PIA:: here is my spitballing on multiple approaches to HC.

First the decision has to be whether we want everyone (true universal coverage) or optimal coverage. The reason is someone has to pay for it. Of course we could just raise taxes but that obfuscates the underlying problem of what services do we want government to provide and who is going to pay for it. Absolutely no one wants to pay for hiways, what do you think they want to do with HC?

Optimalization is my choice because I believe costs can be managed and as in all things government there will be some losers. We can always work on the small subset to try and bring them onboard.

The equation is maximize coverage with acceptable costs and most importantly from a government perspective, bend the curve of rising HC cost drivers. I suspect the solution to this equation requires a single pool, not multiple pools of varying risks. Insurance is always a hedge against the worst outcomes. Not everyone views this gamble the same, but if it is to work, the pool has to be large and inclusive.

maybe you have a counter argument?

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