As I understand, the Health Care Reform is set to be killed by the Supreme Court. Or, for that matter, it may have already happened and I just missed it. (Wait, Wiki just saved me and tells me the ruling is set for June.) I noticed there are some people on these boards that want this piece of legislation gone as soon as possible (and are quite vocal about this), but what I want to know (both from supporters and opponents) is: what then?

- The US uses about 22% of the GDP on health care and this percentage is rising sharply. Faster than in other countries.
- Millions of people are uninsured, and that includes a lot of people who DO have work, but still can't afford it. Which comes as no surprise to me if I hear the prices. Some of these people will also be those that chose not to spend the money on insurance, as they perceive themselves as healthy. This of course only raises insurance premiums for those that do have insurance.
- Legal costs are through the roof, and in order to manage the liability on a micro level, doctors do every test possible, hoping not to be sued for missing something. This is costly.
- Cost-effectiveness is not even discussed, let alone that it is used to allocate money efficiently over the health care sector and over all sectors in the economy. In many European countries (UK, Netherlands, Sweden, Germany, France, amongst others), although it should never be used as a sole criteria, it is understood that a basic understanding of the additional costs per gained health is important.
- My wife just finished an internship in a US hospital, where she learned that insurance companies, even though they pre-approve all the treatment, do not pay the hospital bills 30% (!!!) of the time. This was seen as inevitable, and routine by the physicians. This money is recouped in other ways. In other words: those that do pay, pay (much) more.
- I also have the feeling, from anecdotal evidence, so correct me if I'm wrong, that US doctors seem less inclined (relatively speaking, compared to European doctors) to take quality of life into account: extra life is extra life. US doctors will therefore treat end-of-life patients more aggressively than European doctors will, focusing on any life gain they can achieve. (Dutch doctors are of course notorious for starting palliative treatment early, although I don't think this is wholly deserved.)

Pushing these problems in the shoes of the new bill as I have seen some commentaries ("It got worse since it got here" ) is not fair, because it was wholly unsustainable to begin with. (The 22% was OECD data on 2009, I think.)

So tell me, what should be done instead? Can anything be done? What way should the US go forward, before the whole system collapses, which I am afraid will happen sooner or later.