Savings of a trillion dollars applying the Canadian system to the US? sheesh, that would cover the deficit. ;-)

While I understand the proposal for co-payments, the other option is private insurance/care schemes on top of the public entitlement. Some people are willing to pay $$$ for silver teapots and doilies with care provided by the same physicians as in public. Let them. Apart from anything else it helps makes physicians wealthy with an alternative source of income from the public scheme: a wealthy physician is likely to be committed to the success of the dual system and prudent with the public purse, because their income does not depend on high service utilization and being parsimonoius is an honorable course. The other point is litigation: judges and juries may feel inclined to award whopper damages against a HMO or insurer but are much less likely to hammer the public scheme if somebody sues, for obvious reasons. Things can be expected to normalize in that respect as well.