I feel that a National Health Service is inevitable in the USA. The problem is very complex, and I understand it only dimly. But there are some serious abuses:

HMO chief executives who get more in salary than the ENTIRE rest of the personnel.

Health insurance plans that spend 40% of their budgets on advertising.

Hospital administrators who get salaries of millions of dollars per year while running hospitals that are losing money.

Hospitals charging $5 for an aspirin tablet.

Hospitals now have more backoffice clerical workers than people who take care of patients.

And last, but certainly not least, specious malpractice lawsuits.

Health care problems in the USA are the direct result of unrestrained capitalism at its very worst. Nobody in charge gives a damn about patient care, just profits. Period.

I feel that health care reform without a National Health Service may be possible, but the greedy bastards (and they are that) who run hospitals, health insurance companies, HMOs etc, will not let reforms pass. Therefore, there will be pressure to establish a National Health Service.

Some reforms that might help:

1. Minimum drug price law: whatever minimum price drug companies are charging foreign purchasers for a given drug must be the ceiling price for USA sales.

2. All health insurers must spend 90% of all revenue on paying claims, exclusive of all in-house claim management and payment expenses. No more 40% for advertising, 15% for CEO, 5% for staff and actual operating expenses, 35% for claims payment.

3. Malpractice awards must be limited somehow to ACTUAL LOSSES SUFFERED. Lawyers who file specious suits must be disbarred. Malpractice insurance is absurdly expensive for two reasons:
3.1 Insurers jack up the prices because they know that they have a captive market. Again, 90% of malpractice insurance revenues must go directly for claims payment.
3.2 Crooked lawyers (I know that is redundant) sue for absolutely anything and everything, no matter how absurd and collect huge awards for "punitive damages" and "pain and suffering". This must be stopped. Disbarment is the only deterrent that will work. It must be used liberally.

4. Service providers who make systematic overcharges should be required to pay whopping fines, far larger than the overcharge amounts.

5. Training of additional physicians, nurses, and other "front line troops" to provide for more competition in the marketplace.