This is definitely an extremely important issue than needs to be addressed both here in the U.S. and around the world. The biggest challenge here in America is how to ensure affordable coverage is available to everyone without hurting quality or timely access to needed services. Having endured 5 years of the military healthcare system, I wouldn't wish socialized medicine to become the norm.
If physician compensation is capped at the rate that military doctors and doctors in countries with single-payer healthcare systems receive (in France the average physician salary is a mere $55k/year), you'd find a huge "brain drain" out of the profession into more lucrative careers. We've experienced this type of "brain drain" before- in the teaching profession. As soon as better-paying opportunities opened up for bright young women (including medicine), there was a marked decline in the quality of those entering the profession. Cap physician salaries and many of the best and brightest would choose to become lawyers, investment bankers, management consultants, etc. instead. It's a simple matter of pure economics.
Also, are Americans willing to tolerate long waiting lists for access to needed services? According to recent data about the National Health Service in the UK, 52% of patients have to wait 18 weeks or longer for needed services. In many cases, the wait exceed a full year! In Canada, the average wait time is 17.9 weeks (starting to see a pattern here?) and would be even longer if affluent Canadians did not travel to the U.S. for treatment.
The only time I've ever had trouble getting timely access to services was, you guessed it, when I was covered by the military system. I had a suspicious lump in my breast back in 2000 and was told I'd need to wait 5 weeks for a biopsy. That was unacceptable to me, so I decided to pay out-of-pocket for a 2nd opinion from a breast oncologist in private practice. He was able to get me in to see him within a matter of days AND was able to tell just from a clinical exam & ultrasound that the lump was benign (unlike the incompetent Army doctor who recommended the biopsy).
A huge thing that would help contain healthcare costs is tort reform. Malpractice suits drive up costs both directly and indirectly by encouraging the practice of "defensive medicine". An example of this is the overuse of Cesarean sections by OB-GYN's. Almost 1/3 of deliveries are now via C-section when the World Health Organization recommends the rate be no more than 15%.
Another way to contain healthcare costs would be to limit pharmaceutical marketing. Only 22% of employees of pharmaceutical companies work in research & development; by contrast, 39% work in marketing. In her book The Truth About Drug Companies: How They Deceive Us and What to Do About It, Dr. Marcia Angell of Harvard Medical School notes that the top U.S. drug makers spend about 2.5 times as much on marketing and administration as they do on R&D. In 2004, 11 major pharmaceutical companies spent the following:
| Company | Marketing costs | Research and Development |
| $16.90 billion | $7.68 billion | |
| $12.93 billion | $5.20 billion | |
| $5.59 billion | $9.26 billion | |
| $15.86 billion | $5.20 billion | |
| $7.35 billion | $4.01 billion | |
| $8.87 billion | $4.21 billion | |
| $7.84 billion | $3.80 billion | |
| $7.24 billion | $4.01 billion | |
| $6.43 billion | $2.50 billion | |
| $5.80 billion | $2.46 billion | |
| $4.92 billion | $1.70 billion |
Media outlets wouldn't like it, but I see no reason why there needs to be ANY direct-to-consumer marketing of pharmaceuticals. Here's some startling statistics courtesy of the Organic Consumers Association website article "The Great Direct-to-Consumer Prescription Drug Advertising Con". Between 1999 and 2000, prescriptions for the 50 most heavily advertised drugs rose six times faster than prescriptions for all other drugs, according to Katharine Greider's book, The Big Fix. Sales of those fifty intensively promoted drugs were responsible for almost half the increase in Americans' overall drug spending that year. Spending on direct-to-consumer prescription drug advertising was $7.5 billion in 2005, a more than 1200% increase in one decade (the FDA changed its rules about drug ads in 1997). A study done by Kaiser Permanente found that 30% of those surveyed had requested a prescription for an advertised drug from their doctor. Nearly half had received the requested prescription, even though there are often cheaper alternatives that are equally effective.
Marketing to physicians should also be sharply curtailed. Journal advertisements are fine to a certain extent but there is no reason that pharmaceutical companies should be spending $7,000 per doctor on direct marketing. For an eye-opening look at some of the outrageous practices read "Following the Script: How Drug Reps Make Friends and Influence Doctors" from the Public Library of Science: Medicine journal.
If there was reform of pharmaceutical marketing and malpractice torts, that would go a long way to reducing healthcare costs in America without needing to institute socialized medicine.
