To tell the truth I can't see how real reform could realistically happen at this point. So many very powerful interests make so much money off of US citizens that to transition to a more sensible system would mean
hundreds of billions in lost profit for pharmaceutical companies, for health insurance companies, for hospitals, for physicians, and for every politician and everyone else with their finger in the pot. It's scarce wonder "Obamacare" was such a joke by international standards. There's this crazy scheme in place to gouge Americans and their government for every penny they're worth, and anyone who'd try to rock the boat on it would have every force in the nation knocking on their door.