I agree with almost everything you're saying, with one clarification: > If you go the insurance way of the US and try to let market forces rule Market forces

I agree with almost everything you're saying, with one clarification: > If you go the insurance way of the US and try to let market forces rule Market forces do not rule in the US. If you want an example of healthcare in which market forces rule, look at India. In India, there is massive disparity in terms of equality of access to care. But on the other hand, costs are entirely transparent (unlike the US), and the quality of care that one has access to given sufficient money is comparable to the quality of care in the US. The US is actually much more like socialized medicine than people realize, due to the fact that we have two monopsonic systems[0] that we force private insurers to subsidize. It's the worst of both worlds. That said, I agree that it's not clear that a single monopsonic system would be any better, for all the reasons you mention. I don't think there is a solution. Our actual demand and expectations for quality healthcare has risen dramatically over the last century, and our technology has not kept up (to the extent that, we are able to afford the top care for some people, but it is just not physically or economically possible to extend that to everyone right now, no matter how we structure the market). [0] If the phrase 'two monopsonic systems' sounds like an oxymoron to you, just think about how we refer to Comcast and Time Warner Cable as monopolies - they are, because their markets are completely segmented and do not overlap.