We are headed for huge changes on how healthcare is delivered in the US.
It is hard for me to say if this is 10 or 20 years away. Though I think the ACA has accelerated this process.
Universal Healthcare should be a pillar of a modern wealthy society(as we like to think of ourselves). If implemented correctly then it will result in savings down the road, because a healthier society is a more productive society and doctors will be able to intervene on issues earlier when they are less expensive.
Unfortunately this is not fiscally compatible with the way Americans have come to perceive the delivery of healthcare which is a kin to a fast food restaurant where they can come when they like on the menu at any time they want. Continuing to deliver healthcare this way while adding universal healthcare will be financially ruinous.
There are various factions that will fight tooth and nail to keep the changes from happening because they are making too much money.
What you will ultimately see is the elimination of the small entrepreneurial/small business doctors office. Several physicians with a keen business sense have used this model to make themselves very wealthy at the cost of everyone else in the system.
You will probably see the implementation of an automated medical home.
Your direct care will likely be given by a mid level provider such as a nurse practitioner or physician assistant. The doctor will come in on more serious issues.
The ACA/Obamacare is a start down this path and will likely evolve and change many times over the coming decade.
The republican plan under Ryan was essentially a minor tweak of the current system with no structural changes.
Essentially a way of maintaining the status quo for as long as humanly possible.
Patients on medicare(the largest deliverer of healthcare in this country) would see much of the savings by the government essentially passed on to the people in the form of higher premiums.
Lower middle class elderly would get hammered by this. Upper middle and rich would simply shift costs to supplementary private insurance.
Many providers preferred this system because they feared change.
State driven medicaid systems simply do not work, and when Romeny began spouting off about how successful this model was, I burst out laughing. The state of Florida has easily one of the most poorly run, inefficient, and underfunded medicaid systems in the entire country.
I gladly embrace a company (like MCNA) to privatize medicaid. They not only deliver savings to the state (3-6% typically) but also enhance provider compensation. If there is no change, the entire state will find itself with zero providers