The key to really fixing healthcare.....

.......is not expanding Medicaid, as the Health Insurance Deform Act ("Obamacare") does, as it appears that a paper published in the New England Journal of Medicine has established (H/T Say Anything) that in Oregon, Medicaid recipients had no discernible improvements in health related to diabetes or heart disease.  Since these--along with lung cancer from smoking--are probably THE big hitters for the health of less affluent people, it stands to reason that overall, the benefits for a very expensive program (about $7000 for a family of three if this is indicative) are pretty much nil. 

(overall Medicaid spending in 2009 was $5500/recipient, weighted towards the disabled and elderly--younger people cost the program about $2300-3000 apiece)

Now, speaking as a guy with a pretty extensive family history of heart disease and diabetes, and having been told by his doctor that it's either lifestyle changes or medication, this makes sense.  My doctor, despite being one of the best of the best (he's a resident at Mayo), cannot do anything to have me walk out of his office 30 pounds lighter and with better dietary habits. 

On the other hand, what if we had a system where I paid, to a degree, the costs of my excess weight?  The good doctor could simply say "here's the likely cost if you gain weight, and here it is if you lose weight", and let me make my decision. 

It is, of course, what we've done already, with the "little" exception that due to government, the real costs are hidden more than they ever were before.  Maybe it's time to change that.