Being deeply in the middle of this at the moment, and the choices of my future limited by health care coverage, here is my thought and at least one rational proposal.
– unless compelled to, irresponsible people will not voluntarily buy health insurance coverage they probably won’t use
– people who haven’t paid for coverage when they were healthy will demand coverage when they become sick
– insurance doesn’t work if only the people who have claims are part of the insurance pool
– government involvement is the problem, not the solution. Much of why insurance is in trouble is Medicare and Medicaid force health care providers to cost shift onto private pay and insurance carriers. If you end private insurance and make a single payer, there will be nobody to shift the costs to
– connecting health coverage to employment and which state a person lives in has many negative economic consequences
Here is my compromise:
– allow people to participate in Medicare as an insurer, but only after they have accumulated “x” years of private coverage, either through employment or privately purchased insurance. Facilitate availability of health insurance that is portable across state lines.
This way people (even young people) are motivated to keep coverage for health insurance, even if they don’ t see any immediate need for care. Being in the insurance system probably also means they’ll see a doctor more often for primary care, and head off future health problems when they are inexpensive to fix. This doesn’t compel people to do anything they don’t want to do, basically doesn’t undermine private insurance, and should achieve many of the goals that President Obama says he wants.
Off to see the doctor 
You make rational points so I’m sure they will be ignored, but this does touch on a sort of hostage situation as I see it. It is unacceptable for our society to allow any of its members to suffer the consequence of a poor decision. So the healthy twenty-something year old Bob elects not to buy catastrophic insurance. When he is hit by a bus, society is then held hostage by his decision because we are not willing to let him die on the door step of the emergency room. (not saying that we should, just pointing it out) It seems to me we are faced with a dilema, either someone else will ultimately pay for Bob’s treatment, or he will have to be forced by law to join the pool of payers, even when he doesn’t think he needs to. Part of me wants to allow Bob to suffer the consequences of his decisions, but I’m sure that I would change my mind if I actually saw him dieing a few feet from life saving treatment. Have you any thoughts?
BTW just wanted to say I’ve been following your blog for sometime now and enjoy reading what you have to say.