Most of the healthcare reform bills being considered entrench the status quo, which is unsustainable. What would a better plan look like? Here's my cut:
1) Health Savings Accounts
The "use it or lose it" penalty for health savings accounts would no longer apply--put money in, tax free, into a health savings account; and you can use it whenever you want. The money would also be invested and interest accumulates in your account (if you don't like stocks, they can be put in inflation-protected Treasuries). Once you get old, you have the chance to move some of this money into your retirement account.
2) Mandatory Release of Costs for Hospital Procedures
Put them on the internet, nail them to churches, print them on the back of driver licences, burn them into the backs of people's retnas for all I care. It's insane that people will drive for miles to shave off a penny per gallon of gas but don't--and can't--know how much an MRI costs.
3) A Public Plan
The public plan would only offer catastrophic coverage (ie, severe emergency room care only) with high deductibles. Under the government plan, you, by default, put in ten percent of your salary into a Health Savings Account to handle most health spending. Preventative care is covered.
4) Guaranteed issue, community rating, and mandatory coverage
Everyone needs to buy health insurance. You can buy the government plan, or a private one. No insurer can turn down anyone who wants care, and can only charge premiums based on age.
5) Insurance Exchanges
All insurers must provide a "basic" plan that offers similar catastrophic care as the public option, as well as a more traditional package. Benefits are standardized across the two levels to allow easy comparison shopping. These exchanges are set up on a national level. All insurance spending (but not health account savings) is taxed.
That's it. The left should love the plan because it eliminates (or greatly reduces) the uninsured population while allowing people with pre-existing conditions to purchase insurance. The public option keeps insurers "honest." The right should love the plan because it increases competition--instead of insurance companies making their money by refusing care, they now make money by holding costs down. Young people should love it because they can purchase the public option cheaply. And everyone should love the plan because it reduces healthcare costs: the more people are accountable for their own spending, the more costs go down.
In the long-run, Medicare and Medicaid would be obsolete. People will start entering retirement with lots of money to pay for their own care; those (young or old) who can't afford care will be given subsidies to buy their own insurance (paid out of taxing insurance coverage). This will stave off the government's looming fiscal collapse.
Naturally, we're not going to see anything like this plan.