It's more or less about more or less health insurance

It takes an incredible amount of work to develop an intelligent opinion on a really complicated subject, which is why I don't have much of one on healthcare reform. But, I have links.

It's fairly clear what the problems are: 1) there are a lot of people who receive too little healthcare, mostly because they are un- or underinsured, and 2) aggregate healthcare costs are out of control; as of now annual costs consume almost 18% of GDP, which is far more than in any country in the world, and they are rising faster than inflation, so things are getting worse.

Naturally, if some people underconsume but costs are rising, it must mean that some other people overconsume. This much almost everyone agrees with. The problem is with determining exactly who it is that overconsumes the most. The main candidates are two: sick people or rich people.

The first possibility isn't really that sick people overconsume healthcare but rather that there are too many sick people relative to healthy people in the insurance pool. Every insurance system is a scheme in which people who don't need it subsidize those who do, but in the case of health insurance, too many of those who don't need it opt out altogether, so a shortage of subsidies drives up the costs (this is called "adverse selection"). The second possibility is that people who can afford health insurance buy it and then, since they don't have to worry about the cost of most services, they use those services without worrying how much of them they really need, again driving up the costs.

Which of these alternatives is true is an empirical question, and not an easy one to answer. But note that a lot depends on the answer in terms of what's to be done about the situation. If you believe that what's going on is adverse selection, you'll want more health insurance. Specifically, you'll want health insurance to be compulsory, so that the risk would be pooled more efficiently. But if you believe in the second alternative, you'll want less health insurance, and will want to institute more health savings accounts instead.

Here's an article making the case for possibility #1, and here's one for #2.