there are enough talks about health care reform. the key point is largely unanswered and everyone knows there is no answer!
YES, the american health care system is almost broken. it accounts for 20% US GDP. who to blame for such high costs?
(1) number one killer: drugs. US is among a very few (probably totally 3 in the entire world) nations where there is no cap for pharmaceutical drugs. pharma were born in Europe and were the best in Europe. decades ago, most EU nations imposed cap on pricing of drugs which resulted shifting of pharma research and innovation into US. does US want to kill pharma innovation too?
medical devices are so expensive too with same issue. no cap of pricing means that drug/device company can price the drug as high as possible as long as someone wants to buy it.
(2) number 2 killer is insurance itself. more than 80% of people are well-insured with 90% of burden being paid by employer. with insurance, doctors and hospitals only consider how to diagnose and treat diseases instead of worrying about cost at all.
(3) no cap on malpractice. America has more than enough lawyers. doctors are most times forced to play defensive because they do not want to get into trouble. For example, they will use high tech, expensive tools to rule out remote possibilities. A minor car injury will certainly get MRI scan of head and spinal cord etc even though there is no sign of any such problem at all.

(4) people blame high income of physicians and hospitals. actually the money goes to doc and hospital in US health care is really tiny relative to the gigantic trillion dollar bill. docs make a bit more then engineer on average. however they invested a whole lot more before. the US may want to change the medical education and training here. In this world, only US and Canada medical system require a bachelor degree before medical school. It is highly arguable whether a bachelor degree is that important for medical school. it certainly helps. but god knows how useful it is. why a 4 years education in economy, business and music has a lot to do with medicine? american medical school is ironically expensive. if docs do not make significantly more money than other professions, less people will go to medical school and the tuition for medical school can drop a lot too.

(5) #5 killer is american health care itself. the system is too segmented. each doc has its own clinic. each cardiologist has a set of really expensive machines and 50% of time, those machines are probably idle. this segmentation brings convenience to patients. but it incurs a lot more costs.

obama's health care plan does not solve any of this key pains in cost and thus it won't save much money if any at all. what he does is to "let riches provide free insurance to poors, let hardworking provide insurance to lazy guys and unlucky guys".

someone has to pay for it. gov. does not make any money. so the money has to come from taxes, printed money, borrowed money etc.