Now, as I've said before, identifying a problem whilst admitting that one does not have the answer to it is not an inherently bad thing. AL has pointed out the problem (well, he's hardly the first to do it, but SFAIK this is the first impression in the blogosphere); this is the first step. The second step is brainstorming about it. (The third step is to throw out all the obviously unworkable that we've come up with).
I made comments on his blog, that I'll expand on here:
Extropian bullshit aside, we're all going to die. Any health care system has to contend with the reality that sometimes all you can do is not enough.
The standard by which health care has traditionally been measured is "all you can do" (not that this standard has always been met). Up until (roughly speaking) the end of World War II this wasn't very much; it doesn't cost very much to do nothing. In the past several decades, it has become possible to do a lot; the halt walk, the blind see, and sometimes we can raise the dead. Of course, doing a lot costs a lot.
Health care is not necessarily compatible with civil rights. From the house arrest of "Typhoid" Mary Mallon, to the current insistence that unvaccinated children not attend public school, we are likely in many cases to have a conflict. How strict in favor of (or against) civil liberties we wish to be is going to greatly affect what system we devise.
My own brainstorming on the subject, not to be taken as an attempt to hand down a ukase from on high, but as a starting point for discussion:
We have a national payer system -- call it "Medaccount" -- that, among other things, supercedes Medicare and Medicaid.
Medaccount pays for every medical procedure that existed in 1965.
Prescription drugs are an exception to this; all drugs are covered if the patent on them has expired.
None of this is to be taken to forbid private insurance, private spending, etc.
Medaccount is limited to citizens and permanent residents of the U.S.
Medical care remains voluntary, in the sense that a patient can decline any medication, treatment, etc. However, that a patient did so is a perfect defense against wrongful death or injury suits (this includes such things as a schizophrenic refusing anti-psychotic meds, having a violent episode in public, and being shot by a cop).
If Medaccount doesn't cover some medication or procedure, and you can't afford through non-governmental means -- well, T.S., Eliot, you're gonna die. Is this callous? Why yes, it is -- but the alternative is to have patients and their families suck up the entire GDP to extend somebody's existence for six months.
Comments? Go ahead, call me a son of a bitch; I've got my birth certificate.