I truly believe we will see nationalized healthcare within the next 20 years and the population curve will drive it there. The projected budget deficits may hasten the onset. The fact remains, people get sick as they get older. We have swelling ranks of boomers lining up for medicare and there aren't going to be enough folks paying into the system in the near term to cover the cost of their entitlement. The drug benefit is nothing but pandering for the 2004 election to the AARP and we really can't afford it.
How did we get here? The govt, that's how. The original medicare and medicaid plans paid whatever they were billed. This created gross inefficiencies in the sysytem. As the feds woke up and began to see that they were getting taken to the cleaners with rapidly increasing public healthcare funding costs they began to crank down on providers. As the providers saw their tit drying up they cost-shifted their bloated budgets to the private sector payors (insurance co). Shortly thereafter the private sector got wise and began cranking down on all sides of the equation (hospital, MD, you).
It's a zero sum game folks. Couple that we the fact that there is a clear distinction between what is profitable and what is moral and you have an interesting mix. I don't like it but I do think it's coming.
