Much current healthcare reform debate centers around proposals to extend health insurance to almost all Americans so as to allow them access to care that might spare them from serious illness, death, or financial devastation. Insurance reform is necessary, but it is not sufficient to reverse the current descent of American healthcare into unaffordable chaos. The greater part of the threat lies elsewhere. It is the elephant in the living room that legislators find difficult to mention because it is so daunting to fix. It is the healthcare system itself - a disorganized morass of duplicate or unnecessary facilities, tests, and treatments based on a fee for service paradigm that encourages excess and discourages attempts to reduce waste and inefficiency.

For anyone who doubts that fixing healthcare itself will ultimately be more important than fixing the insurance system, however much it needs fixing, I highly recommend the sobering analysis at the following site, which deserves careful and objective scrutiny -

If the level of healthcare discussion were commensurate with the magnitude of the dangers posed by each element of the problem, we might not necessarily want to see less discussion of insurance, but I believe we would need far more on what the insurers pay for. Indeed, if insurance coverage is extended, and healthcare excess is not curtailed, the problem will worsen rather than subside, because more and more people will be able to demand services that include both necessary ones and wasteful ones that threaten to bankrupt the system.