Real reform won't happen until the American people take their seat at the head of the table and invite doctors, ethicists and healthcare experts (not industry lobbyists) to bring their best knowledge about what interventions are most important, most effective and most cost efficient. Then we can sort out our priorities (you can call it rationing if you want) and create a budget.... and that's just part of it. Read the whole thing.
Only then we can begin to negotiate with third parties (insurers, Big Pharma, etc) to sell us what we need at the best price. That's called competition, and it's what American capitalism is all about, right?
The problem is, the American healthcare consumer (and I include myself here) still thinks someone else is footing the bill. Who that someone is, I don't know. Maybe the rich. Maybe our employers. Maybe the Federal Government.
What we have yet to get is that there is no "someone else". The deep pockets are our own pockets, and they are empty. Our tax dollars. Our pensions. Our companies going bankrupt from paying employee health care costs.
Until the American people get it that it is our responsibility to get our spending in line, and until our representatives have the guts to turn away the industry lobbyists and represent their constituents instead of their campaign bankrollers, we will continue to have uncontrolled health care spending.