Here is an important piece of the puzzle about why health care costs (for both delivery and insurance) rise year after year: " . . . a fundamental reason that private-plan costs have outpaced Medicare fee-for-service spending: 160 million Americans with employer-sponsored coverage are quietly subsidizing seniors’ coverage through cost-shifting. When confronted with inadequate Medicare reimbursements, doctors, hospitals and other providers learned long ago to shift costs to the under-65 population by demanding higher payments from private insurers. This cost-shift, in turn, has fueled premium increases and rising medical costs for working families. Meanwhile, traditional Medicare fails to provide seniors with a comprehensive benefit akin to what working Americans currently have. If Medicare “as we know it” is such a good deal for seniors, why is it that nearly 90 percent of beneficiaries supplement their traditional Medicare plan with Medicare Advantage, employer-sponsored retiree coverage or Medigap policies?" The latter is a good question, but the answer is self evident: MediGAP (my emphasis) fills the coverage "donut hole" in Medicare.

But, we may well ask, why do these kludges, patches, tweaks, and other "baby steps" exist? Everyone knows how to fix health care insurance and delivery so everyone receives insurance and treatment cost effectively. Just apply the formula: Universal. Cradle-to-grave. Single-payer. Problem solved. Of course, everyone also knows that the moneyed and powerful strive mightily to prevent implementation of these principles. Perhaps the best explanation, though, comes from an observation by Winston Churchill on the American character: "America will always do the right thing, but only after exhausting all other options."