Physicians, hospitals, and clinics get reimbursed at rates lower than their expenses for Medicaid (30% below costs), Medicare (10% below costs), and other programs (like SCHIP). Several states don't pay Medicaid for several months at a time, if at all. (Just this week, a large number of California Emergency Physicians are suing to get paid).

Because of this, there are many areas where it is impossible to find a physician that will accept Medicaid, and the number of physicians that accept Medicare and other government programs is dwindling, as costs rise and reimbursements fall.

We need a two-tier health care system, as is the norm in most of the rest of the world:

1. a national network of state, county, and rural hospitals, clinics, and physicians subsidized by the government (financially and with free electronic medical records and bulk purchasing discounts) in exchange for accepting Medicare, Medicaid, and other government programs (such as SCHIP)

2. a private network of hospitals, clinics, and physicians free to set their own rates in order to recoup their costs, and free to negotiate with insurance companies for fair reimbursements for services, instead of the current system (as in California) where insurance companies can set their own arbitrary low rates and are protected by law in doing so

Personally, I do not consider it a good idea to have a national conversation on who should live and who should die.  It actually sounds kind of soul-deadening.  The political process does not strike me as the right way to resolve these issues.

The real issue is not whether difficult decisions will have to be made under a universal health care system - they surely will - but whether the system under consideration is an improvement over what we have now.  Let's think about that.  In both cases, if you're fortunate and have enough money then you can insist on gold-plated treatment to your heart's content, so that's a wash.  If you're less well off, you're at the mercy of your insurance company's decision as far as how much care is reasonable.  That's difficult to think about, but it's hard to imagine a real alternative.

The only difference is that right now, the decision will be made by your private insurance cmopany, whereas in a universal health care system, it might be government bureaucrats administering a public insurance program who will make the decision instead.  There's not a big gap between those scenarios, but to the extent a difference exists, it's probably marginally more likely that the more humane decision will be made by the people who don't have such an acute profit motive.

That does not mean that there aren't also many instances of patients and/or their families refusing to accept the truth that their loved one cannot be saved; how all of that plays out is dependent on skilled communication that is attentive and sensitive to concerns and feelings - sometimes families need to know that it is okay to let someone go, that no one is going to blame them for their loved one's death.

If the communication is good, I think in most cases there is a general agreement on what is or is not to be done - and that is how it should be.  We should not be arbitrarily denying people care, nor should we be forcing it on them; being gravely ill, or being the family member of someone who is, subjects all involved to enough of a sense of loss of control that to take the ultimate decisions out of the hands of those individuals would be devastating.

We need to find a way to care for the whole person, and not treat people as nothing more than their illnesses, or reject them if their prognosis is bad, or see them as little more than invoices with exorbitant bottom lines.  

If all of us were covered by a single-payer plan, the risk would be spread to the point where perhaps we could afford to practice a more humane form of care, and not have to have discussions about who lives and who dies, who is worthy of saving and who is not.

They can't pave a road, build a building or anything  because of rules and regulations as cheaply as a private company so why would they handle healthcare any better?

The key is to cut costs in the current system.  Not throw it out for a whole new one with a new set of problems.

Canada's system only works because the US is there to keep it afloat.  Britian has private hospitals to pick up the slack.  On and on.  

Half of my step family lives in Canada and I would say close to half of them have been struck by one cancer or another. As unbelievable as it might seem, 2 of my cousins have been diagnosed with nose cancer within 2 years of each other and it was taken care of as soon as diagnosed with no waiting whatsoever and also with no recurrences and no visible signs of where the cancer was removed which was extentive for both of them!

I'm also a 2 time breast cancer survivor and I would not hesitate for an instant to have my cancer care in Canada!

Your claims of medical innovations being restricted in those countries are unfounded! What do you base your assumption on that you would have died if you had been treated in Canada? It's been proven, over and over again that Canadians live longer than Americans so I doubt universal health care is a detriment to them.... Also the 6 months waiting claim is quite frankly getting tiresome. Yes, there is triage, therefore, the sickest get treated first as it should be!

The main issue is everyone having access to that system without going bankrupt.  People get basic healthcare in this country.  

It seems ironic that we would trade an insurace company that at least you can sue for a government employee who you can't do anything about.

I also think it would be less suited to control costs as well so you'd have the double whammy of more expensive and rationed care.

You really should look beyond the conventional wisdom.  In some places, doctors actually do medicine for something other than gobs of money.  I have never trusted a doctor since I moved here because it's obvious what their motive is.  Of course, I am sure I have insulted many fine US doctors, but this is the atmosphere they operate in.

But think how much better off doctors would be if the cost of medical treatment is no longer part of their medical liability, because everyone is already covered.