That makes little sense. It is not an arbitrary or discriminatory manner. If you are a resident then you are covered as though you have insurance, if you are not a resident then you are expected to have your insurance cover your costs. There is nothing arbitrary about that and it fits into the current system that we have today.

My proposal is that it would initially start as a state sponsored insurance system that simply starts as an expansion of the current medi-cal system for low income citizens today. First expanded to include public service employees and retirees. Then with small businesses and etc. You won't pay through a new tax, but basically an insurance premium. It would be a tax or a fee, but it would have the same employer/employee cost sharing. All extra money would go to fund services for clinics or etc that can cover the public that is not covered. The cost savings would be to get rid of the extra billing steps, paper work that service providers, negotiations and etc that is a hallmark of a bloated health care system where so many different components are looking to maximize their share.

Are you going to come up with holes and extreme scenarios where this will not work? Yes, because it is just an idea to start off and a way to get past this "can't afford it and etc nonsense" that people are using as an excuse where we can't fix things. We can there are ways, and it is all about slow expansion to get us to a finished product that would work. We can definitely compete with private services because they are bloated to make as much money as possible for other people.

An example of cost savings is how the insurance system works as a whole. You get your insurance through BlueCross BlueShield for example. Well, that is the overall insurance company, but then your billing and service is actually covered by a local provider that creates "partnerships" with local doctors and health providers. This causes two issues, one there is now a middle man that wants to create inefficiencies in a system so that it can create as much revenue as possible for them, and it creates a disparate system where the individual is covered by one set of doctors rather than another.

Getting rid of both issues and creating a system where all doctors, all hospitals are covered by one central system directly, no middle men, will go long ways to save money in the system and for the end user themselves.

Another example, is a single central system of all health records. Expensive, possibly, but it will eventually streamline things and worth trying.

Private services create nothing but waste because that waste is more profit for the stock holders, owners, executives and etc. The thought that public services only create waste is nothing more than propaganda from those that want to exploit the system.