Until consumers realize that the more they consume of health care, the less income they have for everything else, they will continue to demand too much health care. The problem with cost cutting measures designed to make that connection more apparent is that to work everyone must be in that boat - and that is a hard sell. The other problem is that even with all of the consumer responsibility you can think of, the drive for greater and greater profits will have insurance companies constantly searching for ways to avoid paying for the care they promise their policy holders. They don't care so much about the little things - what they want to avoid is paying for serious chronic illness. If you have a high BMI and are getting on in years, they will do everything they can not to cover you - since they look at these factors and see stroke, diabetes, heart attack et al. If they have to cover everyone and can't charge potentially sicker people more, their ability to increase profits over time (which seems to be the goal of privately held firms) will be greatly impacted. In the end, their business model will not handle covering everyone at a market rate. This will lead to either consolidation (until they can't consolidate anymore), bail outs or the offloading of the sickest to some kind of public fund. In other words, single-payer insurance is almost inevitable - whether by government mandate or because of the natural tendencies of the market. Does this mean we can pass such a thing now? It would be nice, but I don't think the industry is that forward thinking. The best thing we can do is pass something now and let time do the rest. When the bottom falls out of the industry, we must simply be ready with some kind of single payer system.