What is the Reality of the Health Care System in the U.S., now?

I woke up, unable to sleep, thinking about the present debate over heath care [or insurance] reform and decided to engage in some writing on the topic.  My initial comment follows and my more detailed analysis will be coming soon.  I am not doing this as a person with great knowledge about the medical care system or insurance system [except as an observer or consumer], but as someone who has seen how the system has operated over these years and has a view of how to improve it for the future.  After all, if we can't improve something, then it must be 'perfect' or unimportant.  That is not true at all of our U.S. health care system.

First point:  What is the Reality of this system, at this point in time?

Any improvements to the present system depend on recognizing what that system is and how it operates.  We are trying to change reality not build change on something that does not now exist.

The reality:  health care in the U.S. is tied to financing;  money drives health care, not personal decisions or choice.

 We have a medical care system in which people get care when they can or will afford it [through personal finances or  insurance coverage for the cost of the care] and when they cannot [through personally funded medical care or visits to an Emergency Room].  Because this system has grown up over the years and because of a traditional American skepticism of government and desire for independence, moving to a Single Payer system or abandoning the insurance policy-coverage methodology is not going to happen at this time in this country.  The system we are reforming relies on the participation in it of insurance companies as the source of funding for it.

Now, onto the goals of this reform process this year [coming]