>Isn't that what reallly needs to change? Medicaid, medicare, and private insurance companies deciding when and what treatment is appropriate instead of the doctor and the patient.
>
>Perhaps this is one of the jokes JS talks about: initially "loss of choice" was to be a disastrous consequence of reform, now it's something that it should have solved. ;-)

Loss of choice has been a disastrous consequence of reform.
I've listed a number of problems before and each one of them stems from previous "reforms".
- Tax code punishes self-employed by denying tax break for health insurance
- Employer based insurance punishes individuals seeking their own coverage and those who lose/change their job, regardless of cause
- Legal restrictions prevent interstate insurance options
- Medicare/Medicaid price controls discourage care and skew provider's costs requiring inflation from private insurance
- Medicare/Medicaid/SCHIP/VA etc programs arbitrarily injecting inflated (borrowed) taxpayer money into the market
- Exhaustive and expensive FDA process for bringing new pharmaceuticals to market
- Legal structure allowing punitive malpractice awards/settlements based on shaky science and the compassion of uninformed jurors

Previous reforms have punished people for seeking alternatives to employer-based or government sponsored care. In addition the interstate prevention laws, restrict choice to one's own state.

There is very little choice in our current system. The joke is that the current system is anything close to a "free market". The punchline is that a complete government takeover will improve the situation.