"Consumer driven initiatives powered by Web 2.0"... WTF?
I don't see any of that in any of the other countries where universal healthcare works and people's quality of life exceeds ours. See: France. I don't see how the Asian and Middle Eastern countries you mention are more like the US than France, Canada, the UK, Germany, Spain and a host of others.
In my wild guess, our president's only chance of reshaping that system will come if he does jui-jitsu with the down economy to knock the wind out of the insurance industry's lobby engine before he even approaches the idea of change. There's a pink elephant in the room - point to it for good journalism.

Single payer will not solve health care spiraling costs. It will just lead to health care rationing and government bureaucrats deciding what services an individual can use.

You can look at the Masschusetts experiment to see increased costs, increased premiums and problems with enforcing an individual mandate.

Health Care is 17% of the US Economy. The Federal Government already controls 20% of the economy with their annual expenditures. How much do they have to control before we are truly a socialist economy?

Sorry. Apart from the gobble-de-gook of "Consumer-driven initatives powered by Web 2.0..." and similar buzzing, the dismissal of single-payer's benefits and promoting of "global" medical tourism becomes immediately evident as self-serving by the author. Fast Company would do well to avoid presenting marketing as journalistic "analysis".

One more comment. The promotion of "medical tourism" versus the current cost-driven need doesn't address issues such as after-care, what happens when complications occur, who evaluates quality of care in Bangkok, Peshawar, Brasilia, etc. Technology isn't the panacea so many Americans seem to think. As the current finanical meltdown demonstrates, human behavior driven by greed will trump mathmatical or other "models" of efficiency which supposedly deliver value in exchange for profit.

Easy answer: cut the war budget, stop shoveling trillions into private banks, and close tax loopholes and collect taxes from the richest among us. Do that and you would have enough money to put in a single payer system with all the modern features that have been used in European healthcare systems for decades. You would cut costs and be able to expand medical coverage, especially preventive medicine and epidemiology that would radically reduce incidents of illness in the US. Nothing profound about it. Unless you need a strawman to knock down in order to defend the failed status quo.

PS I lived in Denmark and had national healthcare coverage (as an American studying there). I could go into the clinic across the street or another of my choosing and see a nurse practitioner immediately. I could then come back later in the day and have an appointment with the doctor of my choice. I could choose based on the doctor's performance, which was a matter of public record. After a diagnosis (if I didn't need a referral to a specialist) I could take my prescription (if I needed one) to the local pharmacy and get it for free (and top quality stuff, no need to discriminate between brands and generics). If dissatisfied with the results, I could request a second opinion and review of the entire process for free. Of course, time off to heal was a given. Except for the chronically or genetically ill, no one stayed sick for more than a day or two.

This bogie about "bureaucrats coming between a patient and his or her choice of doctor" is already the case. That they're private bureaucrats working for insurance companies with a profit motive makes me sick to my stomach (no pun intended). Socialism has nothing to do with it, unless you mean corporate socialism.

Single payer is one way to transfer health care costs from the healthy, the young, and those who take care of themselves to others. Do not get me wrong there are some advantages to single payer.

The problem is that due to lack of competition people who are now willing to travel (overseas or just domestically) to save some bucks will have no incentive to do so. Everyone will receive the same care, even those who are willing to pay the doctor to fully explain all options. When all nurses go on strike at the same time, do you think that they will not get much more money and maybe a couple of months off so they do not get stressed out? Will good doctors quit because they do not get paid enough to do a good job? Will costs go down if everyone gets an annual MRI full body cancer screening. Lets see the full proposal before we start limiting our options. There will be some rationing - if everyone on earth got the care that Americans get medical care would be 100% of world GDP. This would be vary bad for those of us the like to eat a meal once in awhile.

Good article and discussion.

I think it is important to note that universal coverage and single payer are two different things. Everyone in the country can have insurance coverage without going to a single payer model. People should own their own insurance to guarantee portability and the government and employers should have a role in assisting people with paying for it (as needed). This does not require a single payer system.

One major thing that needs to happen is payment reform -- we need as patients to demand good value and be willing to pay for it. We can and should have better outcomes, better safety and better service for a lower cost over time. We need to stop the fee-for-service payment model that drives up costs, and begin reimbursing based on value. Currently, according to the Dartmouth Atlas, Medicare pays the most to providers and geographic areas of the country that provide the worst outcomes at the highest costs (during the last six months of life). If Medicare alone paid more to providers who provide efficient, coordinated care that results in better outcomes, and cut payment to providers who provide poor outcomes at high cost, millions of dollars could be saved. And there examples of providers around the country who provide effective, efficient, coordinated care for less cost.

I work with the Mayo Clinic Health Policy Center, and I encourage you to learn more about what we propose at http://www.mayoclinic.org/healthpolicycenter . Health care reform is possible -- but there is not one single, simple solution. Everyone is going to have to change their behavior including patients, providers, payer, employers and government.

Structural meltdown is impacting all areas of industry and society, including healthcare.

The present healthcare structure in the U.S. includes, of course, multiple for-profit insurance companies that suck billions and billions of dollars away from actual healthcare, including everything spent by practitioners for administration of payment to multiple insurers.

The healthcare insurance industry continues to distort the political process -- some of those billions are spent in _that_ direction, making sweeping them away politically (as in a single-payer system) futile while attempts by some states to address the problem simply allows insurance companies to cherry pick, ultimately defeating the purpose of the program.

Eliminating the present insurance structure -- or greatly simplifying it -- is also impractical from the standpoint of putting many out of work (something that would happen, anyway, were the old promises of HIT to ever be realized, at great cost or not).

Other costs, for equipment and pharmaceutical products (that offer diminishing returns) also contribute to this fine mess.

Wireless healthcare technologies offer the potential of significant savings, particularly as the population ages, but these savings may prove insufficient within the overall situation.

We're entering an unknown period and can only guess at what healthcare might look like in even a few decades, within a situation in which everything else has changed, too, including governments. (Look at California and the UK right now, to name just two examples.)

It's not impossible that healthcare insurers _and_ a great deal of government will be seen as unnecessary and unaffordable.

Will many us use (in our homes) or wear real-time and store-and-forward medical devices that send data to monitoring centers, greatly reducing our visits to hospitals and clinics? (These can't be built and staffed quickly enough, anyway -- there's just not enough $$$.)

Will payment be through some presently non-existent on-line entity, greatly streamlined in comparison to either present government or insurance bureaucracies?

No one knows. The situation is akin to a Philip K. Dick tale, with no shortage of challenges and opportunities.

I agree with you. The biggest problem in American health care has its roots in the post WWII move by companies to provide health insurance as a part of benefit packages. It worked fine for a while, so long as most health care didn't really "cure" anything. Then, Government started the cash bleed by setting the initial Medicare payment schedules at absurdly high rates (which was necessary to co-opt enough physicians away from the AMA's hard-line stance against Medicare). After that, new drugs and new treatments - all expensive - added to the cost problem. Back in the late 1980's many of us were saying (I was a healthcare lobbyist at the time) that managed care, with all its rates tied to shrinking Medicare reimbursement schedules, was going to cause a paperwork tsunami. It did. And then the government made the disaster worse by imposing more paperwork, the most onerous of which was HIPAA. And here we are. And we are to believe that Government being the sole arbiter and payer (yes, arbiter - you'll have to grovel to get treated)is an answer to this debacle?

No. The answer is un-tethering healthcare coverage from employment, making people responsible for decisions and choices regarding cost, and, while I'd rather it not be, mandating that everyone buy health insurance unless they can prove unable to afford it. Then, and only then, would a government stop-gap coverage kick in.

The technology to help people make informed decisions is already there, it just needs to be applied in a true free market system where consumers are charged with making prudent choices for themselves. What we have isn't really a "free market system." So long as consumers are not the direct deciders on the financial side, it will fail to be truly free market.

Would today's health care system resemble anything rational if it were designed from scratch?
Would a rational, free-enterprise health care business model even vaguely look like what we have today?
Answer: NO
We wouldn't design a system where the highest costs suppliers are the first choice (hospitals); we wouldn't design a system where well-care is mostly an afterthought, not the primary ongoing method of initiating health care delivery. A business model would look at the needs of the marketplace, design an efficient delivery system that covered 98% of the population geographically with accessible facilities, either as stand alone's, or partnerships with existing facilities( but with a different pricing model-free-market based delivery systems.
We would include in each facility the most modern technologies, designed to improve diagnostics through automation, with properly trained and certified personnel to engage as necessary, but with higher cost professionals only involved with dealing with the consultative process. We would give a Report Card for each well-care checkup, in writing with conditions, and consumer-driven remedial actions.
There's more,but if we as a society believe and support well-care for each Citizen, and paid for by that Citizen, then most judicious Citizens will opt for quality of care, and vote with their feet as necessary.
It makes no sense for a family of four to pay from $12,000 to $20,000 in health care premiums, plus deductibles and co-pays on top of that, when the out-of-pocket cost for well-care would amount to $1200 a year for the same family, primarily checkups. Using a catastrophic care premium for all costs for a single condition, accident, chronic care, in excess of $5,000 would still leave a savings, a substantial savings. So why haven't we done this?
Vested interests in the current structure, from physicians, to hospitals, government insurers to private insurers, all benefit from our current structure, one in which no rational person's business model would ever allow.
We can do better, otherwise, we meet the definition of insanity,
Doing the same thing over and over, but expecting a different result each time."
Not in the real world.

It is curious to me why otherwise intelligent people continue to oppose a single payer system. Yes, they have problems. Yes, they ration care. But the U.S. health care and payer systems (it is plural) are far worse in providing universal coverage, high quality at a cost that is competitive with the rest of the world. In point of fact, a single payer system will not cost more, it will cost less. For a few simple reasons--administrative costs will drop enormously. Today, as much as 30% of the total cost of care in the U.S. is administrative and much of this is related to the fractured nature of the payer world. Consolidate to a single payer and you've saved perhaps $150 to $200 billion. Change the way providers are compensated (and this would be far more doable in a single payer world) and you will save another $250 to $500 billion because you've taken the monetary incentives out of the system to do more. Your point that if we make pricing and quality in health care transparent, everything will be fine, could be true if we had a single payer where pricing could actually be determined. In today's world, how do you publish a price for a procedure when the fees paid for that procedure vary depending upon which insurer or government program your health insurance is with. The truth is, Medicaid pays 50% of the cost of care to hospitals, Medicare about 80 or 90% and commercial insurers 120 to 125%. In that crazy world, what is the price? Applying technology to a broken system is otherwise known as paving the cow path. It's time for smart people to support a single payer system. It just makes common sense.