Mandatory proportional co-payments, cut demand. Competition among RSFs for members, lowers premiums. Competition among doctors lowers their fees. It is to the benefit of the insureds to keep costs down. There is free fully informed consumer choice of RSF and free consumer choice of provider.
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.