Some ideas

Much of health insurance costs are involved in the ratings game; attempting to control costs by eliminating claimants who have risky medical histories. This defies the meaning of insurance which is to share the risk, but the insured must make a long term commitment. There needs to be a rule that controls such redlining. Regional rates should be established that requires the insurance companies to underwrite an applicant. Any insured should be able to transfer to another company as long as coverage does not lapse. If coverage lapses the company should be able to charge a substantial reregistration fee or subject them to restricted coverage. You cannot allow people to get insurance only when they need it. This has caused a huge problem in the Massachusetts health plan.

Once coverage is assured then he only thing the government needs to do is provide vouchers to the uninsured or the poor to use to buy the coverage of their choice. That way the poor would have the same coverage as anyone else and not be subject to subclass treatment. Insurance companies would still compete.

Coverage should be individualized and removed from businesses. That way no one risks losing coverage if unemployed or laid off, or if the company suffers financial hardship.

Still choices have to be made. The biggest costs lie in the final years of people’s lives. Nothing in the health care proposal addresses this in a humanely acceptable manner. Perhaps it shouldn’t. Various mandated coverages have driven up costs and need to be relaxed. MSAs Individual medical savings accounts) should be encouraged to bring individual market discipline.

There is no way to afford Cadillac coverage for everyone. Perhaps dental, psychiatric, and other maladies will not be covered. Lobbyists will have a steady presence as they push to increase their coverage.

Perhaps health care is expensive because we value so highly what they have to offer. While there are efficiency savings to be had, it does not automatically follow that only a government takeover can realize those efficiencies. In fact I would argue just the opposite. Controlling health care costs in American will require very difficult life and death choices, and a federal bureaucracy is the last organization I would want making those decisions.