So where is the middle ground?
I envision a system where:
1. The wealthy can afford premiums giving them lavish and expensive private heath insurance with care from concierge doctors at opulent clinics and resort hospitals where there is never a wait and always an MRI technician. It will cost them--they can afford it.
2. The middle-class working citizen gets reasonable and affordable health care through his employer for standard private medical premiums using regular doctors at regular clinics and hospitals--basically what we are now used to.
3. The self employed person who can't get group rates, semi-employed students, widows not old enough for medicare, those with bad backs, diabetes and other pre-existing conditions who can't get coverage from private insurers could get adequate and affordable health insurance for reasonable medical premiums using regular doctors at regular clinics and hospitals. This could be government or private. VA insurance should provide care at this level.
4. The low-paid workers and the non-working poor would receive basic and subsidized health care from young residents in teaching hospitals and they might just have to suffer some waiting rooms and go to public clinics if they can't afford co-payments, but no more gulag-style charity hospitals.
I think its a good compromise. Nobody is uncovered and everybody gets to get what they pay for and move up if they can. Sure many lines would have to be drawn and difficult care choices made, but people would have alternate choices, depending on their circumstances.
For example, say a fellow broke his nose badly playing basketball:
1. A destitute homeless fellow would get emergency room treatment, a small bottle of Tylenol, and a band-aid.
2. A minimum wage fellow with subsidized heath insurance would get emergency room treatment, prescriptions for pain, and a follow-up clinic visit to insure it is healing properly. More care if needed.
3. A company fellow, the self-employed, veterans, or other unsubsidized insurance holder would get all of the above plus the option for basic cosmetic surgery with a co-payment.
4. The wealthy could get full coverage for a complete nose job and a facelift, too . . . in the Bahamas . . . at the Paris Hilton clinic.