I debated on whether to wade into this, but the balanced way the questions were phrased by SteveZ sort of reeled me in.
Let me start by saying in no way do I think I have the answers, but I do have some observations, which are only my opinion based on my experiences.
First I do believe that our present healthcare delivery system is irrevocably broken. It is not sustainable from a financial or "personell" standpoint. While we do have government/taxpayer sponsored programs, some of them are so pitiful that a large majority of physicians are now not participating, and this does include Medicare(watch the news on this issue, it's coming). It is not about getting rich for the physicians in these cases, it is about survival. In many instances it either costs money to see these patients, or at best is break even. No business can be expected to survive that. Bear in mind, I am speaking primarily of Primary Care Physicians here.
The problem is so bad now that it is becoming extremely hard to find medical students willing to even go into these fields. Couple a rapidly aging population with a massive expected shortfall in primary care physicians and realize we have already mixed all of the ingredients for a disaster.
Is a "government run" single payer system the answer? I certainly am not confident in their ability to run something this important based on past history. What other entity could do it?
Do we have a responsibility to provide healthcare for everyone? On some levels I think yes. Healthcare as a commodity is a little different than a lot of things. There truly is a bit of an ethical question involved. Should people with more money and resources get more or better healthcare? I do recognize that the sense of entitlement in today's society is beyond absurd though, and that there are multiple abuses within the present system.
My personal humble opinion is that we likely do need, and at some point will have some type of single payer system. Astoundingly enough, physicians that fought it for years are now on board due to the pending collapse of what we have now. My great fear is that it will happen to late and with little planning....reactive rather than proactive action.
Alot of providers involved in the present system know that without a major paradigm shift any action is likely doomed to failure.
As massive an undertaking as it will be, the government is the default "head" of the system I think. Grand steps need to be taken to remove bureaucratic costs, multiple levels of midmanagement, antiquated forms, and ridiculously cumbersome standards. Steps to take special interests out of the picture and disincentivize dishonesty and profiteering from the system would need to be intelligently implemented. I think taking the insurance companies, HMO's, PPO's etc, with their large profits out the equation will give us some wiggle room financially.
As important as ANY of these is the involvement of people Representative of the general population and representative of real world physicians that have to work within the system. A big part of the horrible mess we have now is bureaucrats with little or no real world knowledge setting up a system with inane and arcane rules. Congress passes and approves these pitiful rules while they have the best health care in the country. Parity?
Realize also that like it or not we DO have a single provider system...any patient can go to an E.R. any time for any condition and they will be seen and treated regardless of ability or intent to pay. I would estimate that fully 70-80 % of these visits are non-emergent.
More money is not really so much the solution as better utilization of the resources we have. Can we achieve such a major change in how things have been done for so long? I don't know but it will likely require some sacrifice and adjustment from everyone. It will not be what we are used to, nor will it be painless. The fact is we have to do something..we are in serious trouble at this point.