There are two basic flaws that need to be addressed in any "reform" of the system:
1. The entire system is built on the expectation that people will get the best personal medical care available, but that someone else will pay the bills.
2. It's impossible for any third party such as an insurance company or a government agency to calculate financial costs for medical coverage when the standard of care keeps advancing. Medical insurance today is like an auto insurance policy where you can buy any vehicle available to you on the market if yours gets stolen or gets totaled in a crash. You can be damn sure that's going to be an expensive insurance policy.
Those are very good points, but...
The care has become a train wreck!!!
At some point, perhaps I’ll compose a vanity detailing the last couple years my elderly parents have been through. (By extension, since I, with aid from my wife and daughter, are the primary responsible parties for my parents, we’ve been though this hell too.) I’ll include a brief comparison to an extended critical care (followed by extensive rehab) episode my Mom went through roughly 25 years ago. This assumes I can get an entire weekend to put it together, because that’s about what it would take.
Of course, it’d probably be better for me to just go on a fishing trip or something, rather than increase my chances of an ulcer!
In short though, the decline is beyond dismaying. I’m not even sure what the right word is. Terrifying? And so far, we have found basically the same thing in every one of the several facilities my parents have been in, the last couple years.
To be clear, this is not a problem with all caregivers: Many doctors, nurses, and so on, are terrific. I even call my Dad’s sitters (most, anyway), his “angels.” His ER doctor, a few weeks ago, was wonderful. The EMT’s were super-professional. His hospitalist, a couple weeks ago, was great too. Modern medical technology is a marvel. I could go on.
But, the SYSTEM is fragmented, “paperwork” seems to be the prime concern outside of true life-or-death emergency situations, and communication / coordination / efficiency is just... horrible. I could list & describe examples for hours, and I can come up with multiple examples for every facility my Mom & Dad have been in these last couple years, with the possible exception of the office of my Dad’s present PCP. There have been so many “right hand doesn’t know what left hand is doing” situations, inexplicable delays (inexplicable even to the medical staff, often), and so on, that I almost went crazy. In the last couple months, I am pretty sure my Dad would be dead if I had not been on hand almost daily, “pushing” and / or following up, over a several week period. I am also pretty sure now that compared to “efficient / timely” care at various points, he has been unnecessarily permanently damaged to some degree. At a minimum he will likely require rehab that will take longer than his (best case?) remaining days. But... I have no time to sue. Besides, how does one sue a system? There is no one caregiver I can or would want to pinpoint or hurt...
Most of the problems, IMO, are due to the inevitable red tape that was growing like a cancer even before ObamaCare, and now Obama has put it (the cancer) on steroids. Your 1st point is a factor in this.