I agree with you completely that cost reduction is fundamental, but I disagree with you that the problem is more technical than ideological. Who pays is just as

I agree with you completely that cost reduction is fundamental, but I disagree with you that the problem is more technical than ideological. Who pays is just as important as how much it costs, because under some regimes we get spectacularly unjust outcomes because of ideological constraints on who pays. In other words, a privatized system will always fail to adequately cover certain groups of people: the poor, those with unusually expensive conditions, the unemployed, the elderly, etc. Providing coverage for those groups, motivated by humanitarian concerns, is the reason there is so much ideological debate. The system as it is currently constructed uses a combination of limited-scope public services (medicare for the elderly, medicaid for the extremely poor) and heavy-handed regulations (various acts of Congress) to cover those groups. That is why we have so much ideological debate and why it needs to continue. Cost reduction alone won't solve the totality of issues in the system.