Megan McArdle wonders what universal health insurance would look like in America. As she notes, proponents of UHC like to excise Canada and Britain from the conversation. She seems vaguely dismissive of this -- she shouldn't be. Those are literally the only two systems almost impossible to replicate stateside. You simply can't outlaw the private market in America. I'd guess it's unconstitutional but, in any case, it's totally impossible. So quality or desirability issues aside, those systems aren't feasible alternatives.
As for what UHC will look like? My best guess is that eventual reforms will heavily subsidize private insurance coverage up to 300 or 400% of the poverty line, but the private coverage will be provided under a heavily-regulated government umbrella that eliminates adverse selection, mandates various coverage components, and generally imposes a basic floor of coverage. This may happen under an expansion of the Federal Employee Health benefits Program. It will be paid for through a dedicated VAT tax, and the uninsured will be eliminated through an individual mandate.
There is, obviously, a certain error range here. I could certainly see a Medicare Plus scheme, a la Jacob Hacker, where businesses and individuals are offered the option to buy into an enhanced Medicare program, but can, if they choose, retain private insurance options. The problem with something like that is that insurers will have all the more reason to cherrypick, but the ability of government to bargain down prices will probably chop apart the relative premium savings of the private sector. It's also possible to outlaw underwriting and cherrypicking altogether, though I see that as somewhat -- though not totally -- unlikely. A healthy, fit, young friend of mine was just denied coverage on the individual market for the sole reason that he took an anti-anxiety drug over the last year. No health problems, no congenital deformities, he just had the audacity to actually utilize some health care. That's an unsustainable situation, and whatever the reforms look like, I don't expect it to continue for much longer.
