The American health-care system will probably remain as it is until it completely collapses, because it requires such drastic and unlikely factors.
The first problem with it is that it is regarded as an industry, rather than as a service. Care flows to money, not to need. Is it surprising, then, that in the same system that tolerates multiple nose-jobs and questionable heroic efforts, large numbers of sick are left without basic care? It is no accident that doctor-care, testing labs, and pharmaceuticals are all still highly profitable endeavors. The pressure to cut costs has only accelerated the flight to provided care to the wealthy.
The second problem is that, because preventive measures are so unprofitable, and because the federal government has abdicated any responsibility in this regard, simple treatments are avoided until problems becomes severe enough to warrant expensive care.
Premature births, for example, are often caused by lack of sound pre-natal care and nutrition. An "experimental" program in Texas has been proving for the past 10 years that a minimal effort in providing education and examination to poor or isolated women has dramatically reduced the number of premature babies and their associated costs. So far, to my knowledge, no one else has instituted any similar program available to the general public anywhere else in the United States.
The third problem is our chaotic approach to "the value of human life." For some inexplicable reason, we are geared to provide care to extreme cases (irretrievable Baby Does, irreversible coma victims, those living only through the intervention of life-supports). Perhaps it is the media that has focused our attention to medical extravaganza or the fear of litigation that has pushed medical practice to such extremes. In any case, it has become impossible to limit the care to some people based on prognosis, and such simpler to ignore other people who need basic care.
That these unknowns are consigned to unnecessary pain and early death seems to matter not a whit. Perhaps because of this focus on the "cutting edge" of medical technology, most people believe that we have the best medical system in the world. This is not true.
Institution of preventive measures (better sanitation and clean water, vaccinations, better nutrition) have historically been, without question, the most important means of raising the average age of any population, and we have not run out of things to do. Better pre-natal care; mandatory vaccinations; better health and sex education; more assistance for people who are trying to quit smoking, drinking, or other drugs; routine examinations for everyone for problems that are easily detected and cured or controlled (high blood pressure, breast, cervical and colon cancer) as well as for communicable diseases applied across the board would substantially reduce the numbers of health problems that escalate into expensive diseases. These seem to be such simple and effective measures, but who will fund and provide them, especially if the recipients are poor?
The only system I have ever seen work on anywhere near a rational basis in this country is the not-for-profit HMO with its own staff and facilities. A similar system should be set up on a nationwide scale, with doctors as staff members. This, of course, will never happen.
The reforms that would ensure that medical care becomes more efficient and less expensive would be resisted by every group that has been making money in the health-care industry so far, and they represent a substantial lobby.