I understand that the devil is in the details. But if the US would have initiated this reform much earlier, when the economy was in better shape, it would have been easier to go through the inevitable growing pains. As to the political process to get this through (the lobbying and negotiations), I believe that is more a cronic problem of the US political system (two party system) than of this bill. Any bill involving a lot of money will lead to obstruction and negotiations for personal or political benefit.

In Europe there have been problems as well and even now there are substantial differences in costs and efficiency between the countries. That's why there are regular reforms to improve things. Private health care institutions hardly play a role, because there are few people that can afford it. So the rich in Europe cannot easily get what they can get in the US. But 97% of the population is not rich. Proper health care is by now considered an acquired right for all.

As to the sustainability of the systems in Europe, there are cost increases that may become unsustainable, but it is a gradual process. The quality of interventions has improved dramatically over the years and is still improving and that is probably what makes it unsustainable. If you give all persons aged above 85 one or two artificial hips it is logic that it becomes unsustainable, particularly when the population is aging fast. So there are hard choices to be made to control the budget towards the future.

I believe the US should get this bill passed and then make the necessary adjustments over time to make the system less expensive.