The situation we now have is already worse than the one of which you speak. Tort reform is one way to address cost control. The insurance companies have used malpractice suits as an excuse to boost insurance premiums every chance the have gotten. The doctors also are practicing defensive medicine....ordering additional tests, MRI's, Ct scans, etc. to cover themselves. However, the fact remains that the segment of the population already receiving medical coverage through Medicare is doing so through the current level of funding. Including everyone in Medicare may increase the amount of funding needed, but there would be no need to pay insurance premiums any longer. Right now we are all paying both.

Interesting that you should bring up the Canadian prescription drug matter...a pet peeve of mine. If I am not mistaken Canada has price controls in effect for medications. I remember 2 or 3 years ago all the insanity argued by the pharmaceutical companies claiming that the drugs were not subject to FDA scrutiny. What a joke. They were the same drugs we were buying in America...only twice as expensive. I would agree with you that price controls or improved price negotiation is needed for medications.  Apparently as a result of the influence of the Pharmaceutical industry...Medicare can not use its superior buying power to negotiate lower prices for medications. The law needs to be reformed in this respect.

With respect to shopping around for other plans, that option would still be available to you if you wanted to opt out of the national plan. If the insurance companies had to compete with a more competitve national plan you might even get a better priced premium from them.