I guess the things you've spoken of relate under the health care umbrella, but I do think each has its unique place in the health care debate.
Competition...likely not enough currently to cause any real change in price. Very few (if any) lost cost options. Usually must be employed to have a shot at "affordable" health care.
Costs rising v. quality increase...agree. Though both M'care and BC/BS have set forward pay for performance guidelines. It is a five-six year implementation, which gives gradually decreasing bonuses to physicians and hospitals for moving to electronic health records, e-prescribing, reporting/improving outcomes above a certain %, etc. Now, I can say that while the word "bonus" is a bad word in light of AIG, et al, my hospital has participated in M'care's PQRI for the past two years w/o receiving a bonus despite meeting the goals. Again, no surprise from me as it is a gov't program that ebbs and flows with the economy. And we strive to have the highest quality possible, as there is true competition between hospitals for patients (which I like, as patient satisfaction and safety are top priorities, with physician and employee satisfaction a close second/third).http://www.cms.hhs.gov/pqri/
I admit to not knowing as much re: the BC/BS quality program.
I doubt many think the system is perfect. I have health insurance but was hit with a large bill when we lost the pregnancy earlier in the year. I was kind of surprised, though we did go out of network, which reduced the coverage %. Though, when you have arguably the best hospital in the country (Johns Hopkins) next door, I'm willing to pay the extra.
I lived in SC for 20+ years. I think some who can afford health care are uncertain of change and whether they will like the change. Which is a typical response to any change that might alter the status quo. I also think that per southern mindset, gov't intervention is always viewed with suspicion. Elderly are concerned about what will happen to their M'care benefits.
And I don't blame the uncertainty from some people. Nothing concrete has been laid out (possibly today's revelations provide better insight IMO). Public option? Co-ops? Single payer? Etc.
There will be no perfect system. As mentioned elsewhere, physicians, PAs, NPs, etc., aren't going to settle with being paid less. So if reimbursement is lowered over the patient base/payer mix, there has to be a way to make this up. More patients seen is a good idea as the demand is higher. But this means less physician one-on-one time per patient. msdmnr and doclogic (and other physicians) may not like this but increasing usage of PAs and NPs as a lower-cost alternative to multiple physicians at a location could keep costs down...but likely patient satisfaction suffers as patients want to see a "real doctor."
Another option already exists....excluding insurance plans that reimburse at < 30% of the charge. Medicaid is already excluded by many offices across the country.
My guess is that you will see more affordable insurance plans but that the one-on-one time that you would like from your physician is never going to return to what it was 20+ years ago. Though, many physicians are now offering "boutique" services, requiring a one-time payment per year ($1400+). Maybe an additional small co-pay. But some physicians have moved to this b/c they were so fed up with the insurance companies. Allegedly it allows for more one-on-one time with the physician, appointments whenever needed, etc. It wouldn't cover emergency visits nor visits outside of that particular office. But if you had a good PCP and felt comfortable passing on specialists, it might work.
It's not a good system. I hope for reform but one that doesn't limit a hospital's abliity to employee great physicians and clinical staff, nor limit the ability to raise capital to purchase new equipment to make a patient's visit faster, easier, and more comfortable.
My hospital has recently implemented a Lean/Six Sigma plan across the hospital to improve processes and reduce costs. I'll let you all know how it goes for my various departments.
Increasing taxes doesn't bother me, if it is for health care improvements.