It starts with the "Rationed Base"
Our Health INSURANCE system is broken. However, our Health PROVIDERS are the best in the world. Why is this? The Free Market.
In other words, the sad reality is that a certain amount of inequality is necessary in order to keep the system solvent. Social Security is the model. Before Social Security some people had pensions and most others had nothing. Now, people on Social Security don't have it as good as people with pensions but at least they have something. It’s the best we can do with the resources we have. So the trick is to create some kind of access for all without upsetting those free market successes.
When Bush vetoed SCHIP he claimed that he was against "anything that favored public insurance over private insurance". There has always been a stigma associated with Public Insurance. If we turned the Government into the sole Health Insurance Company, this stigma would be eliminated. There should be a stigma with such things as welfare and food stamps but Health Care is different. Now, many people fear that Single Payer care will lead to rationing. The way to address this fear is with what we call the "Rationed Base". In other words everyone would start from rationed care, but unlike the other countries; most people wouldn't end there. Everyone would receive a National Health Insurance Card, but when they first get this card, it would only be good for very limited base coverage. People would be allowed to negotiate this base coverage. For example; if they need an especially expensive procedure(s) done, they might only be able to get it covered if they are willing to give up coverage on check-ups or other minor procedures for a certain amount of time. For better coverage employers and individuals would pay an unsubsized premium without regard to pre-existing conditions. The elderly would pay a subsidized premium just as they currently do. The "Rationed Base" would be wider for children. The American Health Insurance Card would basically act as a partially pre-loaded debit card.
Competition in the private sector usually keeps prices down, but this hasn’t been true in Health Care. Allowing only providers to compete and buying insurance from a government that is not concerned with profit would keep Health Care prices down for those who could pay for better coverage. Others would have the free "Rationed Base", but with the government acting as the only insurer; the providers would not necessarily know who is paying or how much they’re paying. Employers who choose not to pay for comprehensive coverage because they figure that their employees have the "Rationed Base" even though the employer could clearly afford to pay for coverage, would be required to provide it or face a substantial fine. We would still have providers who don’t take insurance, but everyone who has insurance would in one way or another be getting it from the government. The 50 million Americans who currently have no coverage would have rationed coverage. Again this is the best we can do with the resources we have. It's definitely an improvement on what we have now because rationed care is certainly better than no care at all. There will never be enough money to provide comprehensive coverage for all. Even if there were; there could never be enough doctors to handle that kind of case load and that would lead to rationing for all.
How would we pay for the "Rationed Base"? The states already invest pension funds in the stock market without adverse affects to the economy. Most states also have lotteries, but the revenue they generate is minimal. It's so minimal that it rarely ends up being spent on anything significant. They might as well invest lottery funds in the stock market and use the eventual profits for other priorities like Health Care. In addition we could use corporate taxes (in the tradition of employer based insurance) and vice taxes.
Some people will of course point out that eliminating private insurance companies could put tens of thousands of their employees out of work. Well, Medicare is often used as the model for National Health Insurance. Even though Medicare is a government program; most of it's billing work is currently outsourced to private companies. The private health workers could easily be re-trained for that kind of work.