Obamacare, Trumpcare... why not just Firstworldcivilisedcountrycare?

there's a lot of this I don't object to, people do tend to abuse a system that costs them nothing to access for things that don't need professional care, but it also involves a cost/benefit consideration.

How many people going to the clinic to report their indigestion does it take before the cost of that exceeds the cost of treating a dude with prostate cancer who never went to the doc because money?

There has to be some balance even from the practical consideration, if not the "why should I pay for the fat guys insurance" angle.

My guess is the best plan, given that we're not starting from scratch but have to redeem both the flaws in the ACA and in the mess we had before that, is some combination of a major-care insurance and an individual medical account for routine stuff, plus the national insurance covers preventative treatment and screenings.

Basically, everyone gets budgets X dollars a year in their account for routine things, with the total low enough to discourage weekly unnecessary visits. And it doesn't cover the ER. When you go to the ER if it's certified an actual emergency, it's covered under the major insurance plan and if it's not, you get billed out of pocket (but you can use your routine account to cover it at if you choose to take the hit, or maybe your tax return is garnished for it, or some such)

Anything that's major - a real ER emergency, hospital stay, surgery, etc, is on the national insurance.

All this is not so much about who "deserves" care (given the potential for unhealthy lifestyles) as it is a matter of what system will result in the least need for the most expensive care. On the other end, the government would have to find a way to suppress exploitation and doing it on a national insurance basis provides maximum leverage for that.

As for private insurers, they can maybe sell some sort of Cadillac plan, or possibly contract as subsidiary providers under the Fed insurance, or go to another business model - I don't know. But reality is the Congress will never actually willingly do something that hurts those companies, even if it's in the best interest of the people, because those companies are part of the gravy train that keeps them in office.

I have a hard time believing that's all there is to it. Seems to me that there's a fair amount of price gouging going on. As for people not paying, seems to me like there should be some kind of legal recourse for that.

The idea is essentially an insurance plan that would be run by the government. I imagine it would work much like Medicare or Medicaid, though at least in this case, people paying into the plan are helping to fund it. I don't really see how this infringes on liberties in any way, because it's not like people are being forced to buy anything.

The thing I have the most concern about when it comes to government paying the medical bills directly, or effectively running the health care system is that a situation might develop with the medical industry that would make it much like the military industrial complex. This is to say that costs won't really go down, and quality will not be all that great. When I look at examples of US health care that are already run by the government - military and VA hospitals - I can't say that makes me very eager to have all health care in this country run by them. Also looking at higher education - the government paying out student loans has not really made going to university any cheaper. If anything it's gotten more expensive. It's hard to say why there, too, though I think at least some of it is administrative bloat, which is to say that there are more administrators than there used to be, all demanding administrative salaries. Tuition and housing keeps going up, government keeps giving out loans, students get stuck paying all that back and have to go a longer and longer time in their professional careers before they're debt free and can more meaningfully participate in the economy. Or they just get screwed and can't pay it back, and can't participate in the economy. This can easily happen with hospitals and medical research, because who's going to say no to health care or research that might save lives or what have you? Already works that way with the defense industry, because who's going to say no to keeping our military well-equipped? Wouldn't want people to think you don't support the troops, right? Or who's going to tell all these people making tanks that they're out of a job? I mean, so what if the Army already has way more of them than it knows what to do with (yes, this is an actual problem).