There are obvious and vastly superior alternatives [to ACA]: Medicare for all has been suggested and that would represent a good start. Medicare is not really an insurance program, but rather a universal-payer, pay-as-you-go system (there is no way to stockpile medical services for future use).
An earlier version of the Senate’s proposed health care legislation featured a Medicare buy-in for people under 65 — a feature that remains doable despite today’s political constraints. This “public option” would provide more cost control (by competing with the private insurance companies), generate additional savings in Medicare (because you would be “risk pooling” younger and healthier Americans with the most aged and infirm, who traditionally absorb the highest proportion of our medical costs). It also would help to solve the problem of denying treatment based on preexisting conditions, expands the risk pool of patients, and enhances the global competitiveness of U.S. corporations (because why, in contrast to every other country in the world, should US corporations have health care as a marginal cost of production?). Thus, a Medicare buy-in would bring the U.S. health care system closer to the “ideal” low-cost, universal (single-payer) insurance plan. Highly unlikely to occur, but if the Roberts court does force us back to square one, shouldn’t we try to get it right this time?
---Marshall Auerback via Naked Capitalism