Buy health insurance across State lines,

[Algernon Moncrieff]

7. The FIO would need to be grown into something bigger and more muscular that what's there now

If insurance is to be sold across state lines, then there needs to be a capable federal regulator. I think even the insurance industry would concede that.

Operating across state lines allows for creation of a larger risk pool, which (in theory) is always a safer bet. And, it would create economies of scale, so if the requirement remained that 80% (or is it 85?) of premium has to be spent on patient care, then it should (again, in theory) produce lower costs with more stabilized outlays.

My theory is that I'd be fine with one or two large companies basically taking the market, but the condition for the grand bargain would be that the companies would be regulated like utilities used to be -- rates would have to be approved and profits would be guaranteed, but at a very modest level. Basically, enough to money to attract bright, capable people to manage the enterprise,, but not enough to be paying 7 or 8 figure bonuses to execs.

IIRC, Germany essentially has an arrangement like this -- a big quasi-private company runs the healthcare system under strict regulation.