I was able to retrieve Sean's ideas via my email copy. So here we go:
"If one were drawing up a system from scratch, some form of single payer would make sense.
Since we're not doing that, we need to build on the ACA and make it better. Given cost projections have come in under budget thus far, we could afford, for instance, to address some of the problems in the individual markets whether it is subsidizing providers to increase competition in some areas (premium increases are lower in competitive areas) or increasing subsidies to citizens, which would increase the number of folks with coverage and improve the coverage they do have.
States, like Minnesota, which use a "clearinghouse" model for their exchanges, could switch to an "active purchaser" model in which the states can restrict access to the exchange to only companies that offer plans that meet their goals in addition to those that meet the minimum requirements. . For instance, MNSure plans tend to be low premium/high deductible. The problem with this is that the tax credits available under the ACA are primarily based on the premium. This means that in actuality, people pay more out of pocket here than they do in many other states which have higher premiums and lower deductibles.
We could allow younger people to buy into Medicare if they wanted, too.
We can also do some systemic things to reduce costs. Allowing Medicare to negotiate drug prices would be a major win for that program, for starters. Similarly, Medicare has been in the process of doing more competitive bidding for some supplies and tests -- that should be expanded.
Now, what would *you* do? " Sean