As a surgeon with gray hair, I can say without reservation, as Medicare implodes in 20 years (not next year or the year after) there are really only five steps that can be taken to halt the decline of American health care as we know it.
1. Evidence based, compassionate rationing. Should a bed bound 85 year old patient be given a pacemaker just because we can?
2. Tort reform. I always base things I do and order on the circumstance of trying to explain on the witness stand why I did or didn't do somehting to a jury not of my peers. So far, it's worked. I have not been sued.
3. Get rid of all this paperwork. One chart I just peer-reviewed for a complicated 2 week stay in the hospital was 500 pages long. Standardize all of this so a hospital in Brooklyn is the same as one in Walla Walla.
4. Focus the research so that the next expensive test or therapy is affordable and practical.
5. Incentivize the practice of medicine so it once again becomes a noble profession and it's doctor-patient not doctor-client...