re: How do we lower the cost of health-care so that the quality doesn't fall ?

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Rationing. That is, you can reduce the quantity. There might be some other tweaks (better negotiations for prescription drugs, etc), but there is no magic bullet.

You can get the latest, greatest healthcare but it will cost you. Or you can add waiting lists.

Americans want the best and they want it now. That's the #2 reason our system costs so much.

#1 is that we are a bunch of fatties.

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Referring to the last point, we have a system that is becoming increasingly “color by numbers” and the drawings are made by the pharmaceutical industry. Doctors are becoming pharmaceutical representatives. Prescribe a pill and move on. If that pill doesn’t work, come back and we’ll get you a different prescription.

When is the last time your doctor talked to you about your overall health and not just about the latest ailment that you can get a pill for?

I don’t see any way out of the current system because too many voters get “free” healthcare. Medicare, MHS, VA, etc… Every attempt to go to a single payer system has tried to give the same healthcare to everyone. They try to make it fast, cheap, and good, and the end result is that it will be none of those things.

I have proposed on this board before that we go to a two tiered system:

First, a basic plan that is available to everyone, and paid for with the money that our government currently spends on healthcare. Everyone, including Seniors, Active Military, Veterans, disabled, and others who are on one of the myriad of government programs would all get this. It would be good, solid healthcare, but basic. In other words, you may not get to pick your own doctor, get name brand drugs, have the latest prosthetic, or have the shortest wait times to get non-emergency services, but you would get good overall care. It would have to be monitored to ensure that costs don’t creep up. Insurance companies would be incentivized to fight against the government plan scope creeping up by paying for things like ED medication and other non-essential services, so this might be easier than it seems.

Second, a secondary system that could be administered by insurance companies where they can design supplementary plans that pay for name brand drugs, private hospital rooms, faster access to MRIs, access to your own personal doctor, and the latest and greatest treatment options. The supplementary plans could range from basic to everything under the sun, based on what you’re willing to pay. If you have a supplemental plan, the monies would supplement the money already paid in the primary plan.

Employers could provide supplemental insurance for their employees, or offer a range of plans for purchase via payroll deduction. Citizens could purchase their own plans from private providers, and providers would have to compete for customers, meaning that the Insurance companies would have incentive to be cheaper and/or provide better service than the primary plan, by itself, and their competitors.

I could envision the young, healthy, and those on a tight budget would all take the basic plan. Everyone else could get a cafeteria style plan that fits their needs. Preexisting conditions would be covered under the basic plan benefits.

So everyone would get cheap. You can get good and fast if you're willing and able to pay more.