How Do We Fix Healthcare?

As someone who makes his living in the healthcare and health insurance industries (for nearly 30 years), I am often asked the question – “how can we fix what is broken in our healthcare system, and assure that every citizen has access to care”?  More recently, I get the question – “do you believe the Affordable Care Act (ACA) will be successful? 
In attempting to answer these, and other “healthcare reform” related questions, I always start with the fundamental issue that our nation struggles to address; which is, do we desire a government run, universal, single payer system (see Canada, much of Europe, etc.), or a market based, largely private run, profit based system, such as the type we presently have?  Arguments can be made for each type of system, but of course each has its own set of trade-offs.  In my opinion, cons of the former far outweigh the pros.  Interestingly, there have been attempts by several U.S. Presidents over our nation’s history to transform our healthcare system into more of a government run system:


T. Roosevelt
Called for establishment of a national health insurance system modeled after Germany’s.
F.D. Roosevelt
Administration devoted time to research the feasibility of a national health insurance system that would cover every American.
H. Truman
 Called on Congress to initiate a 10 year plan to transform the American healthcare system into one where coverage would be compulsory for all people (SOUND FAMILIAR?).
J. Kennedy
Advocated legislation to provide health benefits to Social Security recipients.
L. Johnson
Signed legislation creating the Medicare and Medicaid programs to provide healthcare coverage for people 65 and older, the poor, blind, and disabled. (THIS OBVIOUSLY HAPPENED.)
R. Nixon
Backed a proposal requiring employers to provide a minimum level of health insurance coverage for their workers. (AGAIN…SOUND FAMILIAR?!)
J. Carter
Called for a comprehensive national health insurance system with universal/mandatory coverage.
W. Clinton
Launched an effort to provide universal healthcare coverage based on the idea of “managed competition”.
With the exception of Lyndon Johnson’s -Medicare/Medicaid law, each of these attempts to more radically transform our healthcare system failed, in some cases due to extreme opposition from The American Medical Association (AMA).  One could actually make the assertion that passage of the ACA makes the unequivocal statement that America wants to maintain it’s private; market based system, albeit with a fair amount of government involvement.  So back to the questions…How can we fix healthcare and will the ACA be effective?  My answer – we need to decide which type of healthcare system we want, and effectively pursue, run, and manage it.  What we cannot do in my opinion, and how I generally begin the answer to the question posed at the outset of this post, is force the two radically different types of systems to operate simultaneously.