..the first would be a system where the insurance companies will be required to give reasonably-priced coverage to all, the way they do with car insurance.  There will be a minimum standard that meets the basic care someone would need, with some provisions for catastrophic situations.  If you want to and/or can afford it, you may buy more coverage.

I envision it something like this: HMOs negotiate with clinics, big pharma and publicly-owned hospitals to get the rock-bottom lowest rates.  Everyone in the basic pool goes to these places for almost everything.  If you buy a higher tier, you get to choose your doctor, hospital, etc.

Of course this would also have to accompany reforms in the industry so that an insurance company would be forced to abide by the contract they signed if you go into a higher tier.  No more of this “looking for a reason to dump you” crap.  In fact I would propose that if they take more than six months of premiums from you, even if they find out that you had seventeen STDs between the ages of 12 and 20 that you never told them about - tough luck.  You tooks the money nows ya takes yer chances.

Also, obviously, the initial “assigned risk” tier that everyone can buy is issued to all, at any time, pre-existing conditions do not apply.  Suck it up, HMOs. :)

I’m quite sure there are massive flaws in that plan, so let’s hear ‘em.

Plan two, and I don’t know how this would be implemented as a law compelling the HMO industry to comply.  I think it;s rather more of a “new product” kind of thing, a service that an HMO could offer that takes from the way the NHS was presented in Sicko.

The idea here is that there is some kind of incentive in the system for reducing a person’s health risk.  Like in Sicko, a doctor, a clinic a hospital would receive more money for healthier patients.  Get a patient to stop smoking?  Get a bonus.  Lower the bad cholesterol in 78% of your patients?  Get a big bonus.  Improve the ratio of patients who recover fully with little-to-know complications due to mistakes or hospital-spread infection?  Your hospital gets a free fancy new whosiwhatsit machine to further improve the level of care.

Obviously the flaw here is how the hell do you make this work outside of a single-payer system?  I don’t know, but it seems like an idea worth thinking about, so have at it.

Tell me exactly where I’m crazy, why something won’t work and why it’s too expensive.  Then, think of an alternative that will work with a privatized system.  The more solutions we can come up with, the easier it will be to stave off yet another massive government agency doomed to failure by red tape and a desire to consolidate control and power.