Government funded universal health care has many issues. Having run medical groups and nursing organizations, when physicians, nurses, and health care workers are paid on productivity, their productivity soars as the "unit of health care" cost declines. No real magic.

Some examples, physicians paid on productivity on average see 40% more patients per day. Nurses paid per visit doing home visits versus hourly were also around 40% more productive. Surgeons paid per case were 50% more productive (the key to surgeon productivity had little to do with how fast they worked and everything to do with how efficient the operating rooms operated... but the when the surgeon's compensation was linked to that efficiency, they demanded it.

The organizations I ran converted about 70% of the higher productivity into higher wages and the other 30% contributed to the earnings of the entity. We had almost zero turnover.

Are there issues with productivity-based compensation? Yes, instead of pushing people to work harder, you have to push them to slow down, take vacations, and not try to work to much. I saw it with health care techs also, when we paid them per shift versus a weekly salary, they typically opted for more shifts.

I am not saying reengineering compensation to produce efficiency and good outcomes will solve the costs issue, but they will make a huge dent. Another example, of efficiency, in this instance hospitals. When hospitals were compensated per case, rather than per day, the length of stay dropped dramatically (almost 300% for elderly). The two primary drivers of that efficiency were "week-end" discharging and moving patients to step down facilities when less care was required.

I had a hip replacement recently, which in the past required 5 days in the hospital and these days can be done as "same day surgery". If you want to make health care affordable, you have to look at what you are paying people to do.