Providers have complete choice of fees and practice parameters, subject to competition. Universal Coverage Everyone who files a 1040 will have insurance. Those who can afford it pay for it, even if they'd prefer not to. Premiums of indigents are supplemented by the government. All this is done by the agency which has immediate access to the figures, and can most efficiently make the distinction.
Coverage is unrelated to employment, so is available to all.
Providers, subject to competition, have an incentive to lower fees and establish patient friendly procedures and environments. The RSF insurers have the incentive to keep costs and red tape down and benefits up, because they will have to live with the policies they put in place, and benefit from the money they save. Government is not in the position of an unregulated payer, but serves its proper neutral function of regulating private organizations. All this is very different from managed care programs where there is unilateral pressure for low cost, simple indemnity insurance where the pressure is for high cost, or government programs where the pressure is for political advantage. There is one problem with the above system which is particularly difficult.