Obamacare

The real problem in the States, and one that Obamacare doesn't really address (although a few nods at it are heard now and then) is the outrageous costs of health care.

I'm not in the States and have had only a couple encounters with American health delivery, and it seems excellent, although no better than elsewhere.  But the same services cost me triple what it cost in my country, and let me tell you in Vietnam doctors do all right.

When you see something like this, the first step is not to try to guarantee the best possible care for everyone but to look at the incentives and see what is driving costs.  There is little or no competition based on cost and a lot of competition based on appearances (nice looking buildings, clean gowns, the most modern machines, etc).  This is probably because such a large portion of the population is insured automatically through the employer.  That system needs abandoning so that everyone has a direct interest in shopping around for lower costs.

Another thing of course is the outrageous American legal system, where there is a running lottery seeing who can get rich suing others.  I read about drug companies having to pay huge settlements when something went wrong, and I can see why drugs in the States are so expensive.

Finally, I would observe there seems a dearth of clinics in the States; there are a few but they are mostly related to hospitals and serve the hospital.  This is not a true independent clinic.  Clinics are a much more cost-effective way to deliver primary health care than emergency rooms, which have to be equipped for emergencies and should not have to deal with walk-in trade.