Obviously, this is all up for debate. Matt asked for my opinion. This is what I shared. Straighten me out!
Honest opinion: we should not provide "death care" or "slob care". That would change everything. Bonus opinion: focus on and reward people for wellness.
I attended a health care forum hosted by Bob Dole at the Dole Institute. It brought people from various parts of the health care industry (except insurance – that guy didn't show up, and apparently they rarely do). All I remember is that somebody – some expert – quoted a stat that something like 80% of health care costs for a patient's last stay (or maybe all stays?) comes in the last 3 weeks. That's death care, and I don't want to put my buck behind it.
If you don't take reasonable measures to be well, then I don't want to pay for your care. I don't know what those measures need to be, but they should probably be few and straight-forward. "Vegetables" comes to mind. "Corn syrup" comes to mind. Most importantly, they need to be auditable; it should be inexpensive and objective to determine if the guidelines have been met. Too many people develop chronic illness from their lifestyle and then that raises my costs. That's slob care, and I'm ag'in' it.
The government should either compete with, strictly regulate, or obsolete insurance companies. My suggestions above apply in the first two options. I don't know how to obsolete it.
Insurance companies manage risk by randomly pooling its subscribers to disperse costs. That's the origin of employer-provided care; the employer is an easy and (usually) effective way to randomly pool people. I think that model is over-simplified. Insurance costs should be hierarchical based on how healthy I am, right now (yearly re-appraisal?), according to my doctor. This appraisal should not include my medical history – just my current health and the results of that audit I mentioned above.
Primary care physicians should be paid more than specialists. Sure, specialists paid more for their education and are favored by supply-and-demand and such, but this is mucking up the system. It's upside down: specialists have the least contribution to a society's health, and yet they are rewarded the most. GPs are the front-line and need to be treated as such. Their clients-per-day are like students in a classroom and need to be minimized so they can receive the attention and advice needed for wellness.
Basically: reward people for a healthy lifestyle, punish them for an unhealthy lifestyle – deal with it libertarians, if you want insurance. Change the payment/appreciation of GPs versus specialists to reflect that emphasis on wellness. Make a regular check-up more viable and less expensive. Most radically: don't spend tons of money treating dying people or people with extremely rare diseases – it's just not as useful for the society, nor fair to the other people in that risk pool.
Also, reform in the insurance and medical services industries will have non-trivial consequences for any intimately related industries, including pharmaceuticals. Someone needs to research drugs, but that business-model is currently as messed up as the RIAA – it's all about intellectual property, baby.