What if the US government made Medicare available on the open market to people under 65? It would simply become one of the options available to individuals or employers seeking healthcare coverage. It would be priced according to what the market could bear, which I suspect would be fairly high because people would be willing to pay extra for the brand name (try to imagine how much a private company would have to spend to develop a brand like that). This means that private insurers couldn’t whine about subsidized competition (OK, OK, I mean they’d have no logical reason to whine, not that that would stop them). Of course, they could start marketing Medicare supplement coverage to The Rest Of Us.
This would have several advantages. It would broaden Medicare’s risk pool, which currently consists of only the oldest and sickest. It would likely be a net non-tax-based revenue generator for the Federal government, again due to the brand premium (pun partially intended). It would provide a “public option” without having to create a new program complete with a new administrative bureaucracy. It would be an evolutionary, rather than revolutionary, step towards providing universal healthcare, and one that’s consistent with American history and American culture (all countries with universal healthcare got it that way, by refining existing systems, with the possible exception of the British who had the luxury to build a new system when the old one was wartorn).
Obviously there’s something wrong with this idea, since nobody with any clout is seriously proposing it. But what? All I can come up with is that it doesn’t provide enough pie for vested interests to stick their fingers in.