-profit hospitals and doctors, etc.
So two big forces meet in the marketplace and negotiate from strength. You must get some equitable position. the supply side will contain costs and the demand side will get just what's needed and not more. And you know what it does not stifle innovation or the profit motive. Win-Win
Medicare is going broke, and you suggest single payer. Yes if Medicare cannot afford to cover the costs of 15% of the population, then expand it to cover 100%. Brilliant thinking.
What folks like you never understand is that delivering healthcare costs, and you haven't addressed who is going to pay for this.
In fact increasingly doctors are forcing patients to be responsible for paying the difference between what Medicare pays them, and what they bill. Many others are simply refusing to accept additional patients.
This piecemeal approach to the problem means that various groups are pitted against each other, and those with the strong lobbying groups (high end specialists, large hospital networks, medical devices suppliers and Big Pharma) protect their turf.
So it is the primary care physician and the small ambulatory care facilities that bear the burden. I know several PCs and hear their complaints. They regard going into this as a huge mistake. PCs are the focus of how healthcare is delivered, bear huge costs of delivering service, and yet see declining pay rates in exchange.
We will soon have no PCs or OB/GYNs, side from the few trained at those offshore med schools in the Caribbean or 3rd world imports from Nigeria and India.
There needs to be an all embracing discussion on how healthcare is provided in the USA, its economics and the roles that the stakeholders will play in modifying this. It is NOT a quick fix.
This is what I had with the whole process. Obama tried to ram through Obamacare quickly when his focus ought to have been on recovering the economy, which was still in dire shape in 2010. In fact Obama lost the House in 2010 because of his Obamacare fixation.
For this to have worked it should have been phased in more slowly. Yes putting in place the plans to have adult kids be included, removing lifetime maximums, placing minimal standards that health insurance policies had to meet, and preventing companies for using pre existing conditions to refuse coverage.
But the focus should have been on modifying costs rather than pretending as if our problems are solely a health insurance issue.
Had Obama focused on the economy, including starting that Infrastructure Bank that he spoke of in 2008. The Feds would have bought bonds issued by this entity instead of wasting money buying treasuries. The result was that by the time the economy did in fact fully recover it had already been baked into most people's heads, as this was in fact the slowest recovery for a long time.
If Obama was focusing on the economy in 2010, instead of trying to rush through a sloppily built Obamacare he would have kept the House, and seen less of a backlash in the state legislatures. He would then have had the clout to fully implement Obamacare once it was ready.
But his rushing caused the huge embarrassment when the exchanges didn't work. He also didn't have the time to educate the public, so that there was pushback when people saw their insurance replaced by more expensive and comprehensive plans, and also saw their doctors dropped as the HMO plans excluded them.