Obamacare and the European Model

The battle has not really started, but after the new US Congress is seated in January, the new American universal health care law, i.e., Obamacare, is going to be a hot topic in the halls of Congress.
Republicans and Tea Partiers, and a lot of independent voters, want the law repealed. That probably won't happen. But, there will certainly be some drastic changes in the bill that was passed by the Pelosi Democratic Congress last summer. We can only wait to see how it all plays out, but there are a  few things American lawmakers ought to consider as they approach the problem.
First, universal health care is a myth. There will still be millions of Americans without coverage. In Europe, where universal health care has been in effect since the Second World War, there are still holes in coverage, certainly not as gaping as those in America, and more subtle. The coverage is "universal" but the procedures and medications covered are controlled. And, as the populations of most European countries age rapidly, the question of elderly care and home-vs-institutional care is becoming a huge topic because of the cost consequences.
Second, the costs will almost surely be much greater than Congress has predicted. France and Germany are seeing their national health care budgets expand substantially as the medical community finds new medicines and new treatments that always cost more than the older items they are replacing. Add to that the problem of the aging population, and the obsolescence of the medical infrastructure - hospitals, clinics, laboratories - and the costs are rising faster than the governments can find suitable ways to pay. Complementary insurance, paid for by the individual, or co-pays, fill in the holes and save money for the government health care system, but poorer citizens fall through the cracks.
Adding Great Britain to the equation gives a good picture of what is in store for the rest of Europe and the United States. Medical access is more and more tightly controlled, waiting times for non-emergency procedures can stretch out for six months or more, medicines are being eliminated from the qualified list so that costs can be held at current levels, and some treatments and medicines have age cutoffs so that elderly patients do not have access to them. And, more to the point, medical services in Britain are drastically out of touch with the population. Gatekeepers and practice groups make it almost impossible to have a relation with a generalist who knows the patient over a long period of time and understands his or her real problems and needs. That alone is costly in the longer term. Many British citizens pay the cost for private medical care, outside the government system, because it's the only way they can get meaningful, timely treatment.
Switzerland has an "everyone pays" system, in which each citizen (including children at a slightly reduced rate) pays approximately 400 Swiss Francs (about 400 US Dollars) per month for coverage, as well as co-pays. There are many who cannot make such a large monthly payment and the government pays the difference for them.
So, universal health care sounds wonderful, but what are its characteristics? Less service, more gatekeeping by remote medical bureaucrats, the need to buy personal private complementary or primary insurance to get real medical care, deteriorating medical infrastructure because there is no money left to upgrade public facilities, and rising costs that seem to be uncontrollable for the most part.
I have not mentioned the Canadian health care system because I'm not familiar enough with its characteristics, but I cannot believe that similar problems don't exist there as well.
So, US lawmakers, be careful and don't be fooled by pleasant sounding phrases. Universal health care is a multi-headed monster that will eventually be so costly that no government will be able to provide it without making severe and arbitrary cuts in services. Don't toss out private health insurers and employee-provided insurance unless you are sure it can be replaced effectively and at costs Americans can afford.