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Universal health coverage is now the law of the land, thanks to the Supreme Court. And in its broadest outline, if implemented successfully, Obamacare bears more than a passing resemblance to the voucherized Medicare system proposed by Paul Ryan. The "if implemented successfully" part is crucial: we need a really strong, competitive market for health insurance. It should be a national online marketplace, an Amazon.com for health insurance, rather than the state exchanges currently planned.
If there's real competition, premiums may come down. (They will certainly come down for individuals and small businesses if they're part of a national buying pool.) And if every American automatically has health coverage, the age at which Medicare kicks in becomes a less fraught issue. We could gradually raise the age of Medicare eligibility a bit, according to income, and save money.
I can hear liberals and health care wonks groaning. Health insurance is ridiculously complicated in our country. There are a multitude of special interests involved. A functioning insurance market is only part of the answer when it comes to controlling costs: the real efficiencies, and better care, will lie in eliminating fee-for-service Medicare and moving to a system in which doctors are salaried rather than paid for the piecework--the tests and procedures--they perform. You need a master politician to cut a deal where both sides get what they want: Democrats get truly universal coverage; Republicans, reduced costs. And the public gets better service. Thanks to Spielberg, we're now reminded that a master politician always needs some grease to get the wheels turning. So be it. As Lincoln himself almost said, "We shall have a new birth of ... politics!"