Traditional 401ks are tax deferred.

Roth IRA let you pay your taxes now in exchange for never paying taxes again.

This is just a timing issue, and potentially a tax arbitrage issue if you think that rates will be higher/ lower in the future.

This is also a play on capital gains rates, since distributions from a traditional IRA are taxed as ordinary income, principal and all. If you take the tax hit on the front-end, then invest and pay capital gains at the end, you could come out ahead depending on where rates are.

With respect to health care, I don't know how we solve our current system. Government spending is subsidized by private insurance, so if we consolidate everything under a government plan, spending will not go down. Somethings will work on the margin, but we need to burn down the system and replace it with someone sustainable from a fiscal perspective.