As the patient behaves less as a discriminating consumer and more as a powerless piece of the healthcare business model, the less the whole system of healthcare delivery is focused on the sick.
"Reform" is best when people maintain control of their healthcare decisions and costs by having access to coverage plans competing on quality and price across state lines. The care for the poor and patients with pre-existing conditions has been addressed with innovative solutions at the state level such as Idaho, Indiana, and South Carolina.
North Carolina will spend over 10 billion dollars on 2 million Medicaid recipients in FY 2012-13. The rate of yearly increase has taken this budget item, which is divided 1/3 state and 2/3 federal dollars, to the second largest tax expenditure, only behind outlays for education.
Top-down healthcare reform efforts, such as Obamacare, will result in smothering levels of bureaucracy, wasted money, and diminished patient autonomy.
Premium support, increased health plan choices, high-risk pool subsidies, tax credit incentives for self purchased insurance, charitable incentives for provider care, and expansion of healthcare saving account plans are all ideas that help reform our world class medical infrastructure without destroying it.