There are solutions out there, and they are not that complicated. I'm a big believer in a "public option". It would be especially effective in rural markets - where Republican voters live. Opposition to a public option is not fiscal, it's philosophical. During the development of the ACA, the public option was in the bill to the end.
The Origins And Demise Of The Public Option. The CBO scored it as saving up to $110 billion over 10 years.
Costs in the private sector have been rising much faster than costs for government-provided care. Over the next nine years, the Centers for Medicare and Medicaid Services projects that per-enrollee costs for private insurance will rise about 5% per year, about 1% faster than the 4.1% growth in nominal per-capita gross domestic product. At the same time, per-enrollee costs for Medicare will rise about 3.8% and Medicaid costs will rise about 3.6%.
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A bigger problem, in the long run, is the shortage of primary care providers. This issue, again, is particularly acute in rural America.
Anecdotal evidence and new studies indicate that a primary care physician shortage has already begun in some areas. Almost 20 percent of Americans, 56 million people, have inadequate or no access to primary care physicians because of a shortage of providers, and a majority of them are insured, according to a report issued in March by the National Association of Community Health Centers and the American Academy of Family Physicians. Florida, Texas, and California are the hardest hit, the data show. In Texas, only 25 percent of counties in 2004 had enough primary care physicians to serve their populations, while 24 counties had no primary care doctors, according to the Star-Telegram in Fort Worth.
. As that article notes, this is not an issue of lack of insurance, but lack of providers.
There are many ideas and lots of information and data in the cited articles. I'd encourage the reading. Also,
How Do We Get More Doctors Interested in Becoming Primary Care Physicians?
