1. Healthcare is not accessible to a growing portion of the population.
2. Healthcare in the United States is the most expensive in the world.
3. Costs (and profits) are out of control.
Theoretically, a universal, single payer system should be considerably LESS expensive - even if nothing else changed. Why? Because in insurance terms, the larger the "pool," the less the "risk" and therefore the less the "cost." This makes certain "conservative" plans non-starters for dealing with the issues with our healthcare system. Why? because they shrink or constrain the "pool."
An apparent compromise position is to establish health insurance "cooperatives." This, at best, would create multiple pools with fewer insured and therefore have limited effect at decreasing costs.
Another compromise is to do a "public option" that extends Medicare/Medicaid to <b>part</b> of the uninsured population - the SCHIP program for children (for example).
There is no good compromise position that I can see if we are going to address both access and cost issues. We either have a universal system that everyone pays into (including employers), or we fill the pockets of private insurers while increasing the public costs of healthcare.
The second part of the problem is that healthcare provision is private. We have virtually no public healthcare system. Therefore, if we do not start the creation of a public healthcare system, and place controls on private healthcare (and pharmaceuticals), then even if we have a public insurance system, it will potentially bankrupt us on the provision end. This was the problem with the Medicare Prescription Drug Plan which barred any efforts to negotiate drug costs.
If we need public insurance to create price competition with private insurance, then we also need public healthcare to compete with private healthcare. This is not to mention that the efforts of private medicine are already heavily subsidised by public dollars (drug, therapy, and treatment research) which is turned over gratis to the for-profit sector.
One bogus argument on the provision side is that medical malpractice suits drive the cost of healthcare provision. This is patently not true. To the best of my knowledge, there have been no positive impact on costs of either insurance or care provision in those states that have enacted malpractice limits. Further, this is a public check on healthcare facilities and providers. Does this mean that there are not bogus or misdirected suits? No, it does not. However, it provides accountability in an arena where the <b>individual</b> is the underdog - not the providers or insurers.
What has successfully been allowed to happen in the United States is to make healthcare a commodity which is kept artificially short. This combination grows higher and higher costs. To fix the problem, we must make healthcare a right - not a commodity - and decrease the scarcity.
One place to start the prototypes of public healthcare provision would be in rural America. For all the access problems in urban areas, rural areas have a growing crisis. Public facilities with publicly paid practitioners could be easily instituted in rural areas. If the model works there, it can (and should) be expanded to urban areas.