The problems with healthcare are equal parts demagoguery & monopoly.

• The inequity of Obamacare is that it puts the burden for The Poor on the Middle Class.

• The irony of Universal healthcare is that the Middle Class will have less of it.

• A quick healthcare fix would to be add a Medicare For Anyone option.

• Hospitals should become Primary care providers.

• The VA never “failed,” its exploitation was simply exposed.

• Britain's National Health Service is a great model for the U.S.

• Lowering healthcare costs requires a dagger right in the heart of Capitalism & unions.

• You may get your news somewhere else but take your advice from me, the Wysest Myn in the Wyrld.

It seems unlikely that the solution to lowering the cost of universal healthcare can come through politics, there are simply too many players: doctors, insurers, unions & entrepreneurs, who are complicit in the status quo, as proven by the Obamacare debacle. The reason Obamacare doesn't do cost containment is because the Insurance & Healthcare industries did not want it to; they're the ones who get the money, and they're the ones who run up the costs. But don't just blame self-interested business & unions; patients who expect the best of everything for nothing is a significant part of the problem.

Socializing healthcare would be the best solution with its top-down cost containment; it's worked in other countries, and Medicare is already doing it. A Capitalist solution has not been forthcoming for the simple reason that healthcare is not a voluntary commodity; though not technically monopolistic, traditional market pressures do not apply. Liability issues are also unreasonably avaricious, both on the side of plaintiff attorneys & the insurance companies. And unions use the rhetoric of fairness but their reality is as exploitative as any of the other pigs at the trough.

In the meantime, here is a fait accompli healthcare cost containment strategy: first, make Clinic nonprofit & encourage volunteerism; second, advertise set prices that include everything, including labs & devices; third, frustrate liability claims using legal artifices; forth, prevent unionization; and, most importantly, fly under the radar of vested interests. If it could become fashionable to use “organic” healthcare, perhaps it might just catch on?

The National Health Service, or NHS, is Britain's socialized healthcare. The NHS serves 60% of Britain's population via General Fund taxes, meaning there is no Payroll tax. The buildings are not glass monuments to medicine, but instead plain & unobtrusive, in the local neighborhood where patients can walk to them. Trucks with the specialized equipment, like MRIs, come around to the clinics on scheduled days, so everything is available. Everyone within the clinic's radius is assumed to be a patient, and annual patient contact is automated. All-in-all, the people who use it love it.

My wife & I used the NHS for a year while I studied medicine in Newcastle, England, going to the local clinic several times so I have a feel for what it's like. For example, I received a postcard telling me to come in for an annual checkup: I walked. My clinic was a refurbished brick building from the early 20th Century, homey & non-threatening. For starters, contrary to how it's portrayed in the U.S., there are no significant wait times, maybe 10 minutes. The examination was prompt, professional & efficient; I was out within a half hour. During my visits, I paid close attention to how things worked; what was right, and what was wrong. My conclusion: we need look no further for a model of how the U.S. should operate healthcare. The big question is: are Americans too egotistical for low-key, no fuss, utilitarian healthcare?

The Veterans Administration's healthcare has been lambasted for poor service, which was blamed on “government.” What? Do people think the VA has bad doctors with outdated equipment who are too lazy to do their job? Where did the impression that the VA is a failed boondoggle come from? Well, you need to look deeper than your sanctimony for the real reasons. First, Market Forces-types browbeat the VA to adopt policies that would financially incentivize administrators who used Market techniques that act in a perverse manner when applied to a social function, but that's not the primary reason.

The ethos in the military towards the VA is to "get as much as you can get." Everyone is surreptitiously instructed on what to say & encouraged to game the system, with the mentality that veterans deserve it. This attitude is an open secret, and feeds back on itself because doctors in the VA know that a vast majority of the "patients" are faking it so they guess which ones are really sick & put the rest in an endless queue. This worked for decades; the leaches were half-assed shuffled through the system, labeled “disabled” in some manner, and booted out the door with hardly an examination. Unfortunately, from the outside, not knowing what's really happening, this looks like shoddy healthcare, and it is, but it's great service if you're dolling out free money.

Almost all medical costs are fixed. A hospital doesn't get any cheaper by not having patients: the equipment & the medical staff have to be there whether there's one patient or the Waiting room is full. Think of the whole hospital as one cost & more people using it wouldn't make much difference to prices. Also, different costs assigned to different procedures are purely artificial: fixing a broken arm takes no more resources than “sniffles;” and an MRI of a head injury costs no more than treating a diabetic. Primary doctors are multi-disciplinary & multi-tasking, and if a specialist is needed, hospitals have escalation procedures for that; more patients cause little additional burden to the existing hospital infrastructure, and the drugs prescribed are overwhelmingly cheap generics. The ER works on the principle of triage & treat, in & out, every possibility covered as efficiently as possible.

Most large cities have at least one hospital, usually in a poor area, with “Clinic” that utilizes this Fixed Cost idea: Monday/Wednesday is OB/Gyn; Tuesday is GP/Peds; and Thurs/Fri is procedure follow-ups including outpatient surgery, oncology, podiatry, etc. Plus, people know where their hospital is, and feel comfortable that all the other people waiting are just like them. The anonymity is soothing because the reason for their visit does not make them the center of attention, and they aren't reluctant to simply do what everyone else is doing,which is waiting, and if someone truly injured comes in, everybody accepts that that person goes first. Herd mentality has a calming affect, and frankly, it's cheaper too.

It's not like Obama started with the idea of, "Oh, let's make the insurance companies rich." He was a Single-Payer guy, but not one Republican would support him, which forced him to capitulate to a few corrupt Democrats in the pockets of the Insurance industry. Obama probably thought his plan would get changed later, at least I hope he did because what we have is destined to be worse than before. The insurance charade is a scam to make money, especially for the pharmaceutical companies. What we need is actual socialized healthcare, and what we have now only needs a minor adjustment to make it so: just add Medicare for anyone, not just The Old. Only a handful of Republicans would be enough to add this option.

First, let people choose from whatever insurance plans they can afford, but anybody left over gets added to the Medicare roles. We already know what the numbers will be like from Britain's mix of public & private healthcare: the National Health Service, or NHS, Britain's equivalent to Medicare, covers 60% of the population while private insurance are the other 40%. That would triple Medicare's current enrollment but the system is already set up, and expanding capacity is not a big deal: Kaiser Healthcare is a good example. Unfortunately, simply adding Medicare to the options won't be a complete fix because cost containment is mostly on the backs of the doctors, but more serious, Medicare if financed through payroll deductions, and certainly needs to be changed to come out of the General Tax revenue because its cost is devastating to low-wage earners.

The monthly insurance premium for a 2-earner Middle Class 3-children family is about $2K/mo with $1000 deductible for the Silver Plan. If the family earns $120K a year, they don't qualify for an Obamacare subsidy, so with no employer footing the bill, regular families have difficulty affording it, and as premiums continue to increase during the next decade, Middle Class people will simply “opt out” of the system. They won’t have any healthcare, while Rich & Poor people get the best healthcare available in the world. Even Middle Class workers on company plans are at risk as those become increasingly expensive such that more-and-more Small Business owners also opt out. In fact, take-home wages seem to have stagnated in the past decade but if rising healthcare insurance premiums are included, wages have actually gone up. Worse, young workers will continue to have ever increasing Medicare deductions taken from every dollar of their income to give healthcare to The Old, while they have none themselves. Eventually, the Insurance Trust will be broken by an outraged Middle Class or Obamacare will be repealed, leaving costs ratcheted up AND no Universal healthcare. Less people will have healthcare than did before the whole Universal healthcare thing started.