The simple fact is this; the elderly and dying, and chronically ill -- the largest consumers of health care -- are rarely in a position to pay for the actual cost of their care. If those costs aren't socialized in some way (covered by the healthy and whole through some mechanism like insurance and taxes), providers can not afford to provide the care patients need, nor can they expect to enjoy the kind of profits and income that, in the last half century, most have come to take for granted.

There's a reason why my cousin the surgeon, who began practicing in the 1960s, is a millionaire several times over and his physician Granddaddy -- an equally dedicated and respected doctor, in the same part of the world, much earlier in same century, often was paid in barter.  

Medicare has another purpose, too, beyond providing an "entitlement" to consumers who could not otherwise afford care and an assurance of profit and income to providers. That purpose is to off-load responsibility for the sickest, most costly, least profitable patients from private insurers to the taxpayer.

There simply is no way to reform our current health care system without recognizing that it has developed the way it has in order to benefit providers even more than to benefit consumers and citizens. (Large numbers of whom receive no or little benefit until late in life -- if they make it that far).