The main problem with the healthcare system is that insurance companies believe their job is to ensure maximum profit for their stockholders rather than insuring that Americans can afford healthcare. As more and more people get access to healthcare, insurance companies allow medical companies to raise their costs and the costs are passed onto the American people. The fee for service payment might be a good idea if they were not responsible for ever part of the service. The insurance companies instead of using their windfall profits to relieve the costs, they put those profits in the pockets of over inflated CEO's. There is a cost for ever part of a medical procedure from the towels to the toothbrush and soap they give people. We have no become a micromanaged pay structure that charges for every little incidental rather than focusing on the health service and letting the hospital carry the cost of things that are only expensive cause the insurance companies have driven up the prices.
My wife is a medical billing and coding specialist and one day told me exactly how many medical charts are coded every day. It is sometimes in the thousands, and that is usually for just one clinic and the amounts are astronomical. Healthcare reform would definitely help to do away with the individuals who insist on getting on state funded healthcare such as Medicaid even though they work full time jobs and can afford to pay for insurance but instead of paying, they lie about their income. If health service was equal and universal, there would definitely be a lot less abuse of the healthcare system and our nation would be much healthier on the whole.
If healthcare were more focused on healing than being paid per patient or per procedure, then the whole system would probably work better. The one caveat is that I would think a fee for numerous false alarms (such as hypochondriacs cause, not a reasonable suspicion of illness) would need to be put in place to prevent overloading by people abusing the system. However, Obamacare is certainly not a step in the right direction for health care reform, and I don't see any decent health care reform being passed in the near future (especially since Obama thinks he's already fixed it).
The place we are at right now would make doing such a thing very difficult. It would be nice though, and I do think they need to start considering ways to lessen bills from hospitals because people who need help cannot get it without being crazy in debt or having to scrape by.
We're not in a position for that to be possible. What does need to happen however is radical restructuring of how things are billed. Hospitals can near literally charge whatever they feel like for services without having to provide any justification for the prices they come to. That's why it is currently such a disaster.