My biggest fear is letting congress into the exam room. There is so much room here for medical decisions to become political ones. There are so many opportunities for government to screw things up.

The observation about most $ being spent late in life (It is actually in the last 6 months) can lead to some unpalatable solutions like having some kind of criteria that marks someone is likely to die and denying services other than palliative ones. (ie, you can't have chemo, but you can have morphine).

When will assisted suicide become a billable procedure?

I can see people who are obese, smokers, alcoholics, or other self damaging behaviors having higher premiums.

Then there is the whole family planning/abortion issue. One group that thinks public money shouldn't pay for the termination of a pregnancy. Another that feels Dr's should be compelled to give the "morning after pill" regardless of personal convictions. This one is sure to be part of the debate once congress is involved. It may not have happened in other countries, but does any one here believe it won't happen in the US?

What about forcing Catholic sponsored hospitals to perform abortions?

What about coverage for chiropractic, homeopathy, therapeutic massage, nutrition supplements, acupuncture, colon cleansing, health club memberships, diet programs, yoga, meditation, etc. They will all be lining up with their hands out and it will not depend on what is proven by investigation or evidence, but on who has the best organized lobby.

Has congress ever done business any other way?