I can write literally pages on this. Conclusion: I think government should be involved, BUT only for preventive care and early diagnosis WITH rules that reward healthy life style and punish people who do not live responsibly. It is much better to prevent potential health issues and much cheaper than treating it after the fact. Sometimes, it involve gut wrenching decisions, how much longer can a patient live and at what cost.
Background: For the past 20 years, I have watched friends and family members who work in the health care industry or even health insurance industries in both USA and other countries (joy of inter-racial marriages, I get to learn other culture and countries as well as my cousins marry different ethnic groups)
I know friends from college, who, after working hard for quite a few years, gave up on practicing as a doctor. I also still have family members that are practicing medicine as doctor, nurses, in USA and other countries.
I also worked in the insurance industry and also have some exposure to the legal industry.
Ever since I heard my friends telling me heart breaking stories about how they want to give patients care and can't, some chose to quit, after medical school, some quit after residency, some, chose to join cooperatives, take pay cuts, in order to bypass some insurance hassle and treat patients closer to the way they want.
I thought the health insurance industry, lawyers are to blame until I started to gain exposure to those industries due to my work. There are a lot of blames to go around. Health insurance industry has their own problems. Let's just say one of the company I worked for dropped their health insurance policy because they were losing too much money, at least that's the reason I was told by the management when I was wondering why a good health plan, a good, "product", was discontinued.
Because I can write pages on medical malpractice, insurance industry and medical practicianer's problems and challenges, I want to point out to something some people may not be aware and I was not even really aware of it until one of my cousin started to work for NIH.
US government often dole out government funding for research, from basic science to medical, especially pharmaceutical research. Do you want to know who enjoy the fruits of that labor? Private entities, often corporations, can apply, get grant, and then apply for patent on those medication. This goes further, look up on Bayh-Dole Act in the 1980's. That's one source of some of USA's problems.
Medical cost keeps on going up, there are certainly enough waste, but if you look at some of the break downs, why do procedure and medication cost so much? Doctors and hospitals need to cover their cost + making a profit. I do know doctors who will treat patients only out of kindness, but at the same time, you cannot naively believe most of them will starve their own family to do it.
Bayh-Dole act allows private entities, including universities to get goverment funding for research, then apply for patent and enjoy the fruits of their labor. Theoretically, government retain the right o force licensing of the patent for public benefit. In reality, that is rarely exercised. I found one case, LED lighting, was forced by department of energy to allow public cheaper access to efficient lighting. I called NIH and some government agency as I was doing research on this matter and frankly, it was difficult to find cases where government actually exercise the right to force patent royalty licensing for the public benefit, eventhough government paid for the patent development, some, to close to all of the cost of that.
Pharmaceutical companies spend tons on marketing, those including ads run in the media, spam mail + visit to doctor's offices.
Have you ever been in a doctor's office, waiting for your appointment to be called and watch all those nicely dressed gentlemen and ladies from the pharmaceutical industries? Gee, guess who are paying for those perhaps un-necessary medication cost? Initially, it's the insurance, then ultimately, it's the patients, the public, who will pay the bill as insurance drops coverage, reduce coverage to cover the cost. Is it wrong though?
There are increased return to scale on preventive medical care, and you don't need much bureaucracy from the govenrment for that. Everyone just needs an unique ID, that keeps track of what flu shot, immunization, annual physical check ups, etc. have been done and encourage people to get them and reward them for keepign themselves in shape by providing reimbursement for expensive medical procedure later on and deny those reimbursement to people who don't live responsibly.
Food subsdies in USA is encouraging people to eat less healthy.
http://www.time.com/time/health/article/0,8599,1917458,00.html?iid=tsmodule
You probably want to read that. All those antibiotics usage is really causing problems. I've worked with surgeon before, my boss was lamenting the problems caused by drug resistant bacteria. We have seen pharmaceutical rep visit in our office and my boss was especially interested in new anti-biotics to help him combat patient infection problems from drug resist bacteria after surgery.